How has the CalPERS Health Program responded to the COVID-19 pandemic?
From the outset, our CalPERS team has been in constant communication with the health plans to ensure that our members have access to the high-quality care they need. We have engaged our plans on a regular basis to understand how they are delivering care during COVID-19 and to ensure our members have access to telehealth and phone appointments, continuity of their prescription medications, and resources and information on COVID-19, mental health, and wellness support during these challenging times.
You mentioned telehealth. Is this available to CalPERS members?
Yes, our health plans quickly ramped up access to telehealth for routine care. In most cases, members can keep or reschedule appointments with their doctors, changing them from in-person to virtual appointments. To reduce the risk of transmission, especially for those most at risk, access to doctors through phone and video appointments became a necessity and a priority, and as a result, more people are adapting to telemedicine. Of course, not every visit is conducive to telehealth; for members who need in-person services during COVID-19, we are working with the plans to ensure that in-person care is still happening and is safe.
What steps are the plans taking in response to this crisis?
Our health plans have been very responsive to CalPERS and our members. Early on, the plans put timely information about COVID-19 testing and treatment on their websites and waived out-of-pocket costs for testing for COVID-19. With most elective surgeries canceled, our plans have extended prior authorizations, so when procedures begin again, members have continuity of care. Also, the plans are communicating about closed facilities and provider groups and about behavioral health services available through telehealth. And, as a resource to help members, the plans have also been providing online information for mental health, emotional wellness, social isolation, anxiety and depression, relaxation exercises, coping tools, and community support.
Will members have any out-of-pocket costs for treatment of COVID-19?
We are pleased to share that there will be no copay or deductible costs to our members who receive in-network treatment for COVID-19. CalPERS and our health plans will cover these costs for our members through the end of June, at least. We want our members who need treatment for COVID-19 to focus on getting better, not worry about the added expense to receive treatment.
What if a member is getting denied care they need?
We have heard anecdotally of a few instances of members being denied in-person care for chronic conditions due to COVID-19. We take this very seriously and do not want any member to be denied care from their health plan. Our team is responding and in contact with our plans to ensure members are receiving the timely care they need in a safe environment.
Are members continuing to get their prescription medications?
Yes. We have been closely coordinating with our pharmacy partners to ensure members have access to their medications. It’s a good idea to fill your prescriptions through your plan’s mail-order service, especially during this time. There is no additional cost for delivery and most orders arrive within four to five business days.
How has COVID-19 impacted CalPERS’ rate development process for 2021?
The pandemic has introduced a lot of uncertainty as we seek to better understand the financial implications of the pandemic. It may delay our rate-setting process, though we don’t anticipate it delaying Open Enrollment by more than a week or two.
How could COVID-19 impact 2021 health premiums?
In late March, Covered California published projections that premiums in the employer insurance market could increase 4% to 40%. We now expect to be closer to the low end of that range, as California has done an excellent job responding to the crisis. The dramatic decrease in non-emergent care will also offset some of those costs. Ultimately, whether the COVID crisis will raise health premiums will depend on information we do not yet know, such as the number of people infected and requiring hospitalization, the impacted delay of elective procedures, and any federal relief.
Do you see any positive impacts to health care that could come out of this unfortunate time?
One thing that has been transformative has been the transition to and adoption of telehealth for routine care. And, as health plans have ramped capacity and utilization, more people are becoming comfortable with it because they’ve had to. Telehealth will never replace in-person care, but it is an important option, even in times when we aren’t facing a pandemic. It is particularly valuable in the delivery of care to people who live in rural communities and can make it easier for members to fit a needed visit into their busy schedules. My hope is that the learning-by-doing going on now will improve the delivery of telehealth once we are through this crisis.
What can we continue to do?
Think creatively about how you can stay connected to people you love and share your stories so we can all learn from one another. When my family was struggling about what to do for Easter, my eight-year-old daughter suggested we set a place for my mom, who lives alone, so she could join us on an iPad via FaceTime. It would have been better to have her there in person, but it still felt like Easter, and it meant a lot to all of us to be together. All of us need to stay safe, stay informed, and stay connected. Reach out virtually in some way to those who may be more socially isolated during COVID-19. We all need each other more than ever these days.
Learn more about how CalPERS is addressing COVID-19.
Update: This article was edited for clarity on May 29, 2020.