Stahl & Associates Insurance Important COVID-19 Information

The Stahl & Associates Insurance team is diligently monitoring developments as the coronavirus (COVID-19) pandemic continues to evolve. We want to assure you that we are taking the proper precautions and implementing procedures to ensure the safety of our employees, while executing our business continuity plan to continue supporting our clients.

Business Continuity Plan

Stahl & Associates Insurance is activating precautionary measures in our office locations and working closely with our associates regarding travel and other health-related concerns. Our agency maintains a comprehensive business continuity plan to ensure we meet our commitment to our clients, and prevent any interruption of our business processes.

Opening Up Your Workplace

Members of the Stahl Safety Team, Wayne Jensen and Kiah Clayton, provide information and best practices to open up your workplace safely.

Cyber Insurance Issues During the COVID-19 Crisis

Learn more about how to protect your company from cyber crime during the COVID-19 crisis with our guest speaker, Eric Shapiro from Socius Insurance.

CORONAVIRUS AFFECT ON INSURANCE POLICIES AND COVERAGES

CORONAVIRUS AFFECT ON INSURANCE POLICIES

We have received several questions regarding the impact of COVID-19 on insurance policies. It is important you speak to your Stahl & Associates Insurance Account Executive about your specific policies and coverage, as carriers and coverage vary. However, we have provided a general overview below of coverages that are frequently referenced.

Medical Insurance

Your individual medical plan determines the benefits and other services. The benefits do not change because there is a diagnosis or possibility of COVID-19. Most health insurance carriers are making adjustments to make it easier for members to get tested and treated for COVID-19, and are increasing access to other health care services. Most are also covering COVID-19 testing similar to a preventive benefit by waiving copays, deductibles and coinsurance. For questions about benefits and coverage, you can contact your medical insurance carrier directly or reach out to your Stahl & Associates Account Executive.

Disability Insurance

Most carriers will evaluate COVID-19 virus claims according to the terms of the policy and the facts specific to the claim. Generally, an employee who is not sick, but misses work due to a quarantine is not entitled to disability benefits. However, certain paid leave programs may be involved depending on the situation, so it is best to review the applicable policy and plan documents.

Workers’ Compensation

Workers’ Compensation laws provide compensation for “occupational diseases” that arise out of, and in the course of employment, but many states exclude “ordinary diseases of life”. There are instances in which “ordinary diseases” may be covered if it is possible to establish a direct connection between the workplace and the circumstances through which the disease was contracted. The simplest test toward determining whether an injury “arises out of and in the course and scope of employment” is to ask: was the employee benefiting the employer when exposed to the illness or disease? This test is subject to the interpretations and intricacies of state laws. For most employees, an illness from an infectious disease is not work related. A person sick and at work would carry the burden of proving the triggering event of the illness arose out of employment and occurred in the course of employment. There is typically no workers’ compensation for a disease to which the general public is equally exposed.

Workers’ Compensation employers should engage a medical professional on infectious diseases for advice to determine whether the disease is work related. To find out how Workers’ Compensation might respond to the coronavirus, please reach out to your Stahl & Associates Insurance Account Executive.

Business Interruption

Standard property insurance policies usually include two types of coverage for disruptions. Business interruption coverage insures against losses when the policyholder’s operations are directly affected; and contingent business interruption coverage insures against the risk of indirect losses, such as when suppliers or customers are affected. Physical damage typically has to arise from a non-excluded or covered peril that manifests either at the insured property to trigger a covered loss, or a nearby property impacting access to the insured premises. Losses linked to lost business due to fear of contagion or because of supply chain challenges are unlikely to be covered, unless property damage is established. However, proof that contamination or other relatively intangible conditions like bacteria rendered the property temporarily or permanently unusable or uninhabitable, may support a finding that the loss was a physical loss to the insured property.

The Insurance Services Office recently released new endorsements to use with commercial property policies that provide limited business interruption coverage for coronavirus related circumstances. These have not been filed and are not available to the public for purchasing yet.

Please reach out to your Account Executive at Stahl & Associates Insurance for more information or to review the terms and conditions of your policy.

CORONAVIRUS (COVID-19) BUSINESS RESOURCES OVERVIEW

As COVID-19 develops, we have compiled business resources to help you navigate through this uncertain time.

BUSINESSES CAN TAKE ONLINE COVID-19 SURVEY TO REPORT ECONOMIC LOSSES

Florida Governor Ron DeSantis has announced the activation of the Business Damage Assessment Survey to assess the impact of the COVID-19 coronavirus on Florida’s local businesses. The survey, managed by the Florida Department of Economic Opportunity (DEO), will evaluate businesses affected by COVID-19 and the impacts the virus has had on the local economy. This will allow actions to implement economic relief programs for businesses to begin. https://floridadisaster.biz/BusinessDamageAssessments

GOVERNOR RON DESANTIS ACTIVATES EMERGENCY BRIDGE LOAN PROGRAM FOR SMALL BUSINESSES IMPACTED BY COVID-19

Governor Ron DeSantis activated the Florida Small Business Emergency Bridge Loan Program to support small businesses impacted by COVID-19. The bridge loan program will provide short-term, interest-free loans to small businesses that experienced economic injury from COVID-19. The application period is open and will run through May 8, 2020. Up to $50 million has been allocated for the program.

