Working with Your Employer – A Resource and a Potential Advocate for People With Type 1 Diabetes

“I was nervous to ask my HR department questions at first, but once I figured out how they could help me, it was a lifesaver. For me, my HR representative helped me do some key things: find my current policy and the areas that were most relevant, and help me compare my options at open enrollment. I was able to get this information by asking for a meeting, and when we found anything she couldn’t answer, she was able to point me to someone else to call.”
—T1D patient, OH

In this section we’ll discuss

• As a health insurance specialist when choosing your plan
• As a health insurance advocate for future plan decisions
• As a health insurance intermediary if there are unexpected problems
• Sample HR email

If you have health insurance coverage through your employer, your human resources (HR) department can be a helpful resource for you. They may have many roles in your company, but three ways they can be helpful to people with type 1 diabetes (T1D) are below:

1. As a health insurance specialist when choosing your plan

Your HR department is a key player on the team that helps select insurance and other benefits your employer provides. Because they are part of these conversations, they can be a very helpful health insurance advocate in understanding your coverage. Sometimes they will help you personally, and other times they can refer you to someone who can provide more guidance, like a health insurance broker or agent who can help with more specific questions about the plans being offered.

The “How to Choose an Insurance Plan” section shared many considerations you should take into account when choosing a health insurance plan. With that background in mind, make sure to talk to your HR department about your T1D-specific needs and any questions you may have about how a plan may affect your care or finances.

Another reason that HR team members are a good resource for these types of questions is that they are often trained to handle confidential information. While you may not feel comfortable revealing specifics of your condition, or that of a loved one, some information can be helpful when they are assisting you with your health coverage needs. So be confident in knowing that the HR professional you speak to will protect your privacy while advocating for your needs. And you should also take comfort knowing you are protected by the Americans with Disabilities Act, which prohibits employers from discriminating based on the health status or condition of an employee or their family member.

To get the conversation going with your HR contact, feel free to use the sample emails below and customize with only the details you feel comfortable sharing. Remember, there are no silly questions when it comes to things that affect your health, so you should feel comfortable seeking out the information you need.

Important note

Some employers may have had the option to include an additional list of preventive medications, like insulin, in their plan offerings. Inclusion of insulin on this list will allow you to have access to insulin as part of a “preventive” service that will not be subject to your deductible. It is worth asking your HR department if this list is included in the set of plans being offered.

2. As a health insurance advocate for future plan decisions

Beyond helping you understand the details of your plan, your HR department may also offer support as you begin to use services once you’re covered. For example, you may find in using your plan that it doesn’t fully meet your T1D treatment needs in the ways your treatments or medications are prescribed. Because employers may choose to work with different health insurance companies or change the plan options they offer each year, that is useful information for them to know for future planning. While you may not be able to change your plan this year, sharing important coverage considerations critical for a person with T1D could help influence future decisions by your employer regarding the type of coverage available to employees. A sample email is provided below to help you begin a conversation with your employer about how it can choose coverage options that work best for your T1D needs.

3. As a health insurance intermediary if there are unexpected problems

Finally, if you encounter challenges with treatments or services, especially if they appear to be covered in your plan, your human resources department may be willing to reach out on your behalf to gather more detail as your insurance claim advocate.

• If you work for a fairly large employer (100-plus employees), it may likely have more leverage (as a self-insured employer) over the benefit structure and in advocating for certain coverage.
• Your employer may also be able to assist you in the appeals process by providing a letter of support.

SCENARIO 1: You would like assistance in choosing a plan

Sample email:

Instructions: Customize to your particular situation by using the suggested language in brackets if necessary.

Dear [insert HR contact name],

Thank you for all you have done so far to help me at work. Today, I’m reaching out about my health coverage. First, I want to note that I appreciate that the health insurance our employer provides enables me to be a productive and healthy employee. My family has specific medical needs and I would like to find a time to find out more about our options. Are you the right person to speak with? If not, can you refer me to another?

Thank you in advance for your time,
[Your Name]

Talking points once you’ve secured a meeting

1. Gather information on how much you spent last year on medications, treatment, transportation, and other health-related expenses, so you can estimate how much you spend per month.
2. Ask your HR representative to connect you with their broker or a contact at the insurance company to help you figure out the following details:
   • Whether the specific insulin, pump, continuous glucose monitor (CGM) and other supplies that you use are covered under each plan option and what the associated cost-sharing will be.
   • What your monthly costs will be under each plan option for the medications, equipment, and doctor or practitioner visits you are likely to need.
   • Whether the network for the plan you are considering includes your doctors and other providers.

Instructions: Customize to your particular situation by using the suggested language in brackets if necessary.

SCENARIO 2: You would like to help educate your employer about features of your health coverage that are important to you, in hopes of influencing next year’s coverage

Sample email

Instructions: Customize to your particular situation by using the suggested language in brackets if necessary.

