Health+Benefits Vital Signs the December 2021 issue

Disability as Relief for COVID Long-Haulers

Q&A with John Shaw, Benefits Account Executive, Risk Strategies
By Tammy Worth Posted on November 30, 2021

One quarter to one third of all COVID-19 patients have long-haul symptoms.

Symptoms include respiratory problems, fatigue, brain fog, body aches, abdominal issues, depression and anxiety.

Long-term symptoms can last for months beyond a COVID-19 diagnosis and impact people of all ages.

Q
Why should employers look into long-term disability as a part of their benefits plan, particularly taking into consideration people suffering from long-term COVID-19 symptoms?
A

There are a number of reasons employers would want it as a part of their employee benefits portfolio outside of COVID. The disability landscape we see nationally has really been changing. It’s a hot topic because lots of states are entering the conversation and implementing regulations around paid family and medical leave. This is largely because the federal government has not created any kind of solution in that space.

What we have seen from employers is a lot of them focus on short-term disability. This usually lasts up to 90 or 180 days in duration. But what we are finding is that a number of disabilities are generally lingering longer—for more than 90 days—and the emergence of COVID-19 has increased that. Folks are having symptoms and presenting with issues three, six and nine months down the road with no end in sight. Combine that with other comorbidities they may have, and it all compounds.

Q
Are COVID-19 long-haulers requiring employers to look at or use long-term disability differently from in the past?
A

Yes, we have had this whole new long-haul COVID phenomenon going on in employees’ lives for the past year. They are having cardiac, musculoskeletal and mental health issues that are going to continue to present themselves for years to come.

For employers, they would want to…provide that much more protection for these employees. Current things I’ve seen—from data from insurance carriers—is a changing world in this space. Long-term disability used to be for managing mainly musculoskeletal issues among blue- or gray-collar employees. But the emergence of mental health conditions, renal distress and metabolic issues like diabetes are becoming more and more present and have to be dealt with long-term.

Q
Why should employers be concerned with managing these conditions down the road when the employees may no longer even be working for them?
A
Employers need to decide what their philosophy is for taking care of the people who are working for them. When they look at what is impacting their employees’ lives, peoples’ ability to draw income is one of the things that is first and foremost. At least that’s what employees would say. A lot of the foreclosures we are seeing in the market now are happening when people can’t work outside of six months and their income is cut off. If you talk to a lot of employers, many would say their goal on a number of fronts is to be an employer of choice and they want to have a benefit portfolio that everyone else is looking to emulate. Having something in place so they can say they are doing something to assist employees during COVID-19 and beyond is one part of doing that.
Q
Why don’t more employers offer this benefit? Only about 35% of employees nationwide have access to long-term disability, correct?
A

There’s no law or regulation at the federal level that requires long-term disability to be in place, and employers’ not offering it probably stems mostly from that. Also, I think there is, by and large, a misunderstanding around the programs that are available to assist employees in this space.

A lot of people are talking now about state, local, and federal leave programs, but the only federal long-term disability now is Social Security, and it’s difficult to qualify for and there is a long lead-in period. On average, it takes about two years to be approved without any assistance. There is a large cross-section of time where people generally don’t have protection for themselves.

There’s also always a concern about the cost of coverage, whether it’s founded or unfounded. If that is a major problem, when talking about long-term disability, an employer can provide it, or they can make it available on a voluntary basis. If they can’t pick it up, they can make it available to employees to pay for themselves as a way to let people know they understand that it is a valuable service.

Q
For employers who opt in to long-term disability, how can they ensure their plans will properly cover these workers, since this is somewhat uncharted territory?
A

We don’t expect an employer to be an expert at disability. They should think about working with a firm that is capable of doing some analysis to determine policy limitations or exclusions and be aware those issues are in there.

For instance, if you look at many of the symptoms of long-haulers, they can be subjective. The most challenging claims in a business’s long-term disability book are for conditions that have subjective symptoms, like chronic fatigue or fibromyalgia. Something like brain fog, which many long-haulers deal with, is very subjective and sometimes intermittent, so they are not always presenting themselves.

Generally, there is what’s called an elimination period, or point in time when someone is disabled before the policy will start paying benefits to an employee. But if you look at it through the lens of long-haul COVID, where a symptom may be intermittent, many carriers have language that allows for an extension for an intermittent disability. Someone may have to be out of the office for two days, then in for three. For some of these plans, the clock starts and stops when they work or don’t. That can help the employee when there are limited durations when the plans are payable.

For a lot of groups, if you have a long-term disability claim, those claims will be paid for that type over time. Employers may not know how long that will be, but suffice it to say that there is a likelihood that many folks will have symptoms in the distant future. Employers have to make sure their employees will be covered during that time. This is where a benefits advisor can shine—doing that kind of analysis on a contract. That should help employers know they can be comfortable with a plan. And advisors can look at the other issues, like whether or not certain conditions qualify for coverage, and then suggest different options depending upon where the employer wants to take the plan.

Q
It sounds like the industry is just beginning to understand how long-haulers are going to impact long-term disability insurance. Are there changes being made already to accommodate employees’ needs?
A

Employers, brokers and insurers haven’t dealt with things like this before. Even those who have programs in place—they weren’t constructed to contemplate, address and respond to the issues these employees are having. In talking with peers, colleagues, insurance companies and clients, people are starting to wonder how to put the best strategy together. And there is a tsunami of long-haulers racing toward the shore.

Something people are starting to do is put a lot of thought into other types of insurance and other policies. Some are just looking at the lead-in period up to where the policies start to matter to people: during the first six months someone is experiencing symptoms. Employers are trying to understand where gaps may exist on the front end of a policy, like if there are particular symptoms that aren’t addressed, and they are looking at things like COVID income replacement. Employers may be focusing on the front end of things because, when someone qualifies for long-term disability, sometimes they hit a point where they are no longer an employee of that organization. Employers just can’t hold on forever.

Another benefit we see is that disability insurers oftentimes have a group to help someone qualify for Social Security disability insurance (SSDI). It’s an advocacy service; a lot of insurers have a team or a law firm that provides help for clients as they go through the application process. If someone qualifies for SSDI, another thing that can come into play is making sure employees have health insurance as they move on. The employee and employers do these things by working with the disability team to make sure employees have the resources they need in the future. Some of these things won’t be written into a disability policy, but an advisor who knows the space will know what questions to ask of potential insurance companies to see if they offer these services, which are fairly widely available.

There is definitely going to have to be some kind of contemporizing of these plans. I think in the future the “plan” will be long-term disability and employer-drafted policies and benefits working in unison. The way employers should be thinking about long-term disability is: “What is my responsibility to this person as my employee, and, beyond that, how can they survive with this condition?”

Tammy Worth Healthcare Editor Read More

More in Health+Benefits

Post <i>Roe</i>: More Questions Than Answers
Health+Benefits Post Roe: More Questions Than Answers
Many of those questions relate to the provision of reproductive-rights related b...
Health+Benefits Healthcare System Stress Test
Three lessons learned from the pandemic.
Alternative Coverage Investments
Health+Benefits Alternative Coverage Investments
Employers are leaning into unconventional health plan alternatives.