With the increasing effect of the Coronavirus (COVID-19) in the United States, SISCO wanted to provide an update and suggestions for plan design changes to accommodate the COVID-19 concern.   The government has made testing and treatment for COVID-19 a priority, which includes the removal of barriers to receive such testing and treatment for COVID-19.

One of the benefits of self-funding a health plan is flexibility with the design.  Because of that, there is no one solution on how to handle medical charges related to the coronavirus.  Each client should look at their specific plan(s) to review what their medical benefits currently are.  For example, a plan may pay labs or tests at 80% after deductible or 100% after a patient copay.

Options for a traditional plan may include:

• Continue to cover services such as office visits, diagnostic tests and labs, and hospital charges at the current benefit (e.g. co-pays or deductible then coinsurance)
• Waive patient responsibility for medical services such as office visits with a COVID-19 diagnosis and appropriate diagnostic tests and labs so the plan pays 100% with no cost sharing
• Waive patient responsibility for all testing and treatment with a COVID-19 diagnosis so the plan pays 100% with no cost sharing

Options for a high deductible health plan may include:  Effective March 11, 2020, HDHPs will remain within IRS regulations even if the health plan provides health benefits associated with testing and treatment for COVID-19 without meeting deductible requirements. This would include benefits received without a deductible or with a deductible below the minimum deductible for an HDHP. With this, individuals covered in an HDHP would still be eligible to make tax-favored contributions to a health savings account.

• Continue to cover services such as office visits, diagnostic tests and labs, and hospital charges at the current benefit (e.g. deductible then coinsurance)
• Waive patient responsibility for medical services such as office visits with a COVID-19 diagnosis and appropriate diagnostic tests and labs so the plan pays 100% with no cost sharing
• Waive patient responsibility for all testing and treatment with a COVID-19 diagnosis so the plan pays 100% with no cost sharing

Other considerations:

• If you offer multiple plans such as a traditional plan and a high deductible health plan, a decision needs to be made for each plan offered.
• If your plan has a PPO network, will the changes apply to both in-network and out-of-network providers?

If you wish to make changes, please contact your SISCO account manager.   If changes are requested, SISCO will draft an amendment for the client’s review and signature.  No changes can be made to the plan documents or to the benefits administered (claims will be held) until a signature from an authorized representative of the company is received by SISCO.