May 26, 2022

Dental and Vision Benefits Are Inexpensive, and a Big Hit with Workers 

Employers nationwide are looking for ways to attract and retain talent and differentiate themselves from competing employers, and many are looking to the two most popular voluntary benefits: employee dental and vision plans.

That’s important in today’s tight job market. After all, a recent survey from CareerBuilder found that 55% of workers believed an employer’s menu of benefits was more important than salary when considering a job position or offer.

Here’s why dental and vision benefits are so popular and why, if you don’t already do so, you should consider offering them as well.

Background

For many years, dental and vision plans were employer-paid. They were just part of a standard package available to full-time workers at little or no cost to themselves.

However, as businesses have tightened their belts, many of them moved dental and vision plans to the voluntary benefits side of the ledger, with employees picking up some or all of the premium costs via payroll deduction.

Even when workers are covering the costs, dental and vision plans are overwhelmingly popular with them, because of the relatively low out-of-pocket premiums and the terrific value they provide.

Appeal to workers

Employees like vision and dental benefits because they provide real savings that they and their families are able to see every year — because they actually use the plans. 

That’s compared to other voluntary benefits like major medical, life insurance and disability insurance, which employees may need many years down the road, if ever.

According to the “2021 MetLife Employee Benefit Trends Survey,” 68% of employees consider dental insurance and 49% consider vision benefits to be among their “must have” benefits.

Their employers like them because they can provide these benefits, cementing the bond of loyalty between the employer and employee, for a small fraction of the overall compensation budget. Indeed, dental premiums have been falling in recent years.

Appeal to employers

Employers are also embracing dental and vision care as research is increasingly pointing to good dental and vision health as correlated to overall health — hopefully improving worker productivity and reducing eventual health care costs. 

For example, diabetes and high blood pressure are increasingly being discovered during routine eye exams. Optometrists across the country are commonly finding early warning signs of hypertension from observing ocular pressure — a nearly invisible symptom outside of eye exams.

Their patients armed with this knowledge are able to seek intervention before their condition worsens and results in bigger claims against the employer health plan. A study by HCMS Group found that:

  • 34% of all diabetes cases are first identified via eye exams, at a saving of $3,120 per employee, according to HCMS Group.
  • 39% of all hypertension cases are first identified via eye exams, at an average saving of $2,233 per employee.
  • 62% of high-cholesterol cases are first identified through eye exams — saving $1,360 in eventual health care costs thanks to early detection.

Finally, simply offering something like a vision plan — especially to workers who are at high risk of eye strain from staring at a computer for hours every day — sends an important message to workers that you care about their wellness. 

Who pays premiums?

According to the National Association of Dental Plans:

  • Only 6% of employers are currently paying the entire cost of employee dental benefits.
  • At 24% of employers, the worker pays 100% of the cost via a payroll deduction program.
  • 70% of employers share the premium cost with staff who sign up.

Plan structures

Furthermore, about 80% of group dental plans are preferred provider organizations, or PPOs, which aim to control costs by contracting with a limited network of providers willing to cut their rates to plan members in exchange for the promise of a steady stream of plan referrals.

The percentage of plans embracing the PPO model has been increasing, while dental HMOs and old-fashioned indemnity plans have been losing market share. 

May 18, 2022

Employers Focus on Cost Containment, Mental Health and Telemedicine

A new survey has found that managing health care costs and expanding mental health benefits will be a top priority for U.S. employers as they ramp up benefits to compete for talent in the tight job market spawned by the COVID-19 pandemic.

Additionally, virtual care is expected to become an essential and long-lasting feature of employers’ health insurance and employee benefits strategies over the next few years, according to the “2022 Emerging Trends in Healthcare Survey” by Wills Towers Watson.

The focus on health care and insurance costs, mental health and expanded telehealth comes as employers continue pulling out all the stops to compete in a tight job market but face health care inflation headwinds.

Here’s the direction many employers are going, according to the survey.

Dealing with rising costs

In light of continuing rising health insurance costs, 94% of employers surveyed said they are redoubling their efforts to make benefits more affordable for their workers.

