Dealing with COVID Vaccination Status Friction Points with Employees

The controversy over COVID-19 vaccine mandates in the workplace continues growing and human resources are sounding the alarm on how employers should approach the matter.

While the Equal Employment Opportunity Commission and impending OSHA regulations will provide some cover to employers who want their employees to get vaccinated, they need to make sure that they follow certain steps in dealing with those who refuse to have a jab, won’t say if they are vaccinated or are claiming a religious or medical exemption from getting inoculated.

The California employment law firm of Shaw Law Group LLC. recently held a webinar on a number of friction points that could get employers in hot water. Here are some tips to avoid getting sued:

  • If you require your staff to disclose their vaccination status, treat those who refuse to divulge their status as unvaccinated. There is no point in continuing to hound someone about giving the information if they don’t want to. Just assume they are unvaccinated for the purposes of your office rules.
  • If you have set rules requiring your workers to be vaccinated, do not automatically put someone who won’t get vaccinated on a leave of absence if that is your policy. Instead, treat it like an Americans with Disabilities Act request and enter into a meaningful discussion if they request accommodation.
    During this time, you have to consider alternative accommodations, such as requiring them to always wear a mask at work and submit to weekly testing.
  • If you are going to accommodate workers who don’t get vaccinated, you as the employer are obligated to cover the costs of such accommodations (like those in the above bullet point). That also applies to employees who refused to get vaccinated on religious or medical grounds.
  • Have a process in place for handling requests for accommodations. A request for religious accommodation can put the employer in a quandary since they don’t want to require proof of what part of the person’s religion requires them not to get vaccinated. Shaw Law Group warns: “And, do not question the sincerity of an employee’s stated religious belief, unless you have an ‘objective’ reason to do so.”
  • There are no laws or regulations requiring employers to provide a “reasonable accommodation” for political, social or secular personal beliefs that may affect why an employee refuses to get vaccinated.
  • If you have an employee who refuses to participate in the accommodation process and provide documentation backing up their religious or medical exemption request, deny the request.

HIPAA Privacy Rule considerations

Meanwhile, the Department of Health and Human Services’ Office for Civil Rights has issued guidance regarding how the HIPAA Privacy Rule affects employees’ disclosures of their COVID-19 vaccination status.

Employers can require employees to disclose whether they have received the COVID-19 vaccine, according to the guidance. That includes requiring them to disclose their status to a client or another third party like a vendor.

Why is this? HIPAA’s Privacy Rule does not regulate the health information an employer can request from its employees as part of the terms and conditions of employment.

Employers who require staff to provide proof of vaccination status are required to keep all documentation or confirmation of vaccination status confidential, under this rule. Any such documentation must not be stored in the employees’ personnel files and must be kept separately.

Finally, your employees are free to disclose their vaccination status to other employees, customers, vendors or trade partners, as the Privacy Rule does not apply to such circumstances.

The takeaway

As more Americans get vaccinated, there is also a significant portion of them that will continue refusing to get inoculated for a number of reasons.

To avoid being sued for overstepping your authority as an employer, if you are requiring vaccinations, make sure you put in place procedures for handling requests for religious or medical accommodation.

You’ll also need to decide how to handle employees who won’t divulge their vaccination status or are refusing vaccination on grounds other than religious or medical reasons.

Finally, if you decide not to require staff to get vaccinated, decide how you will accommodate unvaccinated workers in the workplace, such as requiring full-time masking and weekly COVID-19 testing.

Helping Your Employees Find the Right Plan for Them

Studies have found that nine out of 10 employees opt for the same benefits every year and that around a third of workers don’t fully understand the group health plan benefits they are enrolled for.

Staying in the same plan after year can be a waste of money if someone is in the wrong plan for them. And not understanding benefits can lead to wasted money as well, as workers often skip necessary appointments, check-ups and treatment regimens for chronic conditions, which in turn puts their health at risk.

As coverage has grown in complexity over the past decade, it’s important that you provide the resources for your employees to choose the health plan that is best for them. Here are three tips that will help them get the most out of their benefits.

Don’t skimp on explaining

While some employees’ eyes are bound to gloss over while someone is explaining the various plan options, their networks, their copays, deductibles and more, it pays to take the time to explain them step by step.

That means breaking the benefits down to the basics in language anyone can understand. Avoid getting bogged down in health insurance jargon and keep it simple. The simpler the better.

