The COVID long-hauler dynamic

It's likely that many employers have not considered how 'long-haulers' may impact their benefit offerings in the future--but they should.

Aside from potential claims costs, employers need to be aware of their leave of absence and continuation of coverage provisions. How long should these ill individuals stay on the health plan? (Photo: Shutterstock)

As we approach the middle of 2021 and almost 18 months of COVID-19, it is likely that every person in the United States knows at least one person that has been diagnosed with COVID-19. If you are lucky, those individuals will have survived and be back to living a normal life. Some are just not so lucky and are being classified as COVID long-haulers – meaning these individuals continue to feel the symptoms long after the disease typically runs its course of days or weeks for most that are diagnosed.

I have a very dear friend that was one of the healthiest people I know prior to September 2020. She was an extremely active and physically fit 38-year-old–she had biceps that everyone could envy. She ate an extremely healthy diet and overall took very good care of herself. Obstacle course races were her favorite workout. In her home life, she is married with two sons. Unfortunately, as a home health physical therapist assistant, it was only a matter of time as an essential worker that she was exposed, and ultimately diagnosed with COVID-19 in September of 2020.

Related: COVID ‘long-haulers’ and the battle for disability benefits

The first symptoms she experienced were kidney pain and back pain. No fever, cough, or shortness of breath. Seven days later, she got hit by the metaphorical truck – totally wiped and shivering while being out in the sun in long pants and a sweatshirt with a temperature of 100.3. A trip to the urgent care confirmed a COVID-19 diagnosis instead of the kidney infection she thought she had.

Then the symptoms started compounding:

About five weeks post-diagnosis, this extreme athlete who was used to running the Spartan races could not walk a mile, even with taking breaks. The amount of activity she could tolerate from day to day ebbed and flowed. After 82 days she could get a slight tasting of salt and garlic. Tomatoes tasted rotten. Goldfish crackers tasted like dirty mold. Coffee tasted like dirty river water. Snickers tasted like a bar of wet bubbly soap.

It took four months of various visits with her primary care physician, a neurologist, a surgeon, and others, before she found a doctor at The Cleveland Clinic who told her he could help and officially diagnosed her with PoTS – postural orthostatic tachycardia syndrome — and put her on a treatment plan. Just when things seemed to be getting better, the weather has changed since treatment started. With her sons’ baseball games in full swing, she was no stranger to learning out how to attend games and stay comfortable – an umbrella to keep out of the sun, visor, sunglasses, cooling towels, a neck fan with refrigeration, and extra fluids. But the heat and COVID won that day and made her feel more ill than she has felt in months.

So here she is, nine months post-diagnosis and while most people are getting “back to normal” as mask mandates are being lifted, sporting events have returned with fans in the stands and increased capacity, and she is still unable to live a life with some resemblance to what she had pre-COVID.

Did I forget to mention she is not able to work? Given that she has to travel for her job as a home health physical therapist assistant, it should be no surprise after reading the above that she is not cleared to return to work by her treating physicians.

For those of us in the benefits world, my hope is that you had a running calculator in the back of your head going thinking how expensive her doctor visits have been. While my friend was very lucky to have had a short-term disability plan, that benefit was only available for 6 months, which is completely average in the benefits world.

Despite COVID-19’s presence in this world for at least 18 months, many are still unfamiliar with the term “long-hauler,” and it is likely that many employers have not considered how these long-haulers may impact their benefit offerings in the future because we’re still learning about this disease and its long term effects. The following is quick overview of considerations:

Health plan benefits

Self-funded health plans are already on high alert with many new recent regulations in play, including rolling of timeframes to submit claims and appeals, elect special enrollment rights, and re-enrollment in COBRA due to the ARPA COBRA subsidies. While overall claims costs were down in 2020 as many individuals elected not to receive care (including preventive care) and elective surgeries were postponed by providers, the postponement of medical care could create large claims costs in the future.

For example, delayed diagnosis of cancer due to a delay in preventive screenings will no doubt create large claims for treatment of said cancer. Plus, these COVID-19 long-haulers raise a lot of additional unknowns – how long will they need treatment? What side effects will be permanent? Will the permanent side effects need continuing care?

Aside from potential claims costs, employers need to be aware of their leave of absence and continuation of coverage provisions. How long should these ill individuals stay on the health plan? Does plan language support the continuation of coverage? Is stop loss on the same page? All questions need to be addressed on a case-by-case basis.

Disability benefits

The considerations for employers related to short-term and long-term disability are similar. Employers need to consider the concept of offering these types of policies. The employer also must decide if these benefits are employer or employee-paid. The length of each policy and the interaction with other leaves, as well as whether health plan coverage should continue during a disability leave. These types of policies are currently critical for COVID-19 long-haulers as they are not currently eligible for any type of additional federal aid, nor are they currently eligible for social security disability.

Employers generally want to do right by their employees and offer benefits to help their employees. There is no doubt that many employers in the United States will have employees that have a similar gut-wrenching story like my friend that have no end in sight. Additionally, the Department of Labor and other governmental agencies have noted that it is unlikely that regulatory modifications associated with COVID-19 will last at a minimum through calendar year 2021. As such, employers who self-fund their benefit plans need to be extremely careful that their plans and policies align in a way that meets the employer’s intent.

With so many unknowns related to COVID-19, including what treatment for long-haulers might look like and what new medications and treatment methods could arise, employers will need to keep a pulse on all these moving parts like any other long-term disease. The next COVID long-hauler you hear about could be your boss, a direct report, the CEO, or your best friend.

Kelly E. Dempsey is an attorney with The Phia Group, LLC. As the Vice President of Phia Group Consulting, Kelly’s specialization is an interesting mix of compliance matters impacting self-funded plans (such as issues relating to ERISA, ACA, COBRA, FMLA, MHPAEA, and MSP) and “outside-the-box thinking,” finding creative and innovative ways to help plans, brokers, and TPAs achieve their various self-funding goals. Kelly is admitted to the Bar of the State of Ohio and the United States District Court, Northern District of Ohio.

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