Nearly two-thirds of employers (64%) said they will take steps to address employee health care affordability over the next two years. Steps they are considering include:

  • Improving quality and outcomes to lower overall cost.
  • Adding or enhancing low- or no-cost coverage for certain benefits.
  • Making changes to their employees’ out-of-pocket costs.
  • Increasing the amount they contribute towards their employees’ health insurance premium.

Employers also felt that many of their employees were not getting the most out of their benefits and needed further education on all of their offerings. More than half (54%) said that lack of employee awareness about where to find programs to support their needs was a significant challenge.

Mental health

Eighty-seven percent of employers said that enhancing mental health benefits will be a priority for them.

That’s in response to numerous studies and reports indicating that the COVID-19 pandemic has spurred a mental health crisis.

Another poll — the “Workforce Attitudes Toward Mental Health” report — by Headspace Health illustrates the depths of the problem:

  • 83% of CEOs and 70% of employees report missing at least one day of work because of stress, burnout and mental health challenges.
  • Only 28% of employees report feeling “very engaged” in their work.
  • Top global stressors for employees are COVID-19; burnout because of increased workload or lack of staff; poor work-life balance; and poor management and leadership.
  • 40% of women and 33% of men surveyed said they feel burned out at work.
  • Remote workers are feeling increasingly isolated.

In response to this, 66% of employers surveyed by Willis Towers Watson said that ensuring that their health and well-being programs support remote workers will be a key priority of their strategy over the next two years. More than six in 10 employers plan to enhance programs and well-being activities to focus on health issues of their employees’ family members.

Virtual care

Use of virtual care — or telemedicine — has exploded during the pandemic, particularly in 2020 and 2021, when many people were afraid to go to the doctor in person for fear of contracting COVID-19.

Additionally, many health care providers pushed virtual care to avoid having too many people come to medical facilities that were burdened by an avalanche of patients.

Congress passed laws allowing health insurers to cover telemedicine as they would other visits to a doctor. And now telemedicine is poised to be a permanent fixture of employers’ health care strategies.

Willis Towers Watson found that by the end of 2023:

  • 95% of employers expect to offer virtual care for medical and behavioral health issues,
  • 61% of employers expect to offer lower cost-sharing for virtual care,
  • 53% of employers expect the expansion of telemedicine to help decrease costs in the long run, and
  • 50% believe virtual care will improve health outcomes for their employees.

Fortunately for employers, a number of companies have cropped up during the last few years that focus on delivering state-of-the art telemedicine platforms.

The takeaway

The pandemic has spurred many employers to prioritize their employees’ well-being, as well as look for ways to manage costs.

With competition for employees fierce, many employers are focused on reducing their staff’s share of costs, while also expanding mental health services in response to growing demand.

Meanwhile, telemedicine services are still evolving, a trend that’s likely to continue for the foreseeable future as health care providers, insurers and employers see it as a way to rein in some costs.

May 13, 2022

IRS Sets Health Savings Account Maximums for 2023

The IRS has announced significantly higher health savings account contribution limits for 2023, with the amount increasing more than 5% for individual HSA plans.

The new limits were announced in conjunction with other changes, such as increases in the minimum deductibles and maximum out-of-pocket expenses for high-deductible health plans (HDHPs).

The IRS also announced rises in the maximum contribution amounts to excepted-benefit health reimbursement arrangements (HRAs).

The increases are much larger than usual due to inflation, which has been trending higher than it has in more than four decades.

Here are the new figures for 2023:

HSA annual contribution limit

  • Individual plan: $3,850, up from $3,650 in 2022
  • Family plan: $7,750, up from $7,300 in 2022

HDHP minimum annual deductible

  • Individual plan: $1,500, up from $1,400 in 2022
  • Family plan: $2,800, the same as in 2022

HDHP annual out-of-pocket maximum

  • Individual plan: $7,500, up from $7,050 in 2022
  • Family plan: $15,000, up from $14,100 in 2022

Maximum out of pocket for ACA-compliant plans (non-grandfathered plans)

  • Individual plan: $9,100, up from $8,750 in 2022
  • Family plan: $18,200, up from $17,400 in 2022

Excepted-benefit HRAs

Maximum annual employer contribution: $1,950, up from $1,800 in 2022. Excepted-benefit HRAs are limited to paying for vision and dental coverage or similar benefits exempt from the ACA, and are not covered by the employer’s primary group plan.

