Wellness gone wild- one employer goes off into never, never land

Every day that passes and I get older (which is actually a good thing these days), my reputation as a curmudgeon is enhanced. It’s difficult not to get angry over some of the things going on, especially in the area of employee benefits where I spent my entire working life.

Below is the text of an e-mail sent to employees (10,000) of a large national corporation. When I first saw it, I thought it was a joke, then I thought to myself, what are they thinking❓ This isn’t funny.

The idea that there is some benefit to the plan sponsor (employer) by having all employees take an annual physical is just silly.

First, the evidence that an annual physical is necessary and valuable to everyone is questionable at best. Researching this topic I found everything from it was a waste of time in most cases to guidelines that were based on age, family history or suggested only specific tests. Nowhere could I find any sources with a blanket recommendation for an annual physical.

Regarding question 1⃣ if the employer’s idea is to save money by requiring the physical, they are missing the boat because 60% or more of claims are incurred by family members, not the employee.

Question 3⃣ why not? What will a PCP DO THAT THE OB/GYN can’t? Besides many plans consider the OB/GYN a primary provider for women. Question 5⃣ is the most absurd. When we want consistent, coordinated care why would even think of telling people, oh, just go to any doctor on the list if your own PCP is busy? No doubt the PCP receiving a call for this service will jump for joy at this additional uncoordinated/not my patient work. How stupid is all this? Question 8⃣ takes us into another dimension of dumbness. Under a doctor’s care, but you also need a physical? And no, it is not always beneficial to have an annual physical. Question 🔟 must mean something, but I’m not sure what. Such a plan does not even appear to meet the requirement to provide coverage with a 60% minimum value.

This entire strategy almost seems like there is an intent to drum up business for primary care physicians and not much more. All this will add to costs not save money. It will crowd some provider offices and create animosity among employees.

Annual Enrollment for Benefits 2015 – Questions and Answers

Recently you received a notice from XXX Benefits announcing that Annual Enrollment for 2015 benefits will begin in September. You were also informed that you are required to have an annual physical if you want a choice of different medical plans.

We are still in the process of finalizing the entire Annual Enrollment process, but we wanted to provide you with another reminder to get your annual physical if you have not already done so.

Based on feedback and questions from employees, we wanted to share some of the common questions and answers. Please keep in mind that all dates are tentative and as we get closer to Annual Enrollment, we will provide you with additional information.

1⃣ Q – Does my family (spouse and/or children) also need to have a physical?

A – No, to have a choice in medical plans, only the employee is required to have a physical. Your spouse and/or children are not required to have a physical. Physicals for your children and spouse/domestic partner are still covered at 100% and it is recommended that they receive one as well, but it is not a requirement.

2⃣ Q – Where can I check to see when I last had my physical?

A – You may log onto Aetna Navigator and view your claims online or call Aetna Concierge and ask for the date of your last physical.

3⃣ Q -Does going to my OBGYN for a well woman exam count as a physical?

A – Your physical must be conducted by a Primary Care Physician (PCP). An OBGYN is not considered a PCP and therefore a physical exam conducted by an OBGYN will not count towards your physical.

4⃣ Q – What is covered under a physical?

A – Download the Preventive Services document for services and codes covered under the XXX plan.

5⃣ Q – I contacted my doctor and he/she cannot see me for a physical exam until January 2015. What should I do?

A – Ask if there is another doctor in their practice who can see you earlier. You can also call Aetna Concierge at 800-xxx-xxxx for assistance in finding a network doctor that will be able to see you this year.

6⃣ Q – How do I let XXX know that I had a physical?

A – Aetna will be sending to Open House (XXX benefit enrollment vendor) a file of all employees who Aetna shows as having had a physical exam by September 30. If your information is not on the claims file, then your first Annual Enrollment confirmation statement will be sent to you along with a Proof of Physical (POP) form that you and your doctor will need to complete. You will have until November to return the completed form to the address listed on the form. You will be notified of the specific date in November at a later date.

7⃣ Q – I am not enrolled in 2014 and would like to enroll in medical in 2015. How will you receive my information since I do not have Aetna?

A – You will receive a POP form with your confirmation statement that you and your doctor will need to complete. You will have until November to send the completed form back. You will be notified of the specific date in November at a later date.

8⃣ Q – If I am currently under a doctor’s care for an illness, do I need to have a physical exam?

A – Yes, you will be required to have a physical exam, as it is always beneficial to have an annual physical exam.

9⃣ Q – Will XXX receive the results of my physical?

A – No, XXX does not receive any personalized health information on their employees.

🔟 Q – If I don’t have a physical, what is my medical plan?

A – The default plan is a high deductible plan. You must meet a deductible of $2,500 employee or $5,000 for family coverage before anything, including prescriptions is covered. Once you meet the deductible, then most services are covered at 50%. Additional information will be distributed with Annual Enrollment materials.