Small business owners with two to 100 employees located in Florida affected by COVID-19 can apply for the short-term loan up to $50,000. The loans are interest free for up to one year and are designed to bridge the gap to either federal SBA loans or commercially available loans. The business must have been established prior to March 9, 2020 and demonstrate economic impacts as a result of COVID- 19. For more information, visit www.floridadisasterloan.org.

HEALTH INSURER RESOURCES

AETNA MEMBER RESOURCES

COVID-19 Testing & Treatment– Updated!

Aetna will waive all copays for members who receive diagnostic COVID-19 tests. This will cover the test kit for patients who meet CDC guidelines (there may be a cost associated with the actual doctor visit). Aetna is waiving member cost-sharing for inpatient admissions at all in-network facilities for the treatment of COVID-19 or any health complications associated with COVID-19. This is for all Aetna fully insured employer plans. Self-insured plan sponsors will be able to opt out of this program at their discretion.

If a member is diagnosed with COVID-19, Aetna’s Healing Better program will send a care package including CVS over the counter medications to help relieve symptoms. The package will also include personal and household cleaning supplies to help protect other members of the household from potential exposure.

Telemedicine

Aetna will waive the copay for all telemedicine visits until June 4, 2020. Members should utilize telemedicine as their first line of defense in order to limit potential exposure in physician offices. This includes costs for all video visits through CVS MinuteClinic app, Aetna covered Teladoc offerings and in-network providers delivering synchronous virtual care.

Care Management

Aetna will proactively reach out to members who are most at risk for contracting COVID-19. Aetna care managers will walk members through precautions they can take to protect themselves, where to get information on the virus, and where they can get tested.

Prescriptions

CVS will waive charges for home delivery of prescription medications. This is a convenient option available to members so they can avoid going to the pharmacy for new prescriptions and refills. This option is especially encouraged for those at higher risk for COVID-19 complications. Aetna will also waive early refill limits on 30 day prescription maintenance medications.

Member Support Line

Members with questions and concerns around the coronavirus (COVID-19) pandemic can call the Aetna Nurse Medical Line at anytime, 24/7: 1-800-556-1555. Members can also contact the Aetna crisis response line at 833-327-2386.

Updates & Additional Information

For updates and access to all of Aetna’s resources for Coronavirus (COVID-19) visit:
https://www.aetna.com/individuals-families/member-rights-resources/covid19.html

CAPITAL HEALTH PLANS MEMBER RESOURCES

COVID-19 Testing & Treatment – Updated!

There is no cost share for the COVID-19 test and Capital Health Plans is waiving all member cost share (copays and/or coinsurance) for medical treatment related to a positive COVID-19 diagnosis, including inpatient and outpatient hospital admissions (emergency room and observation) through June 1, 2020.

Prescriptions

It is a good idea for members to fill prescriptions through a mail-order service, especially during the COVID-19 outbreak. This will eliminate wait time in lines at the pharmacy and exposure to germs. For most prescriptions, members can get a three month supply. CHP has also allowed a nationwide prior authorization process for an early refill of a 30-day supply on routine medications. This means members can get medications filled earlier than normal, if necessary. This does not include controlled substance medications.

Telehealth Visits – Updated!

Capital Health Plan has waived all copays for covered telehealth services including Amwell and any CHP contracted provider that provider that provides telehealth services. 

Website

https://capitalhealth.com/news/novel-coronavirus-covid-19

CIGNA MEMBER RESOURCES

COVID-19 Testing & Treatment– Updated!

Through May 31, 2020, Cigna will waive member cost-sharing and copayments for COVID-19 related treatment. This is for all Cigna fully insured employer plans. Self insured plan sponsors will be able to opt out of this program at their discretion. The deadline for opting out is April 10, 2020.  

Virtual Visits

For members who are chronically ill or immunosuppressed Cigna is extending standard office visit benefits for those who transition from in-person visits to virtual care appointments through May 31, 2020.

Cigna Help Line

Members have 24/7 access to the Cigna Help Line and can call 866-912-1687 to connect with a qualified clinician who can provide support and guidance around Coronavirus COVID-19 questions and concerns.

Prescriptions

Members with chronic health conditions can obtain 90-day prescriptions with free delivery directly to their home. Additionally, members have 24/7 access to Cigna pharmacists through Express Scripts. The Refill Too Soon restriction has been lifted in Florida effective immediately to ensure all members have convenient access to their prescriptions.

Updates & Additional Information

For updates and access to all of Cigna’s resources for Coronavirus (COVID-19) visit:
https://www.cigna.com/individuals-families/health-wellness/topic-disaster-resource-center/coronavirus-public-resources

FLORIDA BLUE MEMBER RESOURCES

COVID-19 Testing & Treatment– Updated!

Through June 1, 2020, Florida Blue is waiving the cost share for treatment of those with a positive COVID-19 diagnosis, including inpatient and observation hospital admissions for fully-insured employer sponsored plans. Florida Blue is working with self-funded employer groups to assist them in meeting the needs of their employees during the Coronavirus pandemic. Florida Blue is also waiving member cost share for COVID-19 testing and the office visit associated with the test.

