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Updates For Brokers & Employers

November 11, 2021

To Our Valued Clients and Partners,

Since our last newsletter, we have a new metric to track, vaccination rates for people aged 5 and over. Last week, on November 2nd, the CDC recommended the Pfizer-BioNTech pediatric vaccine for children aged 5-11. Those vaccines are now rolling out and have already been administered to nearly 500,000 of the roughly 28 million youth in this age group.

Across our region, Oregon and Utah have started to publish vaccination data for 5-11 age group. Washington and Idaho have not yet reported for this age group. According to each state’s health department, the fully vaccinated rate for people aged 5 and over in Utah is 59.7% and 68.4% in Oregon, the fully vaccinate rate for people 12 and over is 73.5% in Washington and 55.7% in Idaho.

Today full vaccination rates for those 12 and over vary widely between states ranging from a low of 47.3% in West Virginia to high of 81.7% in Connecticut according to the CDC.

Coverage for Employer-Mandated Testing 

OSHA’s vaccination and testing ETS does not mandate that employers cover the cost of mandated testing for employees who choose testing in lieu of vaccination. Thus, plan coverage of employer-mandated COVID-19 testing remains unchanged. Such testing falls into the same category as other examinations and treatments required to obtain and maintain employment, and such expenses are typically excluded from health plan coverage. We have a small number of clients that have chosen to amend their plan language to cover asymptomatic COVID-testing for all plan members (not just members who are also employees). In these cases, we accept COVID-19 testing claims regardless of the reason that the test is requested and apply the plan’s designated benefit coverage.

New COVID Treatments  

Vaccines remain the most effective treatment to prevent the spread of COVID-19. Yet, scientists continue the race to develop effective treatments for those facing a fight for their lives with COVID-19 infections. This month shows promise for potential at-home treatments for those suffering from less aggressive cases.

On November 30th, the FDA’s advisory committee will review the emergency use authorization (EUA) application from pharmaceutical giant, Merck, for its molnupiravir antiviral pill to treat COVID-19. Merck and Ridgeback Biotherapeutics’ phase 3 trial results showed a 50% reduced risk of hospitalization or deaths compared to a placebo group in patients with mild to moderate COVID-19 infections. Merck announced in a press release on November 9th that the U.S. government has exercised a second option on doses to treat COVID-19 patients with its drug. The exercised options total 3 million courses of molnupiravir at approximately $700 each or about $2.2 billion in total orders.

On November 5th, Pfizer announced results from clinical trials of its COVID-19 treatment pill. Branded as PaxlovidTM, the new Pfizer oral anti-viral treatment claims to have an “89% reduction in risk of COVID-19-related hospitalization or death from any cause compared to placebo in patients treated within three days of symptom onset.” Pfizer will undoubtedly apply for EUA with the FDA.  

Booster and Vaccine Update

On October 21st, the CDC expanded eligibility for a booster shot for individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine. The following groups are now eligible for booster shots:

If you received If you received

Pfizer-BioNTech or Moderna

Johnson & Johnson’s Janssen
You are eligible for a booster if you are: You are eligible for a booster if you are:
  • 65 years or older
  • Age 18+ who live in long-term care settings
  • Age 18+ who have underlying medical conditions
  • Age 18+ who work or live in high-risk setting

  • 18 years or older

When to get a booster:

When to get a booster:

At least 6 months after completing your primary COVID-19 vaccination series

At least 2 months after your shot

Which booster should you get?

Which booster should you get?

Any of the COVID-19 vaccines authorized in the United States

Any of the COVID-19 vaccines authorized in the United States

We are not seeing consistent state-level reporting of booster dose administration rates yet. The CDC reports that 25.5 million people have received booster doses.

We will continue to monitor closely the FDA’s vaccine approvals and the CDC’s recommendations for COVID-19 vaccine boosters and treatments. While the federal Public Health Emergency declaration remains in place, plans are required to cover COVID-19 vaccines including boosters that have emergency use approval (EUA) by the FDA and follow CDC recommendations. Additionally, once a vaccine receives full FDA approval, it is considered a preventive care covered benefit under the CARES Act, which applies to all non-grandfathered group health plans under the ACA rules.