Don’t think of it as talking down to your employees, because there’s a good chance some of them are not familiar with how health coverage works. Encourage questions, by telling them there are no stupid questions. Invite employees to speak one-on-one with your benefits point person if they have questions they’d rather ask privately.

Make benefits communications all year long

When the new year starts and open enrollment is in the mirror, most employers don’t reach out to staff until a few weeks before the next year’s enrollment period starts.

Plan now for regular benefits communications throughout next year. Send them e-mails and materials during the course of the year that remind them to consider how their current coverage is measuring up to their needs.

This is especially important if someone’s health situation changes. They may be looking to make a change during the next open enrollment, and feeding them periodic memos about their coverage can help them educate themselves and prepare.

Communications could include explainers about cafeteria plans, health savings accounts, how to use their health benefits wisely, and more.

Know your crew

After open enrollment, run a report looking at what plans your employees are signed up for and see if they are concentrated in certain plans. Many employees when choosing health plans ask their co-workers, which often leads to them choosing a plan that is not optimum for them since there are many factors that may vary, including:

  • Their age.
  • Whether or not they are married.
  • Whether or not they have children.
  • Their health situation.

That’s why it’s important to run some analytics on your employees’ health plan choices. We can work with you to make sure that they are in the right plans and identify what might be a better alternative for them.

For example, in many cases, the younger and healthier someone is, the best choice may be a high-deductible health plan with lower premiums, tied to an HSA. Older employees and those with health conditions — those who are more likely to use medical services and be on medication — may need a plan with a lower deductible.

The takeaway

It benefits both your employees and you if your employees are in the appropriate plan for their life and health situation.

Fortunately, you can ensure that they understand their benefits by understanding their needs and helping them learn about their benefits throughout the year.

Draft Would Help Policyholders Meet Drug Deductibles, Copays

A model measure would require health plans to include financial assistance that policyholders receive, as well as drug rebates, towards their pharmaceutical deductibles, copays and coinsurance.

Most health plans do not allow rebates and outside financial assistance to count towards a policyholder’s drug deductible, which critics assert penalizes enrollees.

The model measure introduced by the National Council of Insurance Legislators (NCOIL), a bi-partisan organization of state elected officials who specialize in insurance law, would require them to count those outlays towards coinsurance and deductibles.

It’s expected that some NCOIL members will introduce similar legislation in their home states in 2022 or in subsequent years.

If successful, such laws could be a boon for some patients who receive help from drug companies or whose drugs are eligible for rebates

This is a significant move as pharmaceuticals become more expensive and lawmakers and policymakers wrestle with how to make them more affordable and stem steep annual cost increases.

The problem

Health plans’ and PBMs’ drug formularies have different cost-sharing amounts for different tiers of drugs. The lowest amount of cost-sharing is mostly for generic drugs, some of which are even available with no copays.

There are typically at least three tiers of drugs, with the higher reserved for brand-name drugs for which there are not always generic versions available. The top tier is usually reserved for the most expensive, specialty medications.

For expensive pharmaceuticals, some drug makers will sometimes work with patient advocacy groups to fund programs that offer financial support towards out-of-pocket expenses for patients that purchase their drugs.

Drug companies will also provide rebates. But often, pharmacy benefit managers and health insurers will receive those rebates and there have been questions as to how much of them they share. And they don’t count those rebates towards the patient’s out-of-pocket maximum.

The model legislation

The model legislation is just that: a model. NCOIL has put the proposed measure on its agenda for its Nov. 18 meeting.

It’s expected that some NCOIL members — Republican and Democratic lawmakers from all 50 states — will write and help pass similar measures in their home states.

The preamble to the language in the measure states that it aims to address programs that keep cost-sharing assistance payments from counting towards a patient’s annual out-of-pocket spending limit.

That draft’s model language states: “When calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health plan, a carrier/insurer/issuer or pharmacy benefit manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person.”

Insurance companies and PBMs say that the measure would be improved if it would limit its scope to only include drugs with no lower-cost or generic alternative. That way, it would keep pharmaceutical companies from steering patients to their more expensive drugs when there are lower-cost alternatives.

Right now, there is no pending legislation at the state level, but this could be the starting point to bring some financial relief to drug plan enrollees that are either high users of prescription drugs or have been prescribed expensive medications.

COVID-19 Home Test Kits Reimbursable under FSAs, HSAs

Under new guidance issued by the IRS, at-home COVID-19 testing kits will be considered a reimbursable medical expense under the three main health care savings vehicles offered to employees.

