Changes in Health Care Claims due to the COVID-19 Pandemic

Over the past year, the International Foundation has surveyed U.S. organizations on three separate occasions to examine the implications of the COVID-19 pandemic. In the most recent edition, respondents were asked about changes in the number of health care claims over this period. By observing these trends, organizations can more accurately identify the impact of the pandemic on their program utilization levels and make more informed plan design decisions. The following data is captured from 293 benefits practitioners across the U.S.

Changes in Health Care Claims due to the COVID-19 Pandemic

As expected, compared with 2020, organizations are seeing decreases (either significant or slight) in the number of claims for the large majority of observed categories.

  • Elective Procedure ClaimsAbout nine in ten respondents (89%) noted a decrease in claims over this period, while only 2% noted an increase. The remaining 9% of plans noticed no change in elective procedure claims.
  • Preventive Care ClaimsThis theme is echoed among preventive care claims over this period. More than four in five (83%) noted a decrease, while only 4% noted an increase and 13% noted no change.
  • Dental Visit ClaimsThe same proportion noted decreases (83%), increases (4%) and no changes (13%) in their claims experience from dental visits between 2020 and 2021.
  • Primary Care ClaimsSimilarly, 81% of respondents noted a decrease in the number of primary care claims, while 7% cited a decrease. The remaining 13% cited no change between 2020 and 2021.
  • Emergency Room ClaimsMore than three in five responding organizations (62%) cite a decrease in the number of emergency room claims in the past year. Conversely, 14% cited an increase, while about one in four (24%) noted no change.
  • Vision ClaimsA similar proportion (61%) cite a decrease in the number of vision claims in their plans over the past year. Small proportions (4%) noted an increase, while more than one in three (36%) noted no change in the number of vision claims between 2020 and 2021.

Conversely, during COVID-19, there were noted increases (either significant or slight) in the number of health care claims for several observed categories. These trends speak to a workforce that has shifted to a remote work environment.

  • Telehealth/Telemedicine ClaimsAn overwhelming majority (86%) of responding organizations noted an increase in telehealth/telemedicine claims over the past year. The remaining respondents were split between a decrease (7%) in the number of claims or no observed change (7%).
  • Mental Health ClaimsMore than three in five (63%) respondents cited an increase in the number of mental health claims between 2020 and 2021. Only 9% cited a decrease, while three in ten (29%) noted no change in the number of claims over this period.
  • Prescription Drug ClaimsWhile not overwhelming, 30% of responding organizations noted an increase in the number of prescription drug claims between 2020 and 2021. Small proportions noted a decrease over this period (14%), while more than half (56%) observed no change.

[Upcoming Webcast: Impact of COVID-19 on the U.S. Workforce and Predictions for the Future of Health Care Benefits | Sponsored by United Healthcare | June 22, 2021]

Conclusion

In previous iterations of this study, respondents were asked about anticipated changes in the number of claims into 2021 and beyond. Perhaps the biggest takeaway from this section was that respondents are expecting increases in the number of claims for all measured offerings. This is highlighted most prominently in the areas of telehealth/telemedicine and mental health benefits. How will your plan claims experiences change if workers return to an office? What will change if the majority of workers continue remote work? Make sure to take these anticipated claim changes into account for your future planning.

Employee Benefits in a COVID-19 World—One Year Update was conducted in May 2021 and is the third installment in a series examining the implications of COVID-19 on health care benefits, paid leave and flexibility as well as return-to-office considerations, including physical workplace changes and worker vaccinations. The full report can be found at www.ifebp.org/covidoneyear.

Visit the International Foundation Coronavirus (COVID-19) Resources webpage to find the latest government and workplace guidance.

[Related Reading: While Most Employers are Preparing to Head Back to the Office, Some are Hoteling It]

Justin Held, CEBS
Senior Research Analyst at the International Foundation 

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Justin Held, CEBS

Communications Manager at the International Foundation

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