As Coronavirus continues to sweep across the nation, many employers are uncertain about how it will affect their business and operations. Another key unknown is the extent to which the virus will affect their employees’ health (and how COVID-19 tests and treatment will impact healthcare spend).

To clear up some of the uncertainty, Wincline has dedicated a continually-evolving resource rub to inform employers of the developments in COVID-19 legislation. Informative legislative bulletins, up-to-date news articles, and our insight into the Coronavirus outbreak will appear below.

COVID-19 Legislation

The President signed two pieces of legislation into law as part of the Families First Coronavirus Response Act, which are each set to take effect as of April 2, 2020. Both components seek to afford American workers protection against the chilling economic effects of the Coronavirus pandemic:

  • Provision 1: Emergency Family and Medical Leave Expansion Act – Allows 12 weeks of partially compensated FMLA leave to certain workers based on childcare needs.

  • Provision 2: Emergency Paid Sick Leave Act – Requires employers to provide 80 hours of paid sick time to employees in specific circumstances.

It is essential to note that these two laws only apply to employers with fewer than 500 employees. There are not currently any legislative mandates for employers with 500 or more employees.

Qualifications and requirements for these two new laws are detailed in our briefing, which is available here. As always, if you need clarification on any of the points in this briefing, you can contact Wincline.

COVID-19 Tests and Treatment Costs

It is still early days for determining specific dollar amounts for COVID-19 tests and treatment, partly because the costs naturally vary among provider and location. Here’s what we do know:

  • Health insurance companies (e.g., Cigna, Aetna, BCBS) have agreed to waive member cost-sharing for approved and authorized COVID-19 testing. This means that when one of your employees or their dependents receive a test, they will pay no out-of-pocket costs. Initially, self-funded plans were given the choice to opt out of this scheme; however, that is no longer the case. This means that financially responsible employers should encourage their health plan members to seek COVID-19 tests at locations outside of the hospital or ER. The difference in cost for a single test could be on the order of $1,300 (given reports that they are currently $1,331 and also that the price U.S. CMS recommends that “healthcare providers and laboratories” bill Medicare in Arizona is only $35.91).

  • The best estimate available for all-in treatment costs for COVID-19 come from Peterson-KFF’s Health System Tracker, which benchmarks against inpatient admission costs for pneumonia. This would place average treatment costs anywhere between $9,763 to $20,292, based on whether there are “complications or comorbidity” associated with the treatment. Relevant comorbid conditions include (1) Hypertension, (2) Diabetes, (3) Cardiovascular disease, (4) Chronic respiratory disease, and (5) Cancer (See Table 1).

Additional Coronavirus/COVID-19 Resources

This is a list of resources that we think you should be aware of as you consider the future of your business during the COVID-19 outbreak.

Health Plan Cost Model for COVID-19

Wincline has developed a generalized forecasting model for estimating the costs of tests and treatment for self-funded employers. You access the model freely, and fill in your health plan’s demographic information broken down by age group.

The model projects a best-case, worst-case, and middle-of-the-road scenario based on the best information we have available as of March 31, 2020. If you want to further refine the analysis, we encourage you to conduct sensitivity analysis (e.g., Monte Carlo simulations) to forecast the range and distribution of possible outcomes.

*None of the information in this resource hub is intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

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