Medical & Dental visits in 2020 and Employee Benefits: things you need to know

3 min read

There is no doubt that 2020 has been a year of change and this certainly applies to employee benefits. In a span of just a few months, our world has become more virtual than ever. Many of life’s activities, including medical appointments, are now being done online, or by phone.  When medical practitioners, including dentists, do see patients in person, they are having to adhere to new safety protocols which ultimately increases their cost of doing business. Some of these additional costs are being passed on to patients and plan members. What impact are these changes having on employee benefits plan coverage and costs? Here is what businesses and employees need to know:

Online medical and paramedical appointments

Online doctor visits have become the new norm. Even several types of paramedical practitioners are offering their services virtually. Do employee benefit plans cover these types of visits? Yes, most carriers have announced those practitioners for whom they will cover virtual visits. Examples include online appointments with naturopaths, physiotherapists, chiropractors, psychologists, dieticians and speech therapists. Our recent blog on virtual healthcare during COVID-19 has more details on both public and private coverage available for virtual visits.

Increased costs of in-person medical & dental visits

Medical practitioners and dentists are seeing patients again in person but with enhanced safety protocols in place. Deep cleaning and sanitizing are now the norm between patients. Social distancing requirements have reduced capacity in waiting rooms. Moreover, doctors, dentists and their staff are having to use additional personal protective equipment (PPE). PPE consists of items that medical staff and patients must wear to create a barrier in order to prevent and reduce exposure to infectious disease such as COVID-19. Examples include masks, respirators, gloves, gowns, goggles, visors, face shields, etc.

The cost of PPE is higher than ever, due to increased demand and disruptions to supply chains. For medical professionals, having to purchase larger quantities of protective equipment at exorbitant prices is taking its toll.  The result is, paramedical practitioners and dentists are charging patients for the cost of PPE. Do employee benefit plans cover this type of out of pocket expense? What options are there for coverage?

Coverage options for medical & dental PPE through employee benefit plans

In a majority of traditional benefit plans, carriers are not reimbursing charges for PPE, whether these fees are included in invoices by health practitioners or dentists. However, most carriers are willing to amend a plan to include special coverage for PPE. Adding this coverage constitutes a plan design change, which involves an immediate premium increase.

Another option is to have these charges reimbursed through a Healthcare Spending Account (HSA). HSA’s definition of eligible expenses is based on Canada Revenue Agency’s (CRA) income tax guidelines. It’s important to distinguish that while CRA does consider additional charges for PPE by medical professionals as an eligible expense, it does not appear to allow for the reimbursement of PPE purchased directly by plan members or their dependents. For example, if your dentist billed an additional amount for PPE on your invoice, this cost could be covered through an HSA. However, if you purchased a mask for yourself or a family member in order to visit your dental office, that expense wouldn’t be eligible. Our blog on Health & Wellness Spending Accounts has more information on how this type of account can compliment an employee benefits plan.

The good news

The good news is that the employee benefits industry has been quick to adopt to our new normal. New medical & dental coverage options and increased flexibility are being made available to clients of all sizes. Now is the time to review your employee benefits plan to ensure it’s in line with recent developments. It’s also imperative to take the time to educate your employees on these important changes. We can help with this! Get in touch with us today to learn more.