This new guidance adds to the list of personal COVID-19-related expenses for which employees can seek reimbursement under:

  • Health savings accounts
  • Health reimbursement arrangements, and
  • Flexible spending accounts.

This is good news as these home tests become more common during this stretch of the pandemic.

The IRS earlier announced that personal protective equipment for use in preventing infection and spread of COVID-19 is also reimbursable by HSAs, FSAs and HRAs. That includes:

  • Masks,
  • Sanitary wipes, and
  • Hand sanitizers.

What to do

If you offer one of the above savings vehicles, you may need to amend your group health plan’s language, unless the plan is drafted to reimburse all IRS-permitted expenses. In that case, you can leave it as is.

If, however, the plan lists all permitted expenses, you’ll need to amend it. If you plan to set the effective date for 2021, say Sept. 15, you should make the amendment no later than Dec. 31, 2021 for it to be effective.

Regardless of whether you have to change the plan or not, you should notify all participating staff of the change so they can take advantage of their plan if they need to.

Pandemic Spurs Supplemental Benefits Uptake Among Workers

A new study has found that in response to the COVID-19 pandemic nearly half of U.S. workers added one new supplemental health-related benefit on top of their group health coverage.

The 2021 “Aflac WorkForces Report” found that 44% of employees bought one additional benefit, with life insurance policies seeing the biggest uptake. The fact that so many workers decided to boost their supplemental health benefits reflects the profound effect the pandemic has had on people and how it has opened their eyes to the fragility of life.

“Anxieties over the past year brought questions about health coverage ― especially about whether current coverage is enough for workers and their families,” Aflac wrote in its report. “The survey found that employees sought ways to help offset the financial burdens they experienced, including through supplemental insurance.”

Interestingly, the largest uptake of these benefits was among millennial workers.

With the pandemic still not over and more people having seen the effects on friends, family and acquaintances, the report predicts that the trend will continue.

The most popular additional benefits

The percentages of workers who have purchased a voluntary benefit since the pandemic started:

  • Life insurance: 22% overall and 34% of millennial workers.
  • Critical illness insurance: 16% overall and 23% of millennial workers.
  • Mental health resources: 14% overall and 21% of millennial workers.
  • Hospital insurance: 14% overall and 21% of millennial workers.
  • Accident insurance: 12% overall and 19% of millennial workers.
  • Disability insurance: 10% overall and 16% of millennial workers.
  • Cancer insurance: 4% overall and 6% of millennial workers.

Overall views of supplemental benefits have also improved since the pandemic started. The survey found that:

  • One-third of employees say supplemental insurance is more important now due to the pandemic.
  • 51% of all American workers view supplemental benefits as a core component of a comprehensive benefits program.
  • 90% of employees believe the need for supplemental insurance is increasing.
  • 48% employees (and 63% of millennials) are highly interested in purchasing supplemental insurance to help cover the financial costs related to COVID-19 or other pandemics.

The takeaway

In light of these findings, it’s more important than ever that employers offer more than group health coverage and provide their workers with a slate of voluntary benefit offerings, many of which do not cost the employer much extra.

In fact, the study found that 70% of employers believe supplemental insurance helps them recruit employees and 75% say it helps with retention.

But keep in mind that may employees believe they already have enough coverage to meet their needs. Open enrollment is a prime time to educate them about the health-related expenses that group health insurance doesn’t cover, such as death benefits and long-term care.

One way you can put together a slate of offerings that your workforce needs and is interested in, is to conduct a study of your staff to see which options they would most prefer.  

And finally: Introduce your benefits consultant (in person or virtually) prior to or at the start of open enrollment. That way, employees become familiar with them and can be more comfortable asking questions about the various coverages they can choose from.

Large Employers Must File ACA Forms, Not the Insurers

One mistake more and more employers are making is failing to file the required Affordable Care Act tax-related forms with the IRS.

If you are what’s considered an “applicable large employer” (ALE) under the ACA, you are required to file with the IRS forms 1094 and 1095, often separately and before your annual tax returns are due.

Under the ACA, employers with 50 or more full-time and “full-time equivalent” workers are considered an ALE and are required to provide affordable health insurance to their staff that also covers 10 essential benefits as prescribed by the law. This is what’s known as “the employer mandate.”

Filing these documents is not the responsibility of your health insurer as it’s you that’s arranging the employer-sponsored health insurance for your staff. Be aware that you can face penalties if you:

  • Don’t file the forms in a timely manner,
  • Make mistakes when filing the forms, or
  • Fail to file the forms altogether.