Regular COVID Reporting Continues

All clients currently receive regular reporting on their plan’s COVID-related claims and payments. Please connect with your Account Manager to receive your latest report or you can access this report in BenefitFocus. 

Our focus, dedication, and support remain steadfast as we navigate these unique times with you. Know that our Care Management nurses are reaching out to those members diagnosed with COVID-19 to help them access the care and resources they need to recover safely.

Updated COVID-19 Member Information and Resources on Our Website

We update our COVID-19 information and resource pages for members regularly. Many members call us with questions that are of a more clinical nature. We recommend that members consult their primary care physician for clinical questions. For non-clinical questions, please share this page with members where they will find links to additional resources on self-care, vaccines, and other useful information.

We’re Here for You 

Our focus, dedication, and support remain steadfast as we navigate these unique times with you. Know that our Care Management nurses are reaching out to those members diagnosed with COVID-19  to help them access the care and resources they need to recover safely. Thank you for your continued trust in our organization. We are in this with you and hope that you and yours stay safe and healthy. Please reach out to your Account Manager if you have any questions or if there’s anything we can do to help. 

Best Regards,

Lindsay Harris, MPP President

Healthcare Management Administrators, Inc.

Proving What’s Possible in Healthcare®

Links to prior COVID-19 updates from HMA:

October 15, 2021

  • OSHA Moving Closer to Publishing Vaccination Mandate Rule  
  • Coverage for Employer-Mandated Testing   
  • New COVID Treatments  
  • Boosters and Vaccine Update  
  • Regular COVID Reporting Continues 
  • Member Support 

September 10, 2021

  • President Biden Issues Vaccination Mandates for Over 100M Workers and New Testing and Safety Measures
  • 'Crisis Standard of Care' Activated in Response to Overwhelmed Hospitals
  • Exploring Surcharges for Employees Not Vaccinated Against COVID-19
  • From Delta to Mu
  • Regular COVID Reporting Continues
  • Member Support

August 12, 2021

  • Employer Vaccine Mandates Gaining Popularity
  • The DOJ and EEOC Updates on Employer-mandated Vaccinations
  • COVID Vaccination Requirements & HIPAA Considerations
  • OSHA Updates on Protecting Workers from the Spread of COVID-19
  • The Raging Delta
  • Booster Vaccines Approved…for Some
  • Public Health Emergencies- Anticipated End Dates and Next Steps
  • Benefit Design – COVID Testing 
  • Benefit Design – Telemedicine Coverage 
  • Telemedicine Reimbursement Rates
  • Regular COVID Reporting Continues
  • Vaccine Costs and Trends Across our Membership
  • Testing Trends Across Our Membership 
  • Treatment Claims Trends Across Our Membership
  • Updated COVID-19 Member Information and Resources on Our Website

July 30, 2021

  • The Delta wave?
  • Employer mandates and more vaccine incentives rolling out Public Health Emergencies- anticipated end dates and next steps
  • Do vaccine incentives work?
  • EEOC update on employer-mandated vaccinations
  • OSHA updates on protecting workers from the spread of COVID-19
  • Planning for booster vaccines
  • Telemedicine reimbursement rates
  • PPE Coverage Update
  • Regular COVID reporting continues
  • Trends – current and anticipated
  • Member support

June 28, 2021

  • The ‘next normal’, is it here?
  • Public Health Emergencies- anticipated end dates and next steps
  • Do vaccine incentives work?
  • EEOC update on employer-mandated vaccinations
  • OSHA updates on protecting workers from the spread of COVID-19
  • Planning for booster vaccines
  • Telemedicine reimbursement rates
  • PPE Coverage Update
  • Regular COVID reporting continues
  • Trends – current and anticipated
  • Member support

May 28, 2021

  • The 'next' normal', just around the corner?
  • Overcoming vaccine hesitancy with incentives
  • Continuing COVID support for our clients
  • Planning for booster vaccines
  • Regular COVID reporting to continue
  • Trends - current and anticipated
  • Member support

April 29, 2021

  • The race to vaccinate
  • Is herd immunity possible?
  • Vaccine safety and efficacy
  • Health plan coverage of vaccines
  • Vaccine costs and trends across our membership
  • An update on employer-mandated vaccinations and new OSHA requirements
  • Updated COVID-19 member information and resources on our website
  • Testing trends across our membership
  • Treatment claims trends across our membership

