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COVID-19 ACCELERATES USE OF VIRTUAL HEALTHCARE: WILL THIS GENIE EVER GO BACK IN THE BOTTLE?

Until now, virtual healthcare could still be described as something of a novelty utilized by “early adopters” like those consumers that traditionally are the first to use a new technology.

I bet, until now, if you asked a healthcare expert about when virtual healthcare would become truly a customary part of our national health landscape, most would have predicted a gradual increase in use and a general market acceptance over roughly the next 10 to 20 years.

Boy, with the emergence of the Coronavirus, it sure makes me think those expectations are quickly changing.

As a consequence of the Coronavirus Pandemic and the Stay-At-Home orders and other emergency responses to the pandemic that we have been living out around the country, virtual healthcare is emerging as a significant part of our health care delivery system.

Many patients and their providers who have experienced the convenience of virtual healthcare might not want to go back to a traditional in-person archetype of care that’s been the age-old norm.  At least as it relates to the blocking and tackling of our common, everyday healthcare needs.

Virtual visits have been cropping up as a covered service in many group health plans and even some Medicare Advantage plans recently.  It sure seems now, though, that as a result of this pandemic the door has been kicked wide-open for greater utilization of virtual healthcare services across our healthcare system.

Lots of employers who largely didn’t give virtual health a whole lot of thought before the Corona crisis are paying more attention and even started touting virtual office visits as an important employee benefit.  Many plans are now covering virtual visits and the like with no copays or out-of-pocket cost to employees and their dependents.  (However, please check with your specific plan regarding cost.)

And, even Medicare is making great accommodations for expanding virtual healthcare as a Medicare benefit, at least temporarily until the pandemic situation runs its course.

WILL THIS GENIE EVER GO BACK IN THE BOTTLE?

I doubt it.

 

Medicare enrollment form

How to Enroll in Medicare During the Corona Virus Emergency

Here are the latest Medicare Enrollment postings to the Social Security & Coronavirus Disease (COVID-19) website:

Can I enroll in Medicare?

Date: April 14, 2020

If you already have Medicare Part A and wish to sign up for Medicare Part B under the Special Enrollment Period (SEP), please complete form CMS 40-B, Application for Enrollment in Medicare – Part B (Medical Insurance) along with the CMS L564-Request for Employment Information and proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP). Return the completed forms to your Social Security office by mail or by fax to 1-833-914-2016.

Note When completing the CMS L564

  • State on the form “I want Part B coverage to begin (MM/YY)”
  • If possible, your employer should complete Section B.
  • If your employer is unable to complete Section B, please complete that portion on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
    • income tax form that shows health insurance premiums paid;
    • W-2s reflecting pre-tax medical contributions;
    • pay stubs that reflect health insurance premium deductions;
    • health insurance cards with a policy effective date;
    • explanations of benefits paid by the GHP or LGHP; or
    • statements or receipts that reflect payment of health insurance premiums.

Can SSA help me by phone?

Date: April 14, 2020

During the COVID-19 pandemic, we are asking the public to first try to use our online services before calling us.

If you cannot use these online services, although our offices are closed to the public, employees from those offices are assisting people by telephone. You can find the phone number for your local office by using our Field Office Locator and looking under Additional Office Information. (Note, if you already had a scheduled appointment with your local office, an employee from that office will attempt to call you at your scheduled appointment time.)

If you cannot use our online services or reach your local office, you may call our National 800 Number, where you may be able to take care of your business by using one of our automated telephone services without having to wait for a telephone agent. If you need to speak with an agent, be aware that wait times are longer than usual. You may have to wait 90 minutes or longer, which is why we encourage you to try our online services or call your local office first.

Main Nationwide Phone Number — 1-800-772-1213

To Find Your Local Office Phone Number Go To Local Field Office Locator , enter your zip code and then look for the phone number at the bottom of the page.

For more information you can go here – https://www.ssa.gov/coronavirus/

Medicare and Employer-based Coverage

BBG - Medicare and Employer-based Coverages

When you have both Medicare and employer-based coverage, Medicare will either pay primary or secondary for your medical costs. When Medicare is primary insurance, Medicare pays for your medical bills firstWhen Medicare is the secondary insurance, Medicare pays after the employer-based coverage pays . Usually, secondary insurance pays some or all of the costs left after your primary insurance has paid (for example, deductibles and copays).

This month’s Medicare Minute (courtesy of the Medicare Rights Center) addresses these and other questions:

How does Medicare work with job-based insurance?

What are the differences between primary and secondary insurance?

