Ebola is raising an unusual benefits question: Can the insurance plans consumers already have protect them against quarantine-related costs?
Or, from the insurers’ perspective: Is it possible that insurers could be on the hook for paying quarantine bills?
Ebola is just one of the conditions that could lead to aggressive disease control efforts this year. Other contenders include enterovirus D68, Middle East Respiratory Syndrome (MERS) and influenza. But Ebola is the disease that is now the most effective at capturing the public’s imagination. In August, for example, one user of Quora, a Web-based discussion site, asked, “If you are forcibly quarantined, is it covered by health insurance or do you get billed for it?”
Any U.S. major medical policy that covers hospitalization would pay for hospital care for Ebola or another serious infectious disease and most policies would cover some home health care for patients trapped at home.
But many health plans’ Web-based benefits summaries say nothing about whether the plans do or do not cover quarantine-related expenses.
Questions about the best way to respond to the outbreak of a dangerous infectious disease hit the insurance industry directly in 1918, when life insurance employees found themselves processing death claims for victims of the Spanish Influenza as their own colleagues were dying from the flu.
The Patient Protection and Affordable Care Act (PPACA) did include some funding for efforts to improve public health programs, including pandemic preparedness efforts. In February 2011, for example, the U.S. Department of Health and Human Services (HHS) said California was getting $2.9 million in outbreak preparedness funding. PPACA does require a PPACA-compliant plan to include flu shots and other inoculations in the package of preventive services benefits that an enrollee is supposed to get without having to pay any out-of-pocket costs, but the focus of PPACA is mainly on encouraging people to eat better, exercise and handle minor conditions on their own — not to go to a doctor with stomach pain and a moderately high fever. The standard PPACA summary of benefits and coverage (SBC) does not say anything about quarantine situations. The standard scenarios an SBC includes to show an insured how a policy will work are the birth of a baby and managing diabetes. An SBC usually does not say anything about the benefits available for enrollees who have an infectious disease.
Here’s a look at some of the information we found when we looked at how insurers, benefit plan sponsors and others have dealt with the topic of quarantines.
1. Some health insurers have talked about quarantines in discussions of efforts to prepare for flu epidemics.
Aetna Inc. (NYSE:AET) mentions the possibility of a quarantine in an answer to a question about how the company would maintain its data centers if a pandemic significantly affected its employees.
Aetna said it could run the data centers even with a 70 percent absence rate, has implemented stringent infection-control procedures in the data centers and has developed self-sufficiency procedures to keep the centers running if the government imposes a quarantine.
2. Sellers of trip cancellation insurance are good about spelling out how they’ll handle quarantines.
The issuer of the Sportsman’s Travel Insurance Plans, which is written by a unit of American International Group Inc. (NYSE:AIG), states clearly that it will pay benefits if an insured suffers a travel interruption due to a quarantine.
Image: AP Photos/Lefteris Pitarakis
3. When Blue Cross (Asia-Pacific) Insurance Ltd. saw Hong Kong fighting off an outbreak of influenza A H1N1 in 2009, it added extra flu hospitalization benefits and trip protection benefits.
The insurer did its part to fight H1N1 by doubling the amount of cash benefits it would pay for “room and board” expenses, and it offered an even bigger benefit — 5,000 Hong Kong dollars — for insureds denied entry into a port because of flu or confined due to a compulsory quarantine.
4. The U.S. Office of Personnel Management (OPM) has treated quarantines as a sick-pay issue.
OPM officials decided in 2010 that the government should let employees use accrued sick pay to care for family members who had been exposed to serious communicable diseases. If necessary, the government will advance sick leave to employees who have not yet earned it if that’s necessary to help employees care for relatives exposed to a serious communicable disease.
5. Many schools have posted clear discussions of how they’ll handle quarantines.
The University of Maine, for example, says it will place sick employees on mandatory disability leave or other mandatory leave if public health officials issue a quarantine or public order for people with a communicable disease to stay home.
6. Short-term disability (STD) insurance plans seem to be the plans most likely to help workers pay the bills during a quarantine.
A school district in Michigan has posted the fully text of an STD policy from a major insurer. The policy will provide up to eight weeks of short-term quarantine benefits to insureds who are “involuntarily and necessarily house confined by order of the board of health or other similar official health authority because of infectious or contagious disease.”
The waiting period is the same waiting period as for ordinary STD benefits, and the weekly benefit is the same as elected for ordinary STD benefits, according to the policy text.
7. The Americans with Disabilities Act (ADA) might pop up — but might not do much.
Nancy Lee Jones and Jon O. Shimabukuro analyzed the legal issues facing workers affected by quarantines in 2008.
The analysts suggested that workers and their lawyers might try to get help from the Family and Medical Leave Act (FMLA) and ADA but might find that the might provide some protection for workers who work “at will.”
The FMLA would affect only workers who met FMLA eligibility requirements, and only those who were sick or caring for relatives who were sick, not those who were simply obeying a government order to stay home, the analysts found.
Six states — Delaware, Iowa, Kansas, Maryland, Minnesota and New Mexico — have state laws that prohibit employers from firing workers who are subject to isolation or quarantine.
ADA might provide more protection for the worker than FMLA, but only if the courts were willing to treat being subject to a quarantine as a “substantially limiting impairment,” the analysts said.