Diane Glasser
Health Benefits Specialist
We all remember where we were when it happened, when we heard those magic words, “Qualifying Events have been waived for this year!!” I assure you, no one was more elated than myself, so it’s okay to admit it. I may have been overheard stating that being reprieved from processing 4,000+ forms is my silver lining in this historic pandemic.
But as my excitement wore off, I began thinking. Our members certainly have the choice to refrain from having their preventive exams, and understandably so, in our current environment. It is an individual choice, but at what cost? I began thinking about some stories, one of them very personal, that I’d like to share. Testimonials, if you will, to the very reason our health and wellbeing programs are set up to encourage our members to participate each year in Qualifying Events.
Emergency Appendectomy
I began my career with Manatee County Government in the Employee Health Benefits department in December of 2011, just shy of my 50th birthday. Back then, new employees were placed in the Better plan level, and were required to do their qualifying exams during their first few months to move to the Ultimate plan. I dodged the proverbial colonoscopy bullet that year, as QEs for new enrollees were based on the age they were on their benefit effective date.
And dodge it I did! The next year rolled around, and I truly considered moving back to the Better plan in order to skip the colonoscopy. After all, I’m healthy as a horse, have never been in the hospital outside of childbirth, and had rarely used my Ultimate plan to date! Why subject myself to the humiliation of such an invasive procedure? It had apparently escaped my mind at that time that my paternal grandfather had colon cancer and wore a colostomy bag for the rest of his life, which thankfully was long. He lived well into his 80s.
Eventually, I gave in to the fact I should be setting a good example for our members, given my role at EHB, and had the procedure. Everything checked out- clean and green for ten more years, but then something totally unexpected occurred.
The next year, the year I would have been in the Better plan had I not completed the colonoscopy and my other Qualifying Events, I was diagnosed with a ruptured appendix that required surgery.
My care included two hospital stays, surgery, multiple CT scans, and infusions through an Infectious disease doctor. After I had recovered, I did the math. If I had let myself fall to the Better Plan Level I would have incurred $4,350 in out-of-pocket expenses. My total expenses, since I remained in the Ultimate plan, was $175. Talk about dodging a big, fat, financial bullet!
Through the years, I have spoken to many members with similar stories, not all with the happy ending mine had. Too often, they are calling because they chose not to participate in Qualifying Events and found themselves in the hospital, as well as the Basic plan. This finally motivated them to pick up the phone and call me, to ensure they did what they needed to upgrade their plan level the following year.
Pregnancy – Basic vs Ultimate Plan Level
My job can be very rewarding, especially when employees call to share that they just found out they are having a baby!! My 10th grandchild was born last week and I can tell you the experience never gets old for me. Unfortunately, a few have called me, not just to share their personal information with a complete stranger, but to ask if there is anything they can do to get out of the Basic plan before the new bundle arrives. Having a baby when enrolled in the Basic Plan Level can cost up to $10,000, compared to $100 on the Ultimate Plan Level.
Early Cancer Detection
A few years ago, we changed our guidelines to require all members to qualify every year to be in the Better, Best or Ultimate Plan Level (previously it had been every few years for members under age 50). That year, I learned of a young employee who was diagnosed with cancer at a very early stage, and was able to make a complete recovery, partially due to the rule changing. Under the old guidelines, the patient would not have been required to complete Qualifying Events for another three years. Under the new rule, the cancer was caught early and the employee had a positive outcome. Even if the change only helped this one person, it was well worth it in my book.
I also recall a member who personally brought in some of his employees to hand in their completed QE forms. He mentioned how grateful he was that the County required these exams because it saved his life. He normally would not have gone in for his annual exams before working for the County, but by going he was diagnosed with a cancer that was operable because it was caught early. He was really compelled to share his story and encourage his employees to complete their QE's. He was a young family man that only then realized the importance of his health beyond himself - the importance to stay healthy for himself and his family.
I know many of you do not feel comfortable right now having your preventative exams, and some providers are not scheduling in-person wellness exams at this time. However, I strongly encourage you to make your appointments as soon as you are able. Preventative exams save lives, and this time it just might be yours!