For those 55 or older: People who are 55 or older are allowed to contribute an additional $1,000 a year to their HSA, under federal law.

Also, if both spouses with family coverage are 55 or older, they must have two HSA accounts in separate names if they each want to contribute an additional $1,000 catch-up contribution.

If only one spouse is 55 or older but the younger spouse contributes the full family contribution limit to the HSA in his or her name, the older individual must open a separate account to make the additional $1,000 catch-up contribution.

HSAs explained

Under federal law, an HSA must be tied to an HDHP. An HSA is a special bank account that can be used to pay for or reimburse for your employees’ eligible health care costs. They can put money into their HSA through pre-tax payroll deduction, deposits or transfers.

As the amount grows over time, they can continue to save it or spend it on eligible expenses.

Employers can also contribute to the accounts, but the annual contribution maximum applies to all contributions in total (from the employee and the employer).

The money in the HSA belongs to the employee and is theirs to keep, even if they switch jobs. The funds roll over from year to year and can earn interest. Some plans also have investment options for the funds.

Here’s how they work:

  • Employees can make withdrawals with a debit card or check specific to the HSA.
  • Employees can use the money in their HSA to pay for care until they reach their deductible, out-of-pocket expenses like copays and coinsurance.
  • They can use the funds to pay for other eligible expenses not covered by their HDHP, like dental or vision care (eye exams and corrective lenses).

Planning ahead

Knowing what these limits are in advance can help employers plan their messaging for the 2023 open enrollment season.

If you want to get ahead of the ball, you can start updating your payroll and plan administration systems to reflect the 2023 amounts.

You should also include the new limits in relevant communications you send to your staff, particularly in regards to open enrollment, plan documents and summary plan descriptions for next year.

May 3, 2022

Year-Long Benefits Education Yields Happier Employees

While most organizations ramp up their benefits communications about a month before open enrollment starts, the efforts often drop off at the start of the year.

That’s a shame because many employees are woefully unaware of how their benefits function and are often not taking full advantage of what their employer and they are paying for. Employees that don’t understand their benefits fully may end up paying out of pocket for services that are covered.

With surveys showing that three in five employees have only a basic understanding of the benefits they receive from their employer, it’s important that you continue to educate your staff about their benefits, coverage changes brought on by recent regulations and how to get the most out of their current benefits.

If you enlighten them about what they have and how to use those benefits, they will be more likely to stay with you.

Keep it going

The month or two prior to open enrollment is when most companies kick their benefits communications into high gear. They start sending their employees e-mails, mail and memos making them aware of open enrollment and that they can start researching plans.

Most companies will hold at least one meeting with the troops to answer questions and explain any changes that are being made. But after open enrollment ends, communications often go into hibernation until the prelude to the next open enrollment.

You can fill that void by regularly “dripping” information to them over the course of the year. Each drip can be a short benefits meeting or educational information that is sent out to your employees.

For example, under a Biden administration executive order, as of Jan. 15, all health insurers are required to reimburse covered individuals for up to eight at-home COVID-19 tests per month. By keeping your staff informed of developments like these, they can save money and take advantage of this benefit more fully. Here’s how:

Be proactive

It’s important that you communicate benefit developments to your staff, and that requires that your human resources or benefits team stays on top of changes.

It’s the team’s responsibility to proactively alert employees about changes and updates about their benefits, as well as reminders about how certain benefits work. By sending out these reminders, or holding meetings, you can educate your workers in making the right benefit and coverage decisions.

Leverage technology

One key part of educating your employees requires tapping technology by offering an online hub that houses all of the information about each of the benefits you offer. This way, they can go to this source first if they have questions. It’s also more convenient for them as they can access it in the privacy of their homes.

Many health plans now also have apps for enrollees that give them a plethora of information about their coverage, including how much they have paid in deductibles over the year and other information about their health insurance.