How does Medicare work with retiree insurance and COBRA coverage?

To read or download it, click here — Medicare and Employer-based Coverage.

Open Enrollment

How to Prepare for Group Health Open Enrollment

‘Tis the season for open enrollment in the world of health insurance! Open enrollment for Medicare 2020 has already begun (October 15th – December 7th, 2019). Additionally, individual open enrollment is underway (November 1st – December 15, 2019). Lastly and most important to this article is the fact that many employers are in the midst of their group health plan open enrollment. Many group plans renew January 1st so it’s a busy time of year for employers, brokers, and insurance carriers.

This article is designed to assist employers in knowing what to focus on during this busy season.

Renewals

The most important thing we need to focus on is the premiums that you pay to the insurance carriers. We know this is a huge expense and we work with you to keep this competitive to what’s available in the marketplace.

Most of the January 1st group health insurance renewals are out. Perhaps your increase is palatable enough to forgo shopping and just renew as is. However, that is more the outlier than the norm. Typically, it’s best to assist us with the necessary data needed in order to shop your policy with the competing carriers in the marketplace. By now, your account managers at BBG have been working hard to gather the necessary data for shopping. These items include:

  • Current Census
  • Average Total Number of Employees (ATNE). This is based on how many total employees you employed each month and dividing by 12. Estimates are used for the remaining months of the year.
  • Names of your employees who are eligible but waive off the plan
    • The reason they are waiving
  • If you are a 51+ group we’ll need what is called an Employer Risk Assessment Form (ERAF)

The above will allow us to obtain street rates in the small group market place and potentially underwritten rates in the 51+ marketplace. Street rates are off the shelf rates that are based on your group’s census alone. They are still subject to underwriting but give us a good benchmark to know if we should pursue underwritten rates

Medical Health Questionnaires (MHQs)

The dreaded MHQs need not be so dreaded anymore! Most insurance carriers prefer to receive electronic MHQs via programs like FormFire. Some carriers now require FormFire MHQs. BBG has dedicated team members who can assist your employees in completing this process. We’ve worked hard this year to streamline the process to allow us to help a larger number of you in a shorter amount of time.

So when are MHQs needed? This answer is different depending upon what market segment you are in…

1-50 Small Groups

If you have 50 and under total employees, FormFire MHQs will be needed to obtain underwritten rates from any competing carriers. However, BBG is all about efficiency so we first obtain street rates to determine if this is even worthy of your time. If we determine that it is then we highly suggest proceeding with FormFire.

The only exception here is when we obtain community rates. Community rates are different from underwritten rates and are typically more expensive than their underwritten counterparts.  We’ve been finding that mostly micro groups and other groups with certain characteristics that may adversely impact underwriting are served best by community rates.

51-99 Mid-Size Groups

If you have between 51-99 total employees some carriers require MHQs to release any underwritten rates. However, there are a few carriers who will release underwritten rates if your renewal is <25% and you’ve completed an ERAF.

100+ Large Groups

Typically MHQs are not needed in the 100+ market segment; although, there are exceptions where MHQs can be helpful. Your account manager will assist to know when this applies to you.

When Not to Shop the Market

There are only two instances when it makes sense to not shop the market. 1.) If you are in the 51-99 market and your incumbent carrier asks for your “no shop” number. A no shop number is an increase you are willing to accept in agreement for not shopping.

In our experience, if a carrier is asking for your “no shop” number, they are willing to play ball and negotiate. If you are not sure what a reasonable no shop number is, talk to your account manager and they can assist you with this. However, you can always be aggressive and ask for a flat increase. What’s the worst they can say? No? If the carrier cannot meet it, we can always shop your policy.

2.) Or if you are in the 1-50 market your incumbent carrier may be able to provide some rate relief in an agreement to not shop your policy. The amount of rate relief available in the small group market is much smaller but if you received a favorable renewal a few points of rate relief may be enough for you to decide to stay put. Your account manager and BBG will let you know if this is a feasible option for your specific group.

Closing Thoughts

At BBG, we are fully aware that the most important work we do is to assist the employers we work for in keeping healthcare costs and the coverage your employees receive competitive to what’s in the marketplace. The most important benchmark number we look at is your average cost per employee per year. This number is found by taking your total costs and dividing by your total employees enrolled in the health plan. We realize your enrollment can fluctuate and by looking at this number we are looking at a comparable number year over year.

Open enrollment is always a busy time of the year but the exercise of shopping, completing FormFire, and allowing BBG to negotiate with the carriers on your behalf is the important work. This work allows you to maintain strong benefits year after year.

 

 

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