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.
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.
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.
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.
Employers should consider the enhanced promotion of current benefit offerings to ensure employees take advantage of all existing healthcare services offered, such as:
* If you have any questions regarding FMLA, STD, ADA or Worker’s Compensation, please refer to the COVID-19 HR FAQ.