The IRS requires these forms to ensure that ALEs are providing health coverage to their employees and that the employer is complying with the employer mandate portion of the ACA.

The forms

  • Form 1095-C — This is basically the W-2 reporting form for health insurance. The form tells the IRS which employers are providing coverage and which employees are getting coverage through their employers.
  • Form 1094-C — This form provides information about health insurance coverage that the employer provides.

Here are the deadlines you need to be aware of:

  • Jan. 31, 2022 — Individual statements (Form 1094 C) for 2021 must be furnished to employees by this date.
  • Feb. 28, 2022 — If filing paper returns, Forms 1094 C and 1095 C must be filed by this date.
  • March 31, 2022 — If filing electronically, Forms 1094 C and 1095 C must be filed by this date.

Penalties

The general potential late/incorrect ACA reporting penalties are $280 for the late/incorrect Forms 1095-C furnished to employees, and $280 for the late/incorrect Forms 1094-C and copies of the Forms 1095-C filed with the IRS.

That comes to a total potential general ACA reporting penalty of $560 per employee when factoring in both the late/incorrect Form 1095-C furnished to the employee and the late/incorrect copy of that Form 1095-C filed with the IRS.

The maximum penalty for a calendar year will not exceed $3,392,000 for late/incorrect furnishing or filing.

New Issues for 2022 Group Plan Open Enrollment

Employers are entering the second year of open enrollment taking place during the COVID-19 pandemic, which is still having an outsized impact on the process and which has changed the face of health insurance.

There are a number of issues that will have an effect on health plans, including regulations and laws affecting coverage that were born out of the pandemic. Mercer LLC recently published a list of compliance-related priorities that health plan administrators and sponsors have to consider, including:

Legal and regulatory changes

Health plan transparency in coverage rules takes effect on Jan. 1, 2022. Newly introduced regulations require hospitals to publish their standard prices, and for negotiated rates between health plans and providers to be made transparent too.

Employers will need to communicate these changes to their employees, particularly rules that require health plans to provide enrollees with out-of-pocket estimates for upcoming procedures.

Also, the No Surprises Act, which will prohibit surprise bills for certain out-of-network services, takes effect at the start of 2022 for providers and group health plans. Employers need to meet with their plan administrator to make sure that their plans are in compliance with these new regulations.

COVID-19 issues

The pandemic will continue casting its shadow over health insurance and open enrollment.

Legislation passed last year requires health plans to cover additional services such as mental health and telehealth until the end of this year. Whether your plan offerings will keep providing those enhanced benefits or not, you’ll need to communicate that to plan participants and include it in your plan documents.

You should also confirm that your group plans comply with COVID-19 testing and vaccine coverage requirements in the Family First Coronavirus Response Act, the CARES Act and any state laws.

Gender and family planning issues

Employers should review their benefit eligibility rules after the Supreme Court in 2020 ruled that Title VII of the 1965 Civil Rights Act protects LEGBTW employees from discrimination in benefits.

You should ensure that benefits offered to opposite-sex spouses are the same as are offered to same-sex spouses.

Mental health parity

All health plans have to prepare a comparative analysis of their medical and surgical benefits and mental health and substance abuse treatment benefits to demonstrate that treatment limitations are applied comparably. This job does not fall on the employer, but you should make sure your plan has prepared the analysis or is working on it.

This is part of new laws that require health plans to offer similar benefit coverage for mental health and substance abuse treatment as they do for other medical and surgical procedures and services.

HSA, HRA and FSA revisions

The CARES Act temporarily authorized employers to allow employees with health savings accounts, health reimbursement arrangements and flexible spending accounts to make mid-year changes to how much they deposit in those accounts.

It also authorized them to permit employees to roll over unused amounts in their health and dependent-care flexible spending arrangements from 2020 to 2021 and from 2021 to 2022.

Employers that opted to allow their employees to make these changes and roll over funds, have to communicate to their employees that these changes come to an end on Dec. 31 this year.

There were also some permanent changes made by the CARES Act, including reinstating over-the-counter medical products as eligible expenses for HSAs, certain HRAs and FSAs without a prescription.

These accounts may now allow certain menstrual care products, such as tampons, pads, liners and cups, as eligible medical expenses. These are retroactive benefits to Jan. 1, 2020.