Dear [insert HR contact name],

Thank you for all you have done so far to help me at work. Today, I’m reaching out about my health coverage. First, I want to note that I appreciate that the health insurance our employer provides enables me to be a productive and healthy employee. As you consider the benefits provided by our organization next year, I wanted to make you aware of some things that are important to me.

As a person with type 1 diabetes (T1D) [As a caregiver of someone with type 1 diabetes (T1D)], there are several components to health insurance that are critical to my [my loved one’s] treatment needs and that I would ask that you ensure are included in our organization’s plan offerings. Three things are key in managing T1D:

1. Predictable and reasonable out-of-pocket costs for treatments like insulin and T1D management tools. I [my loved one] need[s] to take insulin multiple times a day to stay alive and healthy. With some insurance plans, insulin can cost dramatically more some months than others, and this creates a hardship for my family and could cause medical emergencies. These out-of-pocket costs can vary in months when the plan deductible hasn’t been met yet, leaving me to pay 100 percent of the costs rather than a set co-pay amount. Also, because the price of insulin fluctuates, if I have to pay a percent of the price of the drug, rather than a flat co-payment, it can be difficult to plan financially.
2. A range of treatment options. Not all bodies are the same, and not all medications and medical devices are created equal. It’s key to be able to access the treatment recommended by my doctor that meets my [family’s] unique needs and not be limited to one brand that may not be suitable. It would be helpful to have an insurance plan that covers multiple brands of insulin and insulin pumps, not just one.
3. Coverage for the latest diabetes technologies. Insulin pumps, continuous glucose monitors and an artificial pancreas are recommended by clinical guidelines because studies show they provide better health outcomes for people with T1D. Many plans are covering these standard-of-care technologies, but a few are not. I hope our organization can provide an insurance plan that provides state-of-the-art care in the future.

These are the most important aspects of a health insurance plan that helps me not only manage my [loved one’s] condition, but also thrive as a productive employee. With that in mind, I am hoping to discuss our plan offerings with you when it’s most convenient.

Thank you in advance for your time,
[Your Name]

Talking points once you’ve secured a meeting

1. 1. If your only plan option is a high-deductible health plan (HDHP)
      Predictable and reasonable out-of-pocket costs for treatments like insulin and T1D management tools are key to managing this condition. With the right plan, I can more easily control my costs. Many employers may offer an option that gives employees access to medications, like insulin, so that it is covered as a preventive service (under the plan’s preventive drug list) and is not subject to the deductible. This consistency in costs ensures that I can access the medications as prescribed throughout the entire year, which is optimal for my health and productivity at work.While many employees find a HDHP suitable for their needs, studies have shown that a plan design like an HDHP, where patients have a higher exposure to out-of-pocket costs, may contribute to patients limiting treatment. Undertreated diabetes—in the form of deferred necessary visits and reduced medication use—predisposes patients to costly medical consequences down the road, not to mention increasing the likelihood of further complicated health issues.¹ Including insulin on the preventive drug list can help alleviate those concerns.
   2. Co-Payments vs. Co-Insurance
      I would like to request that you consider negotiating a plan for our employees that provides insulin and diabetes management tools at a fixed-dollar co-payment rather than co-insurance and treats insulin like a preventive drug, exempting it from the deductible. This is important because prices for insulin and diabetes supplies have increased a lot, and manufacturers can and do regularly change their prices. This results in very high and inconsistent insulin costs for my family and me, and makes it difficult to budget accordingly. Fixed co-payments throughout the year allow me to plan carefully, get needed medication and supplies, and, more importantly, better manage my [loved one’s] condition.
   3. To address choice of treatments
      Having a range of treatment options and the freedom to access the option that best works for my health is also an important detail to my success in managing T1D. Not all bodies are the same, and not all medications and medical devices are created equal. Limiting access to only a single brand of insulin, or a single type of pump or continuous glucose monitor, as some plans do, leaves some unable to access the care prescribed. It’s key to have a treatment that meets my [family member’s] unique medical needs. In fact, organizations like the Endocrine Society and the American Association of Clinical Endocrinologists have clinical guidelines that highlight the value of these treatments and therapies to help patients more effectively manage T1D. For example, here is a peer-reviewed paper that could be helpful in supporting your discussion on pumps and CGMs.
   4. Highlighting emerging tools to help effectively manage T1D
      There are a number of exciting new technologies for T1D patients coming onto the market, most notably the artificial pancreas. These devices have been shown to do a significantly better job of controlling blood sugar than previous technologies, having a direct impact on sleep and energy levels, among other aspects of daily life. Having a plan that allows access to the latest U. S. Food and Drug Administration-approved technology will make it simpler for me [my family member] to control this condition.

^{1. Rabin, DJ, Jetty, A, Petterson, S, Saqr, Z, Froelich, A. Among low-income respondents with diabetes, high-deductible versus no-deductible insurance sharply reduces medical service use. Diabetes Care. 2017; 40(2); 239-245.}

JDRF maintains a forum where insurance issues can be discussed.
If you have questions for the community, you can post them here!

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