1. United States
2. Ill.
3. Letter

I am writing as a constituent and employee enrolled in a self-funded employer health plan. Recently, my employer announced that coverage for GLP-1 medications used to treat obesity would be eliminated effective July 1, despite the plan year not ending until December 31. Employees were given less than 30 days' notice of this significant change. While reasonable people may disagree about the scope of coverage for any particular medication, I am concerned about a broader issue: employees are expected to make benefit and financial decisions based on the health plan offered at the beginning of the plan year, yet employers can make substantial coverage reductions in the middle of that same year. For example, employees elect Flexible Spending Account (FSA) contributions during open enrollment based on anticipated medical expenses. In most circumstances, employees cannot change those elections during the year unless they experience a qualifying life event. If a major medication or treatment suddenly becomes excluded from coverage, employees may face hundreds or thousands of dollars in unexpected expenses without any ability to adjust their benefit elections accordingly. I believe there should be stronger consumer protections requiring that significant reductions in prescription drug coverage or other major health benefits take effect only at the beginning of a new plan year, or that employees be provided with a meaningful transition period and an opportunity to adjust benefit elections. Health care decisions are often made months or years in advance in partnership with physicians. Sudden mid-year coverage changes create financial uncertainty and can disrupt ongoing treatment plans for patients who have relied on the coverage that was in place when they made their enrollment decisions. I respectfully ask that you consider legislation or regulatory changes that provide greater stability and predictability for employees and families who depend on employer-sponsored health insurance. Thank you for your time and consideration. Sincerely,