March 26, 2021

  • Latest Update  
  • Treatment Claims Trends Across Our Membership 
  • COVID-19 Variants Pose Surge Risk 
  • COVID-19 Vaccinations
  • Vaccine Efficacy - What You Should Know
  • Vaccine Eligibility and Access 
  • Health Plan Coverage of Vaccines
  • Vaccine Costs and Trends Across our Membership
  • An Update on Employer-mandated Vaccinations
  • Updated COVID-19 Member Information and resources on our Website
  • Testing Trends Across our Membership 

February 26, 2021

  • US and Regional Update
  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership
  • COVID-19 Vaccinations
  • Health Plan Coverage
  • Vaccine Costs
  • Vaccine Access
  • Government-mandated Vaccinations?
  • What About Employer-mandated Vaccinations?
  • Will RGA Provide Reporting on Employees Who Have Been Vaccinated?

January 29, 2021

  • US and Regional Update
  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership
  • COVID-19 Vaccinations
  • Health Plan Coverage
  • Vaccine Costs
  • Vaccine Access
  • Government-mandated Vaccinations?
  • What About Employer-mandated Vaccinations?
  • Will RGA Provide Reporting on Employees Who Have Been Vaccinated?

December 18, 2021 

  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership
  • COVID-19 Vaccinations Begin...What to Expect
  • Health Plan Coverage
  • Vaccine Costs
  • Government-mandated Vaccinations?
  • Employer-mandated Vaccine Update
  • Will HMA Provide Reporting on Employees Who Have Been Vaccinated?

November 24, 2020 

  • US and Regional Update
  • Testing Trends Across our Membership
  • Treatment Claims Trends Across Our Membership
  • Member Difficulty Finding Testing
  • Preparing for COVID-19 Vaccinations
  • Employer-mandated Vaccines?

October 30, 2020 

  • US & Global update
  • Testing trends regionally
  • Outcome trends by state & age Group across regional Covid-19 positive cases
  • Treatment claims trends across our membership
  • Preparing for Covid-19 vaccinations
  • Employer-mandated vaccines?

September 25, 2020 

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

August 26, 2020 

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

July 24, 2020

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

June 26, 2020

  • Return to work webinar series
  • RGA Open Arms Program launches July 1st
  • COVID-19 updates to our website
  • The CDC expands and updates the list of people at risk of severe COVID-19 illness
  • The joint agencies clarify FFCRA and CARES Act implementation guidance
  • Trends we are seeing 

June 11, 2020

  • Return to work webinar series launched this week
  • COVID-19 updates to our website
  • Case counts increasing following phased re-openings
  • Trends we are seeing 

May 29, 2020

  • Return to work webinar series
  • How to participate in the IRS relief for FSAs and other cafeteria plans
  • Provider personal protective equipment (PPE) surcharges
  • Unemployment fraud update
  • Trends we are seeing

May 15, 2020 

  • Taking Care: An emerging mental and behavioral health pandemic
  • Unemployment fraud rampant and how to report it
  • Return to work testing resources
  • Trends we are seeing

May 8, 2020 

  • Interim Compliance Alert: COVID-19

May 1, 2020

  • COVID-19 Client Impact Reports now available
  • Benefit change request form reminder
  • Trends we are seeing 

April 24, 2020

  • $484 billion and more to come?
  • Proclamations & regulatory orders vs health plans – Options for stability in unstable times
  • The heated debate over when and how to return to work

April 17, 2020

  • Expansion of coverage for COVID-19 and pricing for COVID-19 related claims 
  • Access to non-urgent care during the stay at home orders 
  • Trends, testing, and antibody studies  

April 10, 2020

  • A preview of COVID-19 reporting
  • More Telehealth and Telemedicine updates
  • Trends we are seeing and how they may affect your health plan

April 3, 2020

  • How does the CARES Act affect my health plan?
  • An overview of the recent changes to Telemedicine and Telehealth
  • Trends we are seeing and how they may affect your health plan

March 27, 2020

March 20, 2020

March 12, 2020

March 5, 2020

March 2, 2020