Make sure to notify your staff of these changes. You can tell them that if they have receipts for eligible expenses that date back to then, they can submit them for reimbursement.

Group Plan Affordability Level Set for 2022

The IRS has announced the new affordability requirement test percentage that group health plans must comply with to conform to the Affordable Care Act.

Starting in 2022, the cost of self-only group plans offered to workers by employers that are required to comply with the ACA, must not exceed 9.61% of each employee’s household income.

Under the ACA, “applicable large employers (ALEs)” — that is, those with 50 or more full-time employees (FTEs) — are required to provide health insurance that covers 10 essential benefits and that must be considered “affordable,” meaning that the employee’s share of premiums may not exceed a certain level (currently set at 9.83%). The affordability threshold must apply to the least expensive plan that an employer offers its workers.

The threshold has been reduced from the 2021 level because premiums for employer-sponsored health coverage increased at a lower rate than national income growth this year. That was largely the result of a large reduction in non-emergency health care services as many people stayed away from hospitals when COVID-19 cases were surging.

With this in mind, you will need to balance out any potential premium rate hikes with the affordability level for employees and make sure that you offer at least one plan with premium contribution levels that will satisfy the new threshold. Some employers may need to boost their contributions in order to avoid penalties.

Example: The lowest-paid worker at Company A earns $25,987 per year. To meet the affordability requirement, the worker would have to pay no more than $2,497 a year in premium (or $208 a month).

ALEs with a large low-wage workforce might decide to utilize the federal poverty line affordability safe harbor to automatically meet the ACA affordability standard, which requires offering a medical plan option in 2022 that costs FTEs no more than $103.14 per month.

Failing to offer a plan that meets the affordability requirement to 95% of your full-time employees can trigger penalties of $4,060 for 2022 per FTE receiving subsidized coverage through an exchange. That’s the full-year penalty and the actual penalty prorated depending on how many months an employee received subsidized coverage.

The penalty is triggered for each employee that declines non-compliant coverage and receives subsidized coverage on a public health insurance exchange.

Since most employers don’t know their employees’ household incomes, they can use three ways to satisfy the requirement by ensuring that the premium outlay for the cheapest plan won’t exceed 9.61% of:

  • The employee’s W-2 wages, as reported in Box 1 (at the start of 2022).
  • The employee’s rate of pay, which is the hourly wage rate multiplied by 130 hours per month (at the start of 2022).
  • The individual federal poverty level, which is published by the Department of Health and Human Services in January of every year. If using this method, an employee’s premium contribution cannot be more than $104.52 per month.


Out-of-pocket maximums

The IRS also sets out-of-pocket maximum cost-sharing levels for every year. This limit covers plan deductibles, copayments and percentage-of-cost co-sharing payments. It does not cover premiums.

The new out-of-pocket limits for 2022 are as follows:

  • Self-only plans — $8,700, up from $8,550 in 2021.
  • Family plans — $17,400, up from $17,100 in 2021.
  • Self-only health savings account-qualified high-deductible health plans — $7,050, up from $7,000 in 2021.
  • Family HSA-qualified HDHPs — $14,100, up from $14,000 in 2021.

Coverage for Virtual Substance Abuse Treatment Grows

Thousands of American families have been affected by the tragedy of someone with a substance abuse problem.

For many, especially during the COVID-19 pandemic, finding available and affordable treatment has been difficult or impossible. Recently, however, virtual treatment options have become available, and some insurance companies are beginning to pay for them.

This is an important development for both the group health insurance arena as well as the individual health insurance market. For employers, this is another lifeline that they can highlight for their staff as so many people have been affected by the stresses of the pandemic. For individual policyholders, they could have access to convenient and timely treatment.

Start-up companies across the country are offering virtual substance abuse treatment, including:

  • Boulder Care, which provides digital opioid-addiction treatment.
  • Pear Therapeutics, which provides software-based disease treatments; its lead product is a treatment for substance abuse disorders approved by the U.S. Food and Drug Administration.
  • Ria Health, which employs 45 clinicians who can prescribe treatments online for alcohol-addicted patients.

These start-ups have attracted the attention of group health insurance companies, some of which are starting to cover their treatments for people insured under their health plans. For example:

  • Ria Health has contracts with at least four insurers covering millions of people.
  • Boulder Care has a partnership with Anthem.
  • Pear Therapeutics has contracts with regional health plans in three states.
  • An opioid-addiction treatment provider in Massachusetts has partnerships with UnitedHealth Group and Kaiser Permanente.

