Are your benefits plans ready for Ebola?
As the nation braces for a potential outbreak of one of the worst infectious diseases in modern history, employers and employees should carefully review their benefits contracts to ensure financial protection in the face of significant exposure. It’s obvious from the recent high profile cases that travel and treatment costs for a patient infected with Ebola can run into the hundreds of thousands of dollars, but don’t assume that your standard copays and out of pockets will cover the costs. Why not?
WGA’s Employee Benefits Practice has compiled responses and alerts from carriers and their contractual wording for medical, life and disability, critical illness and travel products. Employers should review their contracts and seek written clarifications that specifically include Ebola, as well as a listing of other pandemic diseases.
Travel- A person testing positive for Ebola will need immediate transfer to one of the four U.S. facilities prepared and approved for care. There are currently no commercial organizations providing medical evacuation services, so all transport services will be handled by the local governmental authority. In the U.S., that is the Centers for Disease Control (CDC). Currently, all decisions and subsequent costs for transportation for an infected individual appear to be covered by the governmental entity in charge of the corresponding region.
Medical Costs- Will Ebola treatment costs be covered by commercial carriers? Maybe. Currently ZMapp and other drug therapies in use for the treatment of Ebola are not approved by the FDA. ZMapp is still in the clinical trials phase, and has not yet been tested on humans. As a result, the drug would not be covered under most insurance programs and stop loss contracts. Furthermore, many medical procedures in use are still deemed experimental. On the other hand, several medical carriers have indicated that they may suspend routine policies and exclusions in coordination with state and federal health authorities to ensure coverage for appropriate care. Companies should review medical plan documents to be sure there is no pandemic exclusion stated. It is also important to note that there are no approved vaccines available for Ebola.
Life and Disability- Virtually all claims would be covered under standard group life and disability as a result of Ebola. However, most plans include an exclusion of coverage for employees who are traveling abroad on short-term assignment. In the past, exceptions could be made on a case-by-case basis if the company alerted the carriers of their plans to send a U.S. employee overseas. Under no circumstance should an employer assume the coverage is in effect without written confirmation. All work assignments outside the U.S. should be approved in advance in writing by the carrier, or the employer should consider an Ex Pat program.
Voluntary Worksite Products-
- Critical illness policies need to have an infectious disease rider included (not standard), and currently, no policies specifically cover Ebola. Carriers are working to evaluate rider wording to include Ebola as an infectious disease.
- For Healthcare workers, some critical illness policies will provide an “occupational infectious disease rider” but those policies are currently limited to HIV and hepatitis. WGA is working to add Ebola to that list with certain carriers.
- Accident policies do not provide coverage for infectious disease.
Global Medical- The risks are also real for companies whose employees travel through Africa and other affected areas. From quarantines to border closings, the outbreak has exposed employers, expat workers and business travelers to unexpected health scares. Most domestic (U.S.) benefit plans will cover health emergencies overseas, but employers and employees who want additional coverage for more than emergency care can purchase a global expatriate medical insurance policy or a medical business travel policy. Click here to read more from WGA’s Global Practice Leader for Employee Benefits Jim Kinney on this type of coverage.
While insurance professionals recognize the threats behind these pandemic outbreaks, employers may not. Therefore, it’s critical for organizations to ensure they have formulated and communicated an effective response in order to protect their workers with comprehensive employee benefits coverage. Click here to read the full White Paper on this topic, and contact WGA to learn more about securing protection for your organization.
About the Author
Christopher Nadeau is a Principal at WGA and head of the Employee Benefits Group. Mr. Nadeau counsels his department to develop and redesign employee benefits programs to match the corporate philosophy, long-term needs and objectives of their clients. He is also an industry leader on Healthcare reform and the cost impact and administrative burden on employers.