Plan communications for the year

Design a content calendar that focuses on putting out timely information and reminders. For example, remind employees about how their health savings account works and what they can spend the funds on.  

During flu season, send out reminders on preventative measures they can take, including how their health insurance can help them get a flu shot.

Another topic could be instructions on adding spouses to their plans or notifications about Medicare for employees who are nearing 65 years old.

The key is to stay in front of your staff and always encourage them to come to your benefits team with any questions they have. One e-mail to your team could result in reminding one of them to come to you for clarification about their coverage.

The takeaway

By regularly communicating about your benefits to your staff, you can provide them with the confidence that they have the information they need about their benefits, and that if they don’t, they know how to get it. That in turn helps them make the best decisions for themselves and their families.

And your organization will also benefit as regular engagement gives you the opportunity to better evaluate your benefits offerings and identify areas where you can improve or expand.

April 28, 2022

How Your Employees Can Get Free COVID Test Kits

While COVID-19 cases start rising again, more people are once again likely to contract the coronavirus — and that usually involves getting tested. But for employees in your group health plan, they have many options for obtaining a test with no out-of-pocket costs.

Under an executive order issued by President Biden, employees in a group health plan are eligible to receive COVID-19 at-home test kits with no cost-sharing, copay, coinsurance or deductible. Additionally, most health plans are also covering tests performed at hospitals, clinics and pharmacies.

While we told you about these new rules a few months ago, it’s likely that a good many of your employees don’t know about it. With that in mind, you may want to disseminate information to them about how they can be reimbursed by their insurer for COVID-19 tests they purchase.

Here’s what your employees need to know:

Steps for reimbursement

Procedures will vary from insurer to insurer, but the order requires that health insurance carriers reimburse members for up to eight tests a month and no doctor’s order, prior authorization or prescription is required. This applies to any tests they purchased on or after Jan. 15, 2022.

Most health plans have preferred pharmacies that they urge their enrollees to go to for their take-home COVID-19 tests. In these instances, the plans will typically cover the cost at the point of sale so that the health plan member doesn’t have to pay out of pocket.

Covering costs upfront eliminates the need for members to submit reimbursement forms.

However, if they go to a non-network pharmacy or drugstore or purchase a kit online, the health insurer is still required to reimburse them for a test up to $12 (or the cost of the test if it’s less than that).

In these cases, the employee will have to pay for the test upfront and then seek reimbursement from their health insurer.

You can contact your health insurer for information and resources for how your staff can receive reimbursement. Most insurers have published materials to make it easier for your workers to access COVID-19 tests with no cost to them.

Typically, to be reimbursed for at-home test kits, members must submit the reimbursement form and a receipt that shows proof of purchase, which should include the name of the retailer, including the street address, or, if bought online, the website address; date of purchase; UPC code for the at-home test kit; and the cost of the kit.

The order that health plans cover these tests with no out-of-pocket costs for their enrollees will sunset when the federal public health emergency is declared over.

On-site tests

Health plans are also covering the cost of tests that are administered at pharmacies or in hospital settings after either a doctor ordered a test or if the person was exposed to someone who had COVID-19.

Like at-home tests, insurers will cover the costs of these tests regardless of if they are received in-network or from an out-of-network provider or pharmacy.

The types of COVID-19 tests health insurers currently cover are:

  • Individual testing with or without symptoms,
  • Testing ordered by a health care provider,
  • Testing for contact tracing, known or suspected exposure, and
  • Testing before or after travel (COVID-19 screening tests for domestic travel are usually covered by most plans, but enrollees should not expect their plan to cover any testing they do abroad).

After the public health emergency ends, however, it’s likely most insurers will stop covering tests obtained out of network.

April 21, 2022

Gen Z, Millennials Grow Disillusioned with Their Health Insurance

Surprise bills and billing errors are driving growing dissatisfaction among Millennials and Gen Zers with their health insurance, a new study has found.

HealthCare.com‘s “2022 Medical Debt Survey” found that about one in four Gen Zers and Millennials with medical debt skipped rent or mortgage payments because of their debt. That’s compared with 21% for Gen Xers and 12% for baby boomers.

