Health plans are looking for ways to stay competitive, gain market share, and increase member retention. Offering an over-the-counter (OTC) benefits program to members is essential to meeting these goals.
OTC products help close treatment gaps. The benefits give members more convenient and affordable care to ailments that otherwise would have gone untreated.
A lot of people rely on OTC products for treatment because prescriptions are often expensive. Most health care plans don’t cover OTC products and cause millions to scrape money together or do without the treatments.
Health plans that offer OTC benefits help members make a positive difference to their health. Affordable treatment help ailments get better and prevent them from getting worse.
The coverage of OTC products could help members prevent expensive and physical/emotional stress of surgeries. Untreated ailments can degrade into life-threatening illnesses.
Prevent potential illnesses by getting the right treatment as prescribed. Affordable medications are important to achieve this.
Health plans can offer this great benefit by partnering with an OTC benefits program. In this article, you will learn what makes a good benefits program, how the program will work, and what products can be covered.
Qualities of a Good OTC Benefits Program
It’s important for companies to find a program that’s the right fit. Health plans must be compliant, and they must be easy for members to access benefits.
A good benefits program will have some of the following qualities:
- Manages member interactions
- Holds products and delivers to members’ homes
- Has a clear and descriptive catalog of qualifying products readily available to members
- Is in good standing with CMS requirements
A good OTC program puts members first. Members will always have access to a highly-trained customer service representative. The program makes its catalog easy to read and easily accessible to all members.
The program’s primary goal is to assure members of what products are covered and how much credit they have at all times. This helps eliminate frustration and embarrassment if cards or receipts get declined.
Companies should look for programs that can manage product selection and distribution. At-home delivery to members is an excellent benefit for those who are disabled or have a lack of transportation.
This makes getting needed medications convenient. Members need medications delivered right to them in a reasonable timeframe. Having fast shipping is essential for a good program.
Companies need to make sure that the program is generating internal audits, financial reports, and CMS-required reports to prove that they are adhering to regulations and are compliant.
How an OTC Benefits Program Works
An OTC benefits program works by having members buy over-the-counter products that work just as well as their prescription medications.
Having OTC products partially or fully covered, grants members the ability to have lower healthcare costs and afford needed treatments. Depending on the benefit program, members will either get reimbursed for qualifying purchases, or they will receive savings on the spot through a card or when ordering online, depending on the.
OTC benefits programs will give members a certain amount of credits each year to be used on OTC purchases.If members don’t use their credits, the remaining amount may be carried over to the next period. This could depend on the OTC benefits plan, so look for your plan’s policies.To get reimbursed for their OTC purchases, members must provide a receipt along with a copy of the prescription.
Members using their OTC benefits can purchase products in a variety of ways. They can check their benefit’s catalog to see what products qualify and then head to a store for purchases.
Some benefit programs have their own online store with covered products. This helps sick and disabled members get medications if they cannot go to a store. Placing orders over the phone is provided by major insurers as another option for members, and some benefit programs have apps to help with purchases.
A good OTC benefits program will make purchasing and getting reimbursed easy for its members. Having tools and a variety of options to purchase OTC products is key to helping everyone get what they need at a low cost.
Products Covered Under an OTC Benefits Program
Every OTC benefits partner will be different in the variety of products covered under their plan. That’s why you should look for a partner that provides clarity on what is and isn’t covered.
There are over-the-counter products that are covered by almost all major health insurers.
One popular product is aspirin. Aspirin use is covered by insurance for its role in preventing cardiovascular disease. It might also be covered to help prevent preeclampsia during pregnancy.
Another type of product that OTC benefits might cover is contraceptives. Certain birth control methods such as female condoms, spermicides, foams, gels, sponges, and Plan B may all be covered.
Fluoride, folic acid, vitamin D, and iron supplements can all be covered. Each benefit partner has different requirements for supplements, but they usually cover them to an extent. Folic acid helps to prevent congenital disabilities, and iron supplements help to prevent anemia and iron deficiency. Using supplements to prevent these illnesses can qualify for coverage. Vitamin D coverage may only apply to people 65 years or older to help prevent falls.
Health insurers can cover smoking cessation medications. There may be a clause in the benefits that states the member is actively receiving counseling to help quit tobacco. There may also be some coverage for OTC pregnancy tools such as breast pumps and supplies.
Every benefit plan will be different, but these are some of the common products that members might have access to. These common OTC products will help members have lowered medical costs if covered by the benefits plan.
Looking to Offer OTC Benefits?
When adding OTC benefits to your health plan, it is important to remember the qualities that make up a good program.
Make it about the members. Providing an affordable alternative to prescriptions allows low-income members to get the treatment they need, instead of doing without it.
Make sure members know how much credit they have, what products are covered, and how to get reimbursed. Keeping members in mind will help you achieve a great program.