Prescriptions

Florida Blue is waiving early medication refill limits on 30-day prescription maintenance medications. Members are also encouraged to use 90-day mail order benefits. If members need help with mail orders, they can call 800-352-2583 or the number on the back of their member ID card.

Emotional Support

Members experiencing stress and anxiety related to Coronavirus (COVID-19) can call 833-848-1762 and speak with a behavioral health counselor at no cost. These counselors cannot assist with questions about COVID-19 testing or treatment. Members should call the number on the back of their member ID card for questions related to COVID-19 testing and treatment.

Teladoc

While Coronavirus (COVID-19) is a health concern, Florida Blue members will have access to Teladoc virtual visits at a $0 copay. Members are encouraged to use Teladoc services to protect their health and the health of others. Members should be aware the COVID-19 testing cannot be done through Teladoc. These tests must be completed in person. Self-funded employer plans can opt in to cover Teladoc virtual visits at $0 copay.

Virtual Visits with In-Network Florida Blue Providers

Members can now have virtual visits with Florida Blue network providers, if the doctor has virtual visit capabilities. This enables members to receive virtual care from primary care providers, behavioral health providers and specialists to help protect the member’s health and avoid a crowded doctor’s office. Members should call their doctor to see if they offer virtual visits. These visits will be at the regular office visit cost share for routine office services and will be in effect for the next 90 days. Self-funded employer plans can opt out if they don’t want this to apply or if they want a different cost share.

Updates & Additional Information

For updates and access to all of Florida Blue’s resources for Coronavirus (COVID-19) visit:
https://www.floridablue.com/blog/covid-cases-confirmed-in-florida

HUMANA MEMBER RESOURCES

COVID-19 Testing & Treatment – Updated!

Humana is waiving consumer costs for treatment related to COVID-19 services. This includes costs related to subsequent treatment for COVID-19, including inpatient hospital admissions. The waiver applies to all medical costs related to the treatment of COVID-19, as well as FDA approved medications or vaccines when they become available. Humana will continue to reassess this as circumstances change.

Telehealth

To help reduce the risk of infection and spread of disease, Humana is encouraging members to use telemedicine as the first line of defense for all urgent (non emergency) care needs. Humana is waiving all out-of-pocket costs for telemedicine visits for urgent care needs through June 7, 2020. This will be limited to in-network providers delivering virtual care and will apply to Humana Medicare Advantage, Medicaid and commercial employer-sponsored plans. Self-insured plan sponsors will have option to opt-out of this program at their discretion.

Prescriptions

Through April 8, 2020 members can get early refills on prescription medicines so they can prepare for extended supply needs.

Member Support Line

Members can call Humana’s toll-free customer support line to speak with a team of professionals they can assist with Coronavirus (COVID-19) questions and concerns. The number can be found on the back of the member’s ID card.

Employee Assistance Program

Members can speak to a professional counselor to help them cope with feelings of stress and anxiety during these uncertain times. The EAP is a free and completely confidential service available 24/7. Members can access the EAP by calling 1-866-440-6556. They also have online access to a library of resources at Humana.com/eap (login and user is eapt).

Updates & Additional Information

For updates and access to all of Humana’s resources for Coronavirus (COVID-19) visit: https://www.humana.com/coronavirus

UNITEDHEALTHCARE MEMBER RESOURCES

COVID-19 Testing & Treatment – Updated!

UnitedHealthcare is waiving member cost-sharing for the treatment of COVID-19 through May 31, 2020. This is for fully insured plans, however UnitedHealthcare will work with self-funded groups who want to implement a similar approach. If a member has symptoms or thinks they may have been exposed to COVID-19, it is recommended that they call their health care provider right away. If a member’s healthcare provider determines the member should be tested for COVID-19 and orders the test, they will work with local and state departments to coordinate testing. The most common place for testing is the health care provider’s office or clinic. There are also several large retail outlets and drug stores that will soon be offering drive up testing in their parking lots.

UnitedHealthcare is waiving member costs for COVID-19 testing provided at approved locations in accordance with the CDC guidelines. This coverage applies to Medicare and Medicaid members as well as fully insured and self-funded commercial employer sponsored plans. While it is discouraged to opt out of covering the test at no cost share, self-funded employer sponsored plans have the option to do so. Any care or treatment for COVID-19 beyond the test will be covered in accordance with the member’s health plan benefits. Member deductibles, copay and coinsurance will apply to any COVID-19 treatment beyond initial testing.

Telehealth – Updated!

UnitedHealthcare has expanded telehealth access in response to COVID-19. Members now have access to health care providers from the comfort of their home, allowing faster support and reduced exposure to the virus. UHC in-network physicians should all be able to provide telehealth services. If a member has symptoms, or believes they might have been exposed to COVID-19, they should call their primary care provider right away. UnitedHealthcare physicians are now enabled to do telehealth visits for members through live video conferencing. All in-network telehealth visits (whether related to COVID-19 or not) are now covered with no member cost sharing until June 18, 2020.