The study reflects the increasing burden that health insurers’ policies for out-of-network care and higher deductibles are having on Americans, particularly those who are the most recent entrants to the job market. Since they typically earn less than those who have more experience, Millennials and Gen Zers are more susceptible to hardships if they receive unexpected bills.

To help these generations of workers, consider offering them educational sessions on how to choose health plans, coupled with training on how to avoid unexpected health care bills by going to in-network providers, and how to shop around in advance for scheduled procedures.

Already facing outsized medical cost hits, an increase in billing mistakes and surprise bills is contributing to a dim view of health insurance among Millennials and Gen Zers. In fact, 68% of Gen Zers who have health insurance but still incurred medical debt said their health insurance plan didn’t cover the service they received (or they received services out-of-network).

Additionally, the study found that:

  • 39% of Millennials are unsatisfied with their health insurance options.
  • About three in 10 Gen Zers (31%) and Millennials (27%) with medical debt believe that their debt is the result of a billing error.
  • 48% of Millennials have received a surprise medical bill.
  • 35% of Millennials have received a mistaken bill or had a claim denied.
  • 26% of Millennials have medical debt.

Affordability of health insurance is also a big consideration. Some 54% of Millennials say their health insurance is somewhat or very affordable.

Millennials are also using their health insurance benefits differently than prior generations:

  • 48% say they have used an urgent care center in the past. These visits can often cost more than a typical visit, but not as much as going to the emergency room.
  • 35% have used telehealth services for physical ailments.
  • 26% have sought mental health services through telehealth platforms.
  • 27% have used discount pharmacy apps.

The takeaway

The key to improving your younger generation workers’ understanding of their health benefits and how best to use them is through education. It starts with perhaps having a special session during each open enrollment focusing on what type of health plans are best suited for their generation.

If you offer high-deductible health plans, educate your staff on the importance of putting money aside in health savings accounts so they have money to pay for those unexpected expenses.

They should also be educated in how to use their health insurance to avoid larger costs, and the ramifications of using providers not in their health plan’s network. The education should also cover the costs of going to an emergency room compared to scheduling an appointment with their doctor or going to an evening clinic at their office.

April 12, 2022

Employers See Staff Drop Coverage, Sign Up on Exchanges

A surge in federal government subsidies has led many people to drop their employer-sponsored health insurance and instead seek out coverage on government-run Affordable Care Act exchanges, according to a report by the Kaiser Family Foundation.

Subsidies, which were increased substantially by COVID-19 stimulus legislation, are so large for some who purchase coverage on exchanges that many of them can access ACA plans that cost just a few dollars a month, depending on their income, according to the report.

But the defectors are likely to return to their employer-sponsored health plans as the subsidies are set to expire at the end of 2022, which will likely make their employer-sponsored coverage more affordable. Only individuals who work for organizations that have fewer than 50 full-time workers have been able to make this switch and enjoy low premiums.

Individuals who work for employers that are large enough to qualify as “applicable large employers” are barred from jumping into the individual market as they do not qualify. They instead are required to sign up for their employer’s group health plan or forgo coverage altogether. 

What’s happening

The American Rescue Plan, which took effect in 2021, expanded and increased tax credits available for purchasing coverage on federal- and- state-run exchanges through the end of 2022. Before that, the law limited eligibility for premium tax credits through the federal and state exchanges to households whose income is from 100% to 400% of the poverty level.

The stimulus bill removed that cap for 2021 and 2022, as well as limit the amount anyone pays in premiums to 8.5% of their income as calculated by the exchange. That means someone who made 450% of the poverty level would receive a premium tax credit that would reduce the premium they pay to 8.5% of their income. In those cases, the total tax credit runs into the thousands of dollars for the year.

The premium tax credit is based on factors that include income, age and the benchmark “silver” plan in a person’s geographic area. The amount they qualify for is basically advanced to them over the course of the year via reduced premiums. If they choose a bronze plan, they can greatly reduce their share of the premium.

These effects have been most pronounced for lower- to middle-income and single-income households. 

