by Jason Coon
In my review of member health plans over the last few months, I’ve heard people say, “I had no idea that was part of our plan” and “how is it possible we were covering that?”. This is the reaction I get when doing our CBA medical health plan reviews for our member organizations. The aim of our review process is to help improve Catholic Identity and strengthen Moral Compliance within their health plans.
What are these discoveries? Services your plan may be paying for, but it escapes your notice because the plan is silent. Assumptions are made that the plan is operating in a compliant or Catholic way, but there are unspoken terms and language that the insurer uses allowing payment for immoral benefits.
Identifying problems buried inside of benefits plans is critical for Catholic employers. While most health plans may appear to be compliant, we’ve uncovered issues within documents, benefit summaries and open enrollment materials, and our members are not always aware of what’s going on behind the scenes within the Insurance Carrier or Third-Party Administrator (TPA) operating and customer service systems.
It’s necessary to address these areas specifically with your insurance business partners and to identify how these services are being covered on their end.
In a several recent reviews, CBA identified various silent benefits which exposes them to additional risk, and which are counter to our faith and their CBA protections. Below are a few examples:
• Abortion
• Surrogacy
• Contraception
• Sterilization
Uncovering these hidden issues requires a multi-step process, focus and diligence, communication, and a strategic plan with business partners in correcting course.
Correcting Course
First, adopt a process by which you’re reviewing your health plans on a consistent basis and always with a Catholic lens.
Once you’ve identified the areas of concern, contact your Carrier/TPA representative to discuss how these services are being covered within their administrative processes.
Finally, work through any changes within the Carrier / TPA administration system or processes and determine how best to update your health plan language.
Some may find that keeping their Summary Plan Description silent is advantageous if the administrative process has been corrected to align with Catholic teaching and mission. Remember here that knowing how to translate your plan intent is critical for all engaging in your plan.
This means plan participants need to understand what is covered and not covered within the plan, as well as those administering the plan. Having an ongoing dialogue about silent services is critical today because they will come up.
Other groups may prefer to update the plan language to reflect these services as exclusions. This improves Catholic Identity and makes clear the Catholic experience the health plan participants will receive on this plan and eliminates confusion of how the plan should be administered.
This last option provides added protection from silent options. It details plan intent and provides a level of transparency between participants and business partners. Still, the Carrier / TPA plan of action for anything silent should always be brought to the attention of their plan sponsor before claims are paid.
New Times and New Standards
Standardized insurance plan language and processes make cross application of benefits and language easier for insurance companies and employers. But be aware that standardization will frequently affect health plans when internal administration processes change due to regulation, coding, or standards are modified. It’s critical to stay connected with your Carrier/TPA representatives on any changes that may affect the health plan.
Also, don’t be afraid to craft and suggest new benefits language that may be more suitable for a Catholic employer in today’s business, cultural, and legal environment.
We will be sharing a new series of webinars and articles soon on Good, Better, Best language options for various excluded and covered Catholic benefits.
Formation and Foundation
Finally, when plans are silent and participants learn of the plan intent, it is always necessary to have a good formative response as to why the plan may not cover certain services. Leading with the love of Jesus Christ and providing a pastoral response is the best first step.
Watch for a new communication effort by Catholic Benefits Association in the coming months called “Everyday Ethics” that addresses complex and personal matters involving the services within and excluded from Catholic health plans.
You’re not in it alone
We understand that a project like this can be intimidating or daunting and CBA is here to assist our membership in this effort. We continue to play a key role in identifying, educating, and correcting health plan language related to our Catholic faith.
Our enhanced Healthcare Benefits Consultative Services now offers a program that can assist your team with managing this effort from plan review through plan audit. Ask about it today!
To learn more of how CBA is helping our members in the areas of plan review, consultative services, and formation services, CLICK HERE.