Virtual Visits

Members of employer sponsored health plans have access to UnitedHealthcare Virtual Visits. Virtual Visit providers Teladoc, AmWell and Doctor on Demand are available 24/7 and have developed guidelines for members who think they may have been infected by COVID-19. This is a good option for members to discuss concerns and symptoms. When needed, the Virtual Visit may refer the member to their physician.

Emotional Support

The Optum Health Line is available 24/7 and staffed by professionally trained mental health experts. Members can call 866-342-6892 at any time to speak to a professional at no cost.

Prescriptions

UnitedHealthcare and Optum Rx members who need help obtaining early prescription refills can call the UHC customer care number located on the back of their medical ID card for assistance in obtaining an early prescription refill.

Updates & Additional Information

For updates and access to all of UnitedHealthcare’s resources for Coronavirus (COVID-19) visit: https://www.uhc.com/health-and-wellness/health-topics/covid-19

HEALTH INSURER ELIGIBILITY

Given the unpredictability of the current situation, many major medical insurance carriers have relaxed their eligibility guidelines for employers who are faced with limiting hours, furloughing employees, layoffs and more. Outlined throughout this document are the latest updates and guidelines from each major medical insurance carrier. Eligibility is changing rapidly: please confirm with your Stahl & Associates Insurance Account Executive.

AETNA UPDATES

Reduction in Hours, Furloughs and Layoffs

Employers who are faced with reducing hours and/or laying off staff due to COVID-19 can maintain their plans, as long as the reduction in hours/lay off is a temporary measure resulting from the COVID-19 pandemic. Monthly premium payments must be made, and the employer should not terminate the employees. This option is available until July 31, 2020. Guidelines must be applied uniformly.

If employees’ hours have been reduced and they can no longer afford their health insurance coverage, Aetna will allow employee terminations without a qualifying event until June 30, 2020. Employers should consult with their benefits or tax advisors about the impact of such actions.

Waiting Periods

Aetna will support changes to waiting period rules for employers who terminate employees due to reduction in hours.

COBRA Options

For groups subject to COBRA, if one person remains actively employed, employees can continue to elect COBRA coverage under the normal notice and election procedure. If the plan has no active employees, the plan will be terminated, and COBRA is not an option.

Enrollment Changes

Aetna will not modify rates when temporary changes in enrollment are due to the COVID-19 pandemic.

Member Support

Aetna is waiving cost-sharing and co-pays for inpatient hospital admissions (in-network) related to COVID-19 for commercially insured members. They are also offering its members access to emotional support resources. Members with questions and concerns around the Coronavirus (COVID-19) pandemic can call the Aetna Nurse Medical Line at any time, 24/7: 1-800-556-1555. Members can also contact the Aetna Crisis Response Line at 833-327-2386.

Updates & Additional Information

For updates and access to all of Aetna’s resources for Coronavirus (COVID-19) visit:

https://www.aetna.com/individuals-families/member-rights-resources/covid19.html

CAPITAL HEALTH PLANS UPDATES

Reduction in Hours/Layoffs

Capital Health Plan has adopted a non-enforcement policy which will apply for currently enrolled eligible employees that will allow them to retain coverage as if they were active employees even if they are furloughed or drop below the minimum hours worked for full time employees. This non-enforcement policy will apply until April 15th at which time they will reevaluate.

CIGNA UPDATES

Reduction in Hours/Layoffs

Cigna is relaxing eligibility requirements during the COVID-19 pandemic and establishing an “extended relief period”. The “extended relief period” starts on March 16, 2020 and goes through May 31, 2020. This period may be extended by Cigna in response to evolving external events as well as Cigna’s financial capacity. As of March 1st, if an active, enrolled employee working 30 hours or more per week is furloughed or has hours reduced below normal full-time eligibility, Cigna will allow the employee to remain on the plan for the duration of the extending relief period. Employers must submit this request to Cigna and all fee and premium payments must be made. These changes to eligibility are available for all funding types. Employers must confirm that the employees who remain on the plan through the extended relief period were active and covered by the plan as of March 1, 2020

Member Support

Cigna is waiving cost-sharing and co-pays for COVID-19 related treatment through May 31, 2020. If you feel your company must opt out of these expanded benefits, please contact your Stahl & Associates Insurance Account Executive.

Updates & Additional Information

For updates and access to all of Cigna’s resources for Coronavirus (COVID-19) visit:

https://www.cigna.com/individuals-families/health-wellness/topic-disaster-resource-center/coronavirus-public-resources

FLORIDA BLUE UPDATES

Reduction in Hours, Furloughs and Layoffs

Employers who are faced with reducing hours and/or laying off staff due to COVID-19 can continue coverage for currently enrolled eligible employees as if they are active employees, even if they are furloughed or experience a reduction in hours worked. This non-enforcement policy will apply April 15th at which time Florida Blue will reevaluate this policy.

Waiting Periods

Florida Blue is still working to determine how waiting periods will be handled for employees that were terminated due to COVID-19 and come back as active, full time employees. However, they have communicated that they will work with groups and their members to ensure individuals have opportunities for coverage.

COBRA Options

For groups subject to COBRA, if one or more employee is terminated due to COVID-19, standard COBRA and state continuation protocols apply. If the terminated employee does not select COBRA, they will qualify for a special enrollment period for an individual policy. If the group terminates the policy all together, then members of that group would be eligible for a special enrollment period and could purchase an individual plan on or off the Marketplace.

