Looking at plan member behaviours during pandemic

May 31, 2022

 For business owners, plan administrators, and sponsors

With more people receiving their first and second doses of COVID-19 vaccine, it’s tempting to look ahead and imagine life returning to normal. Jeff Alcock, Manulife’s head of Group Benefits Operations, is looking in a different direction. He’s been reviewing what we learned in the year and a half since COVID-19 first appeared.

Entering the pandemic there were things Mr. Alcock and his team expected to happen. Some of these materialized. Other predictions didn’t unfold as expected.

How did COVID-19 change your behaviour?

Which statement rings true for you?

  1. I attended all my medical, dental, and other health appointments without interruption. If they were open, I went.
  2. I paused my medical appointments early on, but I have returned to normal.
  3. Even now, I’m not attending my medical, dental, and health appointments as I normally would.

What we expected

In March 2020, medical offices across the country were closed. At the time, Alcock and his team predicted:

  • Plan members will postpone appointments and only seek treatment in an emergency
  • Claims for hospital and travel benefits will plummet
  • There will be an increase in fraud attempts
  • Costs will increase when offices re-open and when new protections and protocols are put in place by providers

What actually happened (so far)

When offices closed, between March and June 2020, the volume of claims fell. “The emergency services we thought would persist, did persist,” Alcock says. “We saw claims coming in for chiropractic, physio, even some massage, because the regulatory bodies did allow for emergency services. But volumes were very low.”

Virtual services gained traction. While virtual delivery was already a proven option for counselling-based treatments, Alcock hadn’t forecast the sharp rise in (and acceptance of) virtual delivery for many other types of care, including physiotherapy. “It really accelerated our interest in virtual delivery,” Alcock says. “And as a result, Manulife went on to launch Phzio, which is a virtual physiotherapy service.”

Travel and hospital claims volumes dropped. That was expected and it will likely continue to be the case until restrictions are lifted.

Treatments were delayed. When offices re-opened, and as restrictions lifted in the summer of 2020, some people resumed their health care routines (people in groups A and B – above). In the case of dental claims, the recovery was rapid as many people returned to their dentists as soon as they could do so.

Massage, physiotherapy, and chiropractic claims followed the same pattern: a deep drop during lock-down and a rapid recovery starting at the end of June 2020. Plan members were willing to seek treatment despite the risk posed by the pandemic. And providers were able to take measures necessary to win back plan members’ confidence.

“We really saw providers stepping up with controls, protocols and safety measures to make patients feel comfortable,” Alcock says. “And that really paid off. We’ve been back to normal in many care types for some time because of that level of comfort.”

But there are still a lot of people who are taking a ‘wait and see’ approach (people in camp C - above). With significant pent up demand, Alcock expects to see even higher claims activity for services as the rest of 2021 unfolds.

Fortunately, the rise in attempted fraud and benefits plan abuse never materialized.

“This might be one of the biggest surprises so far,” Alcock says. Analysis at the plan member and provider levels doesn’t show the increase he’d feared. “It just hasn’t materialized, so we’re keeping an eye on this. We’re not sure if we’re out of the woods yet, but so far we have not seen an increase.”

There have been some price increases, but many plans took steps to exclude Personal Protective Equipment costs in their plan designs. “I think the industry, as a whole, largely managed that pretty well,” says Alcock.

Other learnings and trends

Fewer claims arising from infections and injuries:

  • More people at home and fewer people in the workplace and on the playing field has likely translated into fewer infections being passed between people, and
  • Fewer people being injured in accidents.

Claims for preventative vaccines fell:

  • Likely due to the very limited amount of travel taking place.

Fewer claims for infertility drugs:

  • People might have put treatments on hold during these uncertain times or services simply weren’t available.

Mental health claims increase:

  • The mental health of Canadians has suffered during the pandemic. “Services for mental health, from a paramedical point of view, are certainly increasing,” Alcock says.
  • Fortunately, there’s also been an increase in awareness about mental health issues and the services and options available to help people obtain treatment. This will continue.

Digital adoption, online claims submission, and virtual delivery has accelerated:

  • Plan members and health care providers are both more inclined to use online services.
  • It’s become a necessary, effective, welcome, and convenient way to interact with the health care system.

Reflecting on what he’s seen over the last 18 months, Alcock says, “Between what we thought was going to happen and what did happen, we were mostly right.” He adds, “Some of the information isn’t here yet, so we’ll see more as this progresses.”

This article is intended to provide information about current issues and assist in the decision-making process. The article, however, is not intended to provide medical, financial, or legal advice and any queries you may have should be directed to an appropriate professional advisor.