COVID-19 BENEFITS FAQ

Disclaimer: this information is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

If our employees are no longer working, are they still entitled to group health plan coverage?

Not necessarily. You need to check your group health plan document (or certificate of coverage if your plan is fully insured) to determine how long employees who are not actively working may remain covered by your group health plan. Once this period expires, active employee coverage must be terminated (unless the insurance carrier or self-funded plan sponsor otherwise agrees to temporarily waive applicable eligibility provisions), and a COBRA notice must be sent. If your plan is self-funded and you would like to waive applicable plan eligibility provisions, you should first make sure that any stop-loss coverage insurance carriers agree to cover claims relating to participants who would otherwise be ineligible for coverage.

What happens to group health plan coverage if employees are not working and unable to pay their share of premiums?

In the normal course of events, group health plan coverage will cease when an employee’s share of premiums is not timely paid. However, several actions might be taken that could allow coverage to continue.

First, the insurance carrier providing the health coverage may voluntarily continue the coverage while the disaster is sorted out and until an employer reopens its doors. More likely, the employer may make an arrangement with the insurance carrier providing health coverage to pay the employees’ share of premiums to keep coverage in place (at least temporarily) and possibly until the employer can reopen its doors. Each situation will be different, depending upon the insurance carrier and the relationship between the employer and the insurance carrier. Therefore, each factual situation will need to be individually assessed.

Is COVID-19 testing covered by our group health plan?

The CDC continues to offer free testing for coronavirus. Until further notice, health benefits, medical services, and items purchased in association with testing for or treatment off COVID-19 may be provided by a health plan without a deductible, or at a reduced or no cost to participants, without disqualifying the HDHP or covered individual from making HSA contributions. The exact coverage details and cost-sharing amount for individual services vary by plan. Employers should consult with their plan’s issuer or benefits administrator regarding their plan’s benefits for COVID-19 testing and treatment.

How can we better leverage existing group health benefits for our employees?

Employers should consider the enhanced promotion of current benefit offerings to ensure employees take advantage of all existing healthcare services offered, such as:

• Telemedicine Services: Telemedicine may be an option for persons seeking medical consultation for mild-non-emergency care. If telemedicine services are offered as part of your group health plan, services may include coordination of diagnosis and treatment plans and/or specialist referrals. Telemedicine services may be utilized from the comfort of an employee’s home and may be a valuable option for persons who want to minimize external exposure. Some insurance carriers are waiving out-of-pocket costs for telemedicine visits for urgent care needs for the next 90 days.
• Employee Assistance Program: Employee Assistance Program or Emotional Support Help Line often provides great benefits that impact not only physical, but mental health – stress management, elder care, personal finance, and substance abuse consultation to name a few. Check with your employer or health provider to see if this program is available.
• Wellness Program Services: Wellness programs are a rich resource of education related to disease prevention. Many offer basic education on a variety of pertinent topics such as basic hygiene and traveling tips.
• Disease Management Programs: Disease Management Programs are often tailored to employees and/or families at risk of developing chronic medical conditions, such as high blood pressure and diabetes. Individuals in these programs may be more susceptible to COVID-19, so ensure they have the opportunity to consult with their coaches or case monitor as necessary to manage their health conditions.
• Preventive Care: Flu shots and other vaccines, as well as diagnostic testing, are often provided at no or low cost via a group plan or wellness program.
• Prescription Refills: Select insurance carriers are allowing early refills on prescription medications to ensure individuals have their medications. Check with your insurance carrier if you are on any medications and need/will need a refill soon.

* If you have any questions regarding FMLA, STD, ADA or Worker’s Compensation, please refer to the COVID-19 HR FAQ.