What Might Be the Health Plan Cost Impact of COVID-19?

As the impact of COVID-19 continues to grow, Segal has developed a model that forecasts its impact on health plan costs.

Model assumptions for the forecast include the cost of testing, the percentage of people being tested and, of those tested, the percentage who have the coronavirus.

It also looks at the percentage of those with the virus who have no additional cost, plus the cost of treatment, cost of hospital treatment and treatment distribution.


Forecast Your Costs. Contact Our Consultants

Get in touch to schedule time with one of our health professionals, learn more about the forecast model and discuss next steps.

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Actions You Can Take Now: What We're Recommending

As we continue to assess the impact that COVID-19 may have on group health plans, we're recommending that plan sponsors take some or all of the following steps.

  • Cover testing at 100%
  • Consider temporarily relaxing refill too soon and PA edits
  • Encourage home delivery/mail-order pharmacy to limit exposure for the at-risk populations
  • Promote telehealth and expand for mental health treatment
  • Consider donating paid vacation days to employer group banks
  • Expect off-label usage of drugs (such as Hydroxychloroquine – the old Malaria drug)
  • Monitor impact on trend due to postponement of all “elective and non-essential procedures”
  • Review current insurance policy contract to assess how remote working arrangements, furloughs and layoffs could jeopardize eligibility for some portions of your workforce and how insurers are responding.

States and the federal government are guiding health providers to postpone all “elective and non-essential surgeries."

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