Premium Payments and Deferrals

At this time, Florida Blue is following their normal payment and delinquency processes. They are waiting for guidance from the Office of Insurance Regulations and will provide updates as they develop.

Updates & Additional Information

For updates and access to all of Florida Blue’s resources for Coronavirus (COVID-19) visit:

https://www.floridablue.com/blog/covid-cases-confirmed-in-florida

HUMANA UPDATES

Reduction in Hours, Furloughs and Layoffs

Humana is relaxing the requirements that employees need to be actively at work to be eligible for coverage. This is effective until May 1, 2020 as long as monthly premium is remitted, and coverage is offered on a uniform basis. If all employees are laid off, as long as one person remains employed and covered by the plan, you can continue to offer coverage to employees who have been laid off until May 1, 2020.

Waiting Periods

Humana will waive the waiting period for employees who are laid off. New hires will be subject to standard waiting periods.

COBRA Options

For groups subject to COBRA, employees can elect to continue coverage under COBRA by following standard notice and election periods. If the group is terminated entirely, COBRA and/or state continuation for fully insured plans will not apply

Enrollment Changes

If a group’s enrollment drops by more than 10% as a result of the COVID-19 pandemic, rates and premiums will not be adjusted off renewal.

 Premium Payments and Deferrals

Humana will offer a 30-day grace period for premium payments or applicable state law.

Updates & Additional Information

For updates and access to all of Humana’s resources for Coronavirus (COVID-19) visit:

https://www.humana.com/coronavirus

UNITEDHEALTHCARE MEMBER RESOURCES

Reduction in Hours, Furloughs and Layoffs

For fully insured plans, if an employer reduces hours for part of, or their entire workforce in response to COVID-19, UnitedHealthcare will temporary allow them to remain on the plan through May 31, 2020. Monthly premium payments must be made, and coverage must be offered on a uniform, non-discriminatory basis. For groups that are self-funded, if UnitedHealthcare is the stop loss carrier, and admin fees and claims costs are continually paid, employers can continue to cover reduced hour employees even if they are not actively at work during the emergency. The plan must be administered on a uniform, nondiscriminatory basis. Self-funded groups with a third party stop loss carrier, should confirm with their stop loss carrier that their stop loss coverage aligns with their plan coverage as well as any questions surrounding reduced hour employees.

Waiting Periods

UnitedHealthcare will waive any rehire waiting periods for employees who were terminated due to COVID-19.

 COBRA Options

For groups subject to COBRA, and one or more employee is terminated due to COVID-19, standard COBRA and state continuation protocols apply. If employees are terminated and either they do not elect COBRA or there is no COBRA available, affected employees will have the opportunity to enroll in the Exchange in their state. Both small employers and individuals must elect Exchange Market Place Coverage within 60 days of the termination, or they will have to wait until the next open enrollment period.

Enrollment Changes

If a group’s enrollment drops by more than 10% as a result of the COVID-19 pandemic, rates and premiums will not be adjusted off renewal.

 Special COVID-19 Enrollment Opportunity

The following applies to fully insured employer groups. Self-funded groups may choose to amend their eligibility requirements at their discretion and should contact their stop-loss carrier before doing so.

UnitedHealthcare is providing fully insured small and large employer groups with a Special COVID-19 Enrollment Opportunity to enroll employees who previously did not enroll in coverage. The opportunity will be limited to those employees who previously did not elect coverage for themselves (spouses or children) or waived coverage. The enrollment opportunity will extend from March 23, 2020 to April 6, 2020 with an April 1, 2020 effective date. Employers are not required to adopt the Special COVID-19 Enrollment Opportunity, and no opt out action is required. Dependents can be added if they are enrolled in the same cover or benefit option as the employee. This is only intended to waive policy restrictions on adding new enrollees outside of open enrollment or normal special enrollment periods. Members cannot change plan options.  Standard waiting periods will be waived; however, existing eligibility and state guidelines will apply. Small employers (2 – 50 employees), will be required to supply a wage and tax statement to validate eligibility.

 Updates & Additional Information

For updates and access to all UnitedHealthcare’s resources for Coronavirus (COVID-19) visit:

https://www.uhc.com/health-and-wellness/health-topics/covid-19

 

BENEFITS/ EMPLOYMENT FREQUENTLY ASKED QUESTIONS

COVID-19 is changing the benefits and employment landscape daily. Stahl & Associates Insurance will be updating our FAQs as changes occur. Please contact your representative at Stahl & Associates Insurance with specific questions about your business or employees.

1. Will health insurance providers cover the cost of the COVID-19 testing and treatment?

 Yes. The Families First Coronavirus Response Act (FFCRA) requires health plans to cover testing for COVID-19 without employee cost sharing, prior authorization and other medical management requirements. Expanding on the FFRCA, the Coronavirus Aid, Relief and Economic Security Act (CARES Act) was signed into law on March 27, 2020 adding multiple provisions to employer health plans. Under the CARES Act Group health plans must cover the following, without cost-sharing:

  • FDA-approved tests (which was previously in the FFCRA);
  • Tests for which the developer has requested or intends to request FDA emergency use authorization (unless the test is denied by the FDA);
  • Tests developed in and authorized by a State that has notified the Secretary of Health and Human Services of its intention to review tests intended to diagnose COVID-19; or
  • Other tests that the Secretary determines appropriate.