However, the premium tax credit comes to an end on Dec. 31, 2022, and the premium tax credit regime reverts to the prior one.

How to handle next open enrollment

It’s advisable that you assess your health insurance enrollment and see if any of your staff dropped their group health coverage and signed up for individual coverage on the exchange. If you are an applicable large employer, that should not have happened for the reasons mentioned above.

If you are a smaller employer not subject to the ACA, you should reach out to any employees who signed up on an exchange and inform them about the impending premium tax credit changes. Advise them that reverting to the old premium tax credit rules is likely to result in their share of the premium increasing substantially.

Remind them that your annual open enrollment is their only chance to secure group health coverage and that they should review their marketplace coverage as early as possible. If they wait too long and miss your open enrollment deadline, they could be stuck with the more expensive marketplace coverage.

April 6, 2022

Measure Would Cap Insured Out-of-Pocket Cost of Insulin at $35

The U.S. House of Representatives has passed legislation that would cap the out-of-pocket cost of insulin at $35 a month for people with group or private health insurance.

While the measure still has to face a vote in the Senate, it has broad backing after the cost of insulin has skyrocketed in recent years. People who used to pay less than $100 a month for the vital medication are sometimes paying more than $1,000, depending on their health insurance coverage.

More than 37 million Americans have diabetes, and this legislation could be a game-changer for the estimated 7 million who have to take insulin to control their condition.

In the past decade, the cost of insulin has tripled in the United States, with average out-of-pocket costs rising to about $666 a month. But some people need specific brands and can pay more than $1,000 a month for their brand.

For example, David Tridgell, a Minneapolis endocrinologist, wrote an op-ed in The Washington Post citing the costs typical diabetics face:

  • Patients with Type 1 diabetes tend to use two or three vials of insulin per month. At the current cost of one vial of Humalog 50/50, these patients would spend $780 to $1,170 on their insulin every month.
  • Type 2 diabetes patients sometimes need six or more vials a month, which would run up the costs to $2,341 or more every month.

It can be especially costly for individuals enrolled in high-deductible health plans, in which enrollees have to pay the list price for their insulin until their deductible is met. This could mean thousands of dollars out of pocket before the insurer will cover the drug. Because of the soaring costs, many people report reducing dosages or rationing to make their insulin last longer.

Diabetes can lead to other serious health complications, including kidney failure, heart disease and loss of vision.

How it would work

HR 6833 would bar private health insurers, health plans and self-insured employers from applying a deductible on insulin and require that diabetics pay no more than $35 or the amount equal to 25% of the negotiated price of the selected insulin product, whichever is lower.

For no more than $35 a month, the Affordable Insulin Now Act would require private group or individual plans to cover both vial and pen dosage forms and any of the following insulin types:

  • Rapid-acting,
  • Short-acting,
  • Intermediate-acting, and
  • Long-acting.

Medicare Part D plans, Medicare stand-alone drug plans and Medicare Advantage drug plans would be required to charge no more than $35 for whichever insulin products they cover in 2023 and 2024, and for all insulin products beginning in 2025.

HR 6833 passed on a vote of 232 to 193, with 12 Republican representatives voting with the Democrats. The measure has been sent to the Senate.  If it passes the Senate and is signed into law, it will take effect in 2023.

We’ll keep you posted if this bill lands on President Biden’s desk and he signs it.

April 1, 2022

HDHPs Can Continue Covering Telehealth with No Cost-Sharing under New Law

An expired provision that authorized high-deductible health plans to reimburse for telehealth and other remote health care services before the deductible has been met, has been revived.

The provision was extended from April 1 through Dec. 31 after President Biden signed the Consolidated Appropriations Act of 2022.

Due to the COVID-19 pandemic and ensuing emergency legislation, HDHPs had been required to cover telehealth services with no out-of-pocket costs for the health plan enrollee, but those rules expired at the end of 2021.

The extension was included in the budget bill as telemedicine has grown in popularity because it’s convenient particularly for people who have to travel far to their appointments. It also expands provider choice and access, proponents say.

