Personal Protective Equipment (PPE) Fees
July 14, 2020
Throughout the COVID-19 pandemic, Green Shield Canada (GSC) has been committed to finding ways to reduce the burden on plan sponsors. For all standard GSC head office billed non-refund clients, we made a three-month commitment back in April to reduce premiums in light of the drop in claims volume – 75% on dental rates, and 20% on health rates, including vision but excluding drug. The reduced claims volume also lowered costs for our plan sponsors with ASO funding arrangements.
Fast-forwarding to today, health and dental providers are beginning to re-open their doors for in-person appointments (e.g. our dental claims have returned to 2019 volumes), while following new standards established by their associations, regulatory bodies, and the Government, including the use of personal protective equipment (PPE).
In light of this, some providers are transferring the cost of PPE to their patients, and we are taking this opportunity to confirm our position on these new PPE fees.
PPE fees – what you need to know
After extensive internal reviews, we have determined that PPE fees are not a standard eligible expense under GSC health and dental plans. As a result, the portion of claims related to PPE fees will not be reimbursed – though plan members can be reimbursed for these fees through health care spending accounts (HCSA) or personal spending accounts (PSA), where applicable (see below for another HCSA update).
When dental claims are submitted with PPE fees, the entire claim will be entered as billed and reimbursed according to plan design so that eligible procedure codes continue to be reimbursed.
When health claims are submitted with PPE fees noted on the receipt or invoice, GSC is taking the following approaches:
- If the PPE fees are clearly indicated, that portion of the claim will be processed separately using an ineligible procedure code, meaning it is denied
- If the claim shows that the cost of an item or service has been combined with a PPE fee (but not broken down), the entire claim will be denied. A breakdown of charges is required and will be requested before the claim can be reprocessed.
We expect that some plan sponsors may, in fact, wish to enhance their plans to include coverage for PPE costs – and, depending on your current funding arrangement, there may be options to do so. To determine whether you are eligible, please contact your GSC account team for more information and the applicable rate adjustments.
Looking further ahead
The GSC team continues to closely monitor the health and dental landscape, with various initiatives in progress. The Canadian Life and Health Insurance Association (CLHIA) has requested that all provinces issue their revised 2021 dental fee guides earlier than usual to allow sufficient time to assess the anticipated adjustments. Additionally, GSC will be conducting a mid-year review of our reasonable and customary fees (typically an annual process) for the higher volume paramedical claims – like physiotherapy, massage, and chiropractic visits, and some medical item claims – to determine whether our current reasonable and customary amounts are still sufficient. Stay tuned for more details later this summer on these factors and their impact on trend.
Another update related to COVID-19 – more flexibility to carry forward HCSA credits
Given the impact that COVID-19 has had this year in shutting down most health care providers for a significant period, the Canada Revenue Agency (CRA) is allowing additional flexibility for carrying forward HCSA credits, with the intent of helping plan members who were unable to use their credits because of the absence of health care options. Plan sponsors who offer an HCSA with credits expiring any time up to December 31, 2020 can opt to extend their carry-forward period by a further 12 months as another way to support plan members. Contact your GSC account team for more information.
Please visit Greenshield's official support destination on all things COVID-19 related: