Last month a nominal number of people assembled on the steps of Niagara Falls City Hall with colorful handcrafted placards in protestation against vaccine mandates. Some were health care workers, some were not. Health care workers who have refused COVID-19 vaccines and claiming religious objection have been granted a reprieve from Gov. Kathy Hochul’s mandate requiring complete COVID-19 vaccination for all New York health workers. In God they trust. On October 14th a panel of judges will decide if the mandate will be upheld.
Most private insurers purposely waived cost sharing fees for members who contracted Covid-19 and needed hospitalization or emergency room care. Cost sharing fees are the out-of-pocket costs such as copays, coinsurance and deductibles. Those costs could really add up if you were seriously ill and needed treatment stronger than aspirin and chicken soup before the pandemic. Cost sharing waivers saved insured Covid-19 patients $1,300 or more depending on the severity of the infection and treatment needed according to the Peterson-Kaiser Family Foundation Health System Tracker. The amount saved could be the difference between a trip to the ER or a 14-day hospital stay.
However, health insurers began to slowly rescind the cost sharing waiver for Covid-19 treatment after the Pfizer, Moderna and Johnson vaccines became available to most adults. For example, cost sharing waivers for fully insured Independent Health members will remain in place until December 31, 2021. Coverage for Independent Health self-funded plan depends on the employer group; the cost sharing waiver end date could be different.
Highmark Blue Cross and Blue Shield of Western New York fully insured members with Commercial or Medicare Advantage needing Covid-19 treatment will not pay for Covid-19 treatment through December 31, 2021. Employers who supply self-funded insurance can choose to offer this option to their employees.
Plenty of Niagara County businesses and employers offer self-funded health plans to their employees. A self-funded or self-insured plan places the financial risk on the employer. The employer sets aside a monthly amount that reflects the expected health costs of their employees. At the end of the year, the total claims paid are reviewed against the total monthly cost. In a nutshell, if the total claims paid is less than the total monthly cost, the employer shares a percentage of the balance with the insurance provider, basically to cover the insurance company administrative fees. The employer keeps the rest to reinvest in the business, perhaps by increasing staff, improving technology, or giving employee bonuses. If the total claims paid are greater than the total monthly cost, the employer does not receive any money back.
Many health insurers are offering employers the choice to opt out of the cost sharing option. This means if you are insured you will be expected to pay the cost sharing fees you may have avoided last year at this time. Your boss does not have to offer the cost sharing option to the health plan. While it is your body and your choice to disavow a mandate and a vaccine, it is arguably your health, your job, your family, your financial outlook, and your employer’s bottom line.
Employers who offer self-funded plans have tough decisions to make. If you are an employer, is it financially prudent to keep unvaccinated employees who could potentially increase expected monthly health care costs?
If you are currently employed and have insurance through your employer, can you afford to pay $1300 or $5000 in cost sharing fees? Can you afford out-of-pocket costs without a job? Do you have a mortgage or a car payment or both? Perhaps your vaccinated coworkers will create a GoFundMe account if you become hospitalized with Covid-19, but why should they? There are three perfectly good vaccines available. Religious exemptions are not an acceptable reason for non-payment. You may put your life in God’s hands, but you will send payments to accounts receivable.
Sharon Bailey lives in Niagara Falls. She is a writer and musician who takes solace in long walks along the Niagara River Gorge.