HDHPs are usually only required to cover preventative care and 10 essential services mandated by the Affordable Care Act with no out-of-pocket costs for the policyholder. All other medical care must be paid for by the enrollees until they meet their deductible.

If a health plan were to violate this rule, it would result in the enrollee being barred from contributing to their attached health savings account (HSA).

The HDHP exemption was initially codified by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a sweeping relief package to keep the economy afloat at the start of the pandemic.

The technical language of the act stated that HDHPs remain qualified for the purposes of HSA contributions if they cover telehealth or remote medical services before the enrollee has met their deductible. The exemption expired on Dec. 31, 2021.

That means there is a gap of three months through March 31 when coverage for telehealth before meeting their deductible would result in an HDHP enrollee being ineligible from contributing to their HSA.

This could result in confusion among enrollees, so employers need to be prepared for this.

What employers should do

As a result of this change, you should review your plan documents and summary plan descriptions to see if they have been updated to reflect this new HDHP exemption starting April 1.  If not, contact your insurer to get updated documents.

You should also inform your staff about the changes via usual company communications, memos and as an agenda item at your next company meeting.

March 22, 2022

Push to Expand Telemedicine Parity Continues

Telemedicine got a big boost during the COVID-19 pandemic, and now a number of states have been moving to ensure that health plan enrollees still have access to it and pay for it just as they would in-person visits.

During the pandemic, insurers agreed to pay for virtual visits just as they would for a face-to-face appointment, doctors who had been reluctant to try new technology embraced it as a way to limit patient exposure, and lawmakers loosened federal regulations that for years had restricted telemedicine’s use.

But more than two years into a public health emergency, some health insurers have begun to roll back their pandemic-era coverage policies or fallen into a pattern of extending coverage for only a few months at a time. There are now efforts in a number of states to require that health insurers cover telemedicine visits the same as face-to-face ones.

Thirty-one states mandate both coverage parity and payment parity. The language of the payment parity mandates differs by state. In eight of them, the mandated payment applies only to the deductibles, copayments and coinsurance faced by the insured. For example, in Texas, coinsurance, copayments and deductibles for telemedicine “may not exceed” those for the same service provided in person.

Other states mandate parity in how insurance plans reimburse providers. For example, in Arkansas and California, reimbursement for health care services provided via telemedicine must be “on the same basis as in-person services.”

Telemedicine improves outcomes, saves money

Recent studies have shown that telemedicine can yield significant savings for group health plans and covered employees — but only if the employees actually use it.

The main thrust of telemedicine is to give workers the option to talk to a health care provider over the phone or by video link about a health issue they may be having. Maybe waiting for an appointment slot to open with their doctor would take too long, or perhaps driving to the doctor’s office may be unfeasible for whatever reason.  

Experts say that allowing health plans to charge for telemedicine visits the same as they do for in-person visits can reduce the likelihood that an illness is left untreated, which increases treatment costs in the end, especially if they have to go to the emergency room for treatment.

Telemedicine benefits

Convenience — For many people it’s hard to take time out of the day to go to the doctor, particularly in areas where access to care is limited. For non-serious cases, telemedicine is a good option. If the physician or nurse feels that symptoms are serious, they can always ask the covered individual to come in for an appointment.

Cost savings — Just by its nature, telemedicine can save money, particularly for individuals who habitually go to ER or urgent care for routine services. Telemedicine can be marketed to employees as a much less expensive alternative for after-hours care.

Managing chronic illness — Telemedicine is ideal for workers with chronic conditions who may have a hard time getting to regular doctors’ appointments. Technology exists that can transmit health data from a patient’s home to a doctor’s office.

Addressing concerns

Many people are uneasy about working with a provider over a video link if they have had no prior patient relationship with them.

You can address these concerns by:

  • Highlighting credentials of doctors in the telemedicine network.
  • Working with us or your health insurer to try to change plan designs in order to eliminate copays for telemedicine.
  • Setting aside a room at your offices where your staff can access telehealth services, particularly if they have chronic conditions that may need monitoring on a regular basis.
  • Choosing the right vendor, which is crucial. Evaluate vendors based on patient satisfaction, the quality of the providers and the breadth of specialties available.