Virtual treatments for addiction are becoming popular for several reasons. Patients may feel a social stigma from receiving in-patient treatment at rehabilitation centers.

Instead, virtual treatment in their homes permits them to keep their conditions private. It also provides flexibility. Ria Health offers its services on demand while enabling patients to customize their goals.

Receiving treatment faster

Demand for substance abuse treatment has grown during the pandemic.

Studies show that a quarter of American adults reported drinking more alcohol during the health emergency, including more than half of parents of elementary school children. As a result, space has been at a premium at in-patient rehabilitation facilities. Some have had lengthy waiting lists.

Virtual treatment gives new options to patients who cannot get admitted to rehab centers.

Because of the pandemic:

  • Some states made new rules for prescribing medicine via telehealth visits less restrictive.
  • The federal government started requiring payment parity for physician visits done via video.

Both of these factors have encouraged the growth of these start-ups.

These solutions are attractive to insurers because they reduce costs. Substance abuse patients who cannot get into rehab centers may overdose and end up in emergency rooms.

ERs are often the most expensive places to obtain care. Planned treatments over periods of time reduce the need for ER visits.

Multiply the savings over hundreds of thousands of patients, and it should be no surprise that insurers are signing seven-figure contracts with these providers.

Employers see these new plan features as an additional way to retain valuable employees. In any large group of employees, there will be some who are suffering from addiction or have family members who are, and they will value this benefit.

If you are an employer who offers these plans, you may want to check with your health insurers to see if they’ve changed coverage terms for this type of treatment. If so, you may want to consider spreading the word among your staff.

For some of your employees or their family members, life-saving help may be just a video chat away.

Accident Insurance Can Save Your Workers from Ruin

Even if you are providing your staff with health benefits, they could be left under great financial pressure if one of them has a major accident off the job that leaves them debilitated and unable to work.

Millions of working Americans struggle with managing out-of-pocket costs for non-medical and medical expenses after suffering an unexpected event such as an accident.

If you are already offering your employees health insurance coverage, you can help fill the gap by also offering voluntary accident insurance, which can pay for:

  • Lost wages,
  • Deductibles and other expenses not covered by insurance,
  • Transportation to and from hospitals and doctors, and
  • Home modifications.

Many Americans are ill-prepared financially

According to a survey by Prudential Insurance Co.:

  • Two-thirds of Americans say it would be very or somewhat difficult to meet their current financial obligations if their next paycheck were delayed for just one week.
  • Half of all households say they have less than $10,000 in liquid assets available for use in an emergency.

Why your employees need coverage

  • Health insurance only covers a portion of expenses, and only after the employee has paid their deductible and copay.
  • Employees sometimes have to pay out of pocket for medicines, medical equipment and visits to out-of-network physicians.
  • Employees have to pay out of pocket for travel to appointments, home accommodations, caregiving and housekeeping if they cannot do those things on their own after an accident.
  • Lost wages are a sometimes-overlooked cost of illness or injury. This can be an issue not only for the employees directly impacted by illness or injury, but also for family members who are providing care for them.

The types of accident insurance

Traditional treatment-based plans. These pay benefits based on the occurrence of an accidental injury and the type of treatment or procedure required to treat an injury.

The injured individual will often submit a separate claim for each service they receive related to the accident. For example, if they were in a car accident in which they broke both legs, they would file individual claims for:

  • The costs not covered by health insurance for each service to treat the injury.
  • The cost of paying for transportation to doctors’ visits and physical therapy sessions.
  • Each time a home caregiver visits them to provide care.

Incident-based plans. These pay benefits based upon the incident and type of injury. This can simplify the claims process by reducing the number of claims that must be submitted.

In the case of the car accident victim with broken legs above, they would likely be required to submit evidence only for the fractures and for their hospital stay to be reimbursed.

Benefits to the employer

A more robust benefits package — Offering accident insurance paid for by employees allows you to provide a more robust benefits package that can improve employees’ satisfaction with their jobs.

A smoother transition to high-deductible health plans — Employers replacing traditional medical insurance with an HDHP may find the transition more readily accepted by employees if it is accompanied by an offer of a voluntary accident insurance plan.

Potential for improved productivity — Employees under financial pressure may be less productive than those who are not, and knowing they have accident insurance can put their fears to rest.

Low cost and administrative burden — Most employers offer accident insurance that is paid for by the employee, meaning there is little or no cost to the organization.