COVID-19’s impact on the stop-loss market won’t be known for some time. For example, while most ICU stays are generally expected to cost less than the average employer’s stop-loss deductible, we don’t know how big those claims can get because they are still coming in. And while it may be that the deferral of elective treatment will offset much of the new COVID-related spending, we don’t know that for sure either.
Meanwhile, employers are weighing changes that will affect their benefit costs: should we cover treatment for COVID-19 at 100%? Should we cover all virtual visits at 100%? How will furloughed employees pay for benefits? Should we offer a special enrollment period?
These decisions will have important consequences for employees. At the same time, self-funded employers need to check with their stop-loss carrier to fully understand the potential impact to the business. While stop-loss carriers have proven flexible and generally accommodating, they must be notified of any changes to the plan, eligibility definitions and leave policies. Many stop-loss carriers have produced detailed FAQs that very clearly outline which benefit decisions are acceptable, but others have not, and some carriers may even require a formal plan amendment to document the changes. Ask your stop-loss carrier to confirm acceptance of any proposed plan changes now to avoid issues later. Documenting these changes with the carrier up front will help to avoid ugly claim denials later in the year.