In addition, some states have announced that insured health plans are required to waive-cost sharing related to the testing and treatment of COVID-19. Many national and local carriers have decided to comply with this voluntarily.

2. If we change our plan to cover COVID-19 testing and/or treatment without cost sharing, do we have to amend our plan documents?

Carriers for fully insured plans will issue any necessary documents to comply with any federal, state, or carrier mandates, such as covering COVID-19 testing and/or treatment without cost sharing. Self-funded plans should work with their Stahl & Associates Account Executive and Claim Administrator to generate plan document amendments documenting any change to the plan. Plans that are subject to ERISA must issue a summary of material modification (SMM) for any changes made to the plan document.

 3. Will employees still be eligible to make HSA contributions if our plan waives cost sharing associated with COVID-19 testing and treatment?

Yes. On March 11, 2020 the IRS released IRS Notice 2020-15, allowing HSA compatible high deductible health plans to cover services related to COVID-19 before participants meet their deductible, without interfering with participants’ HSA eligibility

4. How has the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) impacted FSA, HSA and HRA plans?

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) removed the requirement that individuals must obtain a prescription from a doctor for the purchase of over-the-counter (OTC) medicines and drugs under health saving accounts (HSAs), health flexible spending accounts (health FSAs), and health reimbursement arrangements (HRAs). Additionally, menstrual care products have been added as eligible medical expenses for purposes of these accounts. Employers can choose whether to include over the counter medications in their HRA. If they choose to do so, the plan document will need to be amended.

5. Can employees discontinue or change their DCAP elections if eligible daycares are closed and/or the employee is now staying at home to take care of their child during the COVID-19 pandemic?

Yes. Current IRS regulations support an election change to stop DCAP contributions in these instances. DCAP elections may be revoked and replaced with a new DCAP elections reflecting the new cost, if any. Employers should check their cafeteria plan document to ensure that reducing or stopping the DCAP election is permitted.

 6. If we reduce an employee’s hours or pay during the COVID-19 pandemic, will that give employees the right to drop their existing benefit elections?

Cafeteria plan rules do not allow for mid-year election changes due to a reduction in pay. However, they do allow for election changes if work hours are reduced to the point that the participant is no longer eligible for the coverage in which they are enrolled. If an employee continues to work their full-time hours and do not lose eligibility, then their coverage will remain irrevocable under cafeteria plan rules (unless another qualifying event occurs). If the employee cannot pay their premium (i.e. wages are not enough to cover required deductions), then the coverage would ultimately be terminated due to nonpayment. If contributions to a coverage are on a post-tax basis, generally, the employee may drop that coverage at any time.

 7. Can we decrease employer contributions for benefits due to a business interruption or slow down caused by COVID-19?

Yes. However, applicable larger employers subject to the ACA’s Employer Shared Responsibility should review how significant decreases in employer contributions would impact their ability to meet affordability requirements. If coverage becomes unaffordable due to a significant decrease in employer contributions, this could expose the employer to a penalty risk. This could also result in a significant increase in cost to the employee, which the IRS recognizes as an event which would allow employees to make election changes, assuming the Section 125 cafeteria plan document permits.

8.  What is the difference between a furlough and a layoff? 

Furloughs are typically temporary periods in which the employee is required to take unpaid time from work but remains in active status. Furloughs include reduced work hours, days, weeks, or months off without pay designed to allow workers to return to work at the end of the furlough period. During a furlough period paid vacation, pension, and retirement benefits may continue to accrue, depending on employer policy.

 Laid off workers are inactive employees that are terminated from payroll. Generally, benefits do not accrue for laid off worker. Depending on the plan language, if a previously laid off employee is rehired, the employee may not have to satisfy a new hire waiting period.

9.  If our employees are not “actively at work” during a temporary layoff or furlough, does that result in their loss of benefit coverage?

Maybe, it depends on your plan language. Some plans permit continued eligibility in the events of furloughs or temporary layoffs. Or, your plan may include an “actively at work” or full-time status provision causing employees to lose coverage during a temporary work stoppage. Many insurance companies are making exceptions and allowing employees to stay on the plan during a temporary layoff or furlough. Please consult with your agent about your options.  

10. Can we continue active employee medical benefits for individuals we put on temporary layoff or furlough?

Maybe, it depends on your plan language. Employers may be more generous than the law requires for plan eligibility. Employers need to ensure their carrier or stop loss carrier has agreed to the changes, and ERISA plans should follow the Summary of Material Modification (SMM) rules. 

11. Can we continue benefits for employees who are furloughed or temporarily laid off?

It is recommended to check your plan documents and with your benefits insurance carriers for layoff provisions that allow for extended benefits. Many insurance carriers have relaxed eligibility requirements due to the COVID-19 pandemic. If you want to continue benefits for active employees on a temporary layoff or furlough, you should check with your insurance carrier (and stop-loss carrier if applicable) to see how they are handling eligibility at this time.

12. Can we pay the employee portion of premium for those who are on a temporary layoff or furlough?

Yes, employers can pay the employee portion of the insurance premium during a temporary layoff or furlough. It is recommended that employers see guidance from their tax advisors about possible tax implications.

13. Can we pay for COBRA for employees which we have to layoff?

Generally, the answer is yes. However, there are a few things to consider when making this decision. Employers should ensure that COBRA subsidies are offered on a consistent basis and should understand potential implications. Employers should also check to see if any state COBRA laws apply and also review benefits not subject to COBRA in order to determine whether there are continuation or conversion requirements attached to those policies.

14. Can employees on furlough change benefit elections?

Yes, if furlough causes loss of eligibility for the employee, then the employee may change their election. If eligibility is not changed due to the furlough, there is no event unless the employer’s Section 125 cafeteria plan document addresses circumstances as outlined by IRS Notice 2014-55.

 15. Are employers required to continue employer-sponsored group health coverage for an employee on Public Health Emergency Leave or Emergency Paid Sick Leave?

Yes. An employee who takes leave for either of these reasons is entitled to continued coverage under the group health plan. The employee’s share of premiums should be made, and the employer must provide advance, written notice of the terms and conditions under which payment must be made. The employee’s contributions should be collected via one of the methods available for unpaid FMLA including:

  • Payment would be due at the same time as it would be made if by payroll deduction,
  • Payment would be due on the same schedule as payments are made under COBRA,
  • Payment would be prepaid pursuant to a cafeteria plan at the employee’s option,
  • Existing rules for payment by employees on “leave without pay” may be followed, provided that such rules do not require prepayment of the premiums that will become due during a period of unpaid FMLA leave or payment of higher premiums than if the employee had not taken leave; or
  • Another system voluntarily agreed to by the employer and the employee.
  • The employer may require that payment be made to the employer or to the insurance carrier, but no additional charge may be added to the employee’s premium payment for administrative expenses.

16. Has the federal government provided any delays or other relief for the filing of Forms 5500 or other notices and disclosures?

Not at this time. The Department of Labor was provided the ability to postpone certain ERISA filing deadlines by the CARES Act, but no action has been taken at this time.

17. What is the Families First Coronavirus Response Act (FFCRA)?

The Families First Coronavirus Response Act (FFCRA) was signed into law on March 18, 2020 and is intended is to reduce economic strain on citizens and employers. The FFCRA makes changes to several regulations, including emergency paid sick leave, expansion of FMLA and more. The requirements under FFCRA take effect on April 1, 2020 and will remain in place until December 31, 2020.

 18. What expansions have been made to Family Medical Leave Act (FMLA) under the FFCRA?

The FFCRA expands FMLA to allow an eligible employee to take leave if they are unable to work due to a need to care for a minor child if the school or place of care has been closed or the child care provider is unavailable, due to a public emergency.

If leave is needed under the expanded provision, the first 10 days of leave may be unpaid, and employees can elect to use vacation, personal, medical or sick leave. The employee and employer must agree any substitution. After 10 days, the employer must compensate the employee for the remainder of the FMLA leave. Payment must be at no less than 2/3 of their regular rate of pay and caps at a maximum of $200/day and $10,000 aggregate.

19. Under the FFCRA what is the definition of an “employer”?

An “employer” is considered any employer with fewer than 500 employees. Small businesses with less than 50 employees are exempt if it would jeopardize the viability of the business as a going concern as well as employers with less than 25 employees (if special conditions apply). Schools and public agencies (regardless of size), are considered “employers”.

20. Under the FFCRA what is the definition of an “eligible” employee?

An “eligible” employee is one who has been employed by their employer for at least 30 days. Certain healthcare providers and emergency first responders are excluded from this definition.

21. Under the FFCRA what is the definition of a “public health emergency”?

A “public health emergency” means an emergency with respect to COVID-19 declared by a Federal, State, or local authority.

 22. What is the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)?

The Coronavirus Aid, Relief and Economic Security Act was signed on March 27, 2020, and includes multiple provisions affecting employers and employee benefit plans.

23. When are employee’s eligible for Emergency Paid Sick Leave?

Employees are eligible for Emergency Paid Sick Leave immediately upon hire.

24. Are part-time employees entitled to Emergency Paid Sick Leave?

Yes. Part-time employees are entitled at their regular rate of pay for the average number of hours that they would work in a two-week period.

 25. For what reasons would an eligible employee be able to use Emergency Paid Sick Leave?

Employee can use emergency paid sick leave if they are:

  • Subject to a federal, state, or local quarantine or isolation order related to COVID-19;
  • Advised by a health care provider to self-quarantine due to concerns related to COVID-19;
  • Experiencing symptoms of COVID-19 and seeking a medical diagnosis
  • Caring for an individual who is subject to federal, state or local quarantine or isolation order related to COVID-19 or has been advised by a health care provider to self-quarantine
  • Caring for their child if the school or place of care of the child has been closed, or the childcare provider of child is unavailable, due to COVID-19 precautions; or
  • Experiencing any other substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretary of Treasury and the Secretary of Labor.

26. What steps should employers take to make sure they are compliant with new regulations under the FFCRA?

In order to ensure they are compliant with FFCRA employers should:

  • Evaluate current paid leave policies and address new requirements for absences related to COVID-19
  • Post the required FFCRA notice on premises and/or distribute to employees via email and/or direct mail
  • Check updates from Federal, State and local activity and review all applicable COVID-19 related legislation

Stahl & Associates Insurance is closely monitoring the Coronavirus COVID-19 outbreak will continue to provide updates as they evolve. If you should have any questions, please contact your Account Executive at Stahl & Associates Insurance for additional information. We are happy to assist with guidance or any questions.

This document is for general informational purposes only. While we have attempted to provide current and accurate information, this information is provided “as is” and Stahl & Associates Insurance makes no warranties regarding its accuracy or completeness. This information should not be considered legal or tax advice or as a recommendation of any kind. Employers should seek legal advice with their own attorneys and tax advisers regarding their situation.

PEOPLE SAFE SOLUTIONS & COVID-19 GUIDANCE

The People Safe Solutions Team recommends the following strategies for maintaining a safe workplace and workforce during the COVID-19 crisis.

CONSTRUCTION INDUSTRY

General Work Environment

  • Maintain the mentality that everyone could have COVID-19
  • Maintain a minimum of six feet distance between individuals (ALWAYS)
  • Avoid touching your eyes, nose and mouth
  • Do not allow non-essential visitors to your site(s)
  • Clean and sanitize your cell phone/electronics frequently throughout the day
    • Cleaning your cell phone could be as important as washing your hands since it touches your hands and face on a regular basis

Working with Shared Equipment or Areas

  • Everyone should clean and sanitize “High Touch” areas after each use throughout the day
    • Tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, sinks, etc.
  • Use bottled water instead of a common water cooler
  • Clean and disinfect shared equipment and tools (copiers in offices, coffee machine, hand or power tools, etc.) before and after every use
  • Do not share personal protective equipment (gloves, safety glasses, face masks, etc.) with anyone at any time
  • Common areas need to be cleaned and sanitized before and after each use
    • Example: Clean and sanitize the chair and area that you sit at to eat lunch

Delivery of Packages or Mail to the Office

  • Designate a package drop off area away at least six feet from employee workspaces
    • Example: Use a card table, or clean trashcan
  • Clean and sanitize all mail and packages as they arrive
    • Example: Spray with Lysol and let sit for a few minutes
  • Discard outer boxes or packaging immediately
  • Clean the drop off area after each delivery
  • Be sure to wash or sanitize your hands after handling any delivery

For groups subject to COBRA, if one person remains actively employed, employees can continue to elect COBRA coverage under the normal notice and election procedure. If the plan has no active employees, the plan will be terminated, and COBRA is not an option.

MANUFACTURING INDUSTRY

General Work Environment

  • Have the mentality that everyone could have COVID-19.
  • Maintain a minimum of 6 feet distance between individuals (ALWAYS).
  • Avoid touching your eyes, nose and mouth.
  • Do not allow non-essential visitors to your site(s).
  • Clean and sanitize your cell phone/electronics frequently throughout the day.
    • Cleaning your cell phone could be as important as washing your hands since it touches your hands and face on a regular basis

Working with Shared Equipment or Areas

  • Everyone should clean and sanitize “High Touch” areas after each use throughout the day.
    • Tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, sinks, etc.
  • Use bottled water instead of a common water cooler
  • Clean and disinfect shared equipment and tools (copiers in offices, coffee machine, hand or power tools, machinery etc.) before and after every use.
  • Do not share personal protective equipment (gloves, safety glasses, face masks, etc.) with anyone at any time.
  • Common Areas need to be cleaned and sanitized before and after each use.
    • Example: Clean and sanitize the chair and area that you sit at to eat lunch.

 Delivery of Packages or Mail to the Office

  • Designate a package drop off area away at least 6 ft. from employee workspaces
    • Example: Use a card table, or clean trashcan
  • Clean and sanitize all mail and packages as they arrive.
    • Example: Spray with Lysol and let sit for a few minutes
  • Discard outer boxes or packaging immediately.
  • Clean the drop off area after each delivery.
  • Be sure to wash or sanitize your hands after handling any delivery.

Reduction in Hours/Layoffs

Capital Health Plan has adopted a non-enforcement policy which will apply for currently enrolled eligible employees that will allow them to retain coverage as if they were active employees even if they are furloughed or drop below the minimum hours worked for full time employees. This non-enforcement policy will apply until April 15th at which time they will reevaluate.

RESIDENTIAL SERVICES INDUSTRY

General Work Environment

  • Have the mentality that everyone could have COVID-19.
  • Maintain a minimum of 6 feet distance between individuals (ALWAYS).
  • Avoid touching your eyes, nose and mouth.
  • Do not allow non-essential visitors to your site(s).
  • Clean and sanitize your cell phone/electronics frequently throughout the day.
    • Cleaning your cell phone could be as important as washing your hands since it touches your hands and face on a regular basis.

 Work Performed in Private Residences

  • Contact customers prior to arrival to ask if anyone in the house is sick. If possible, reschedule the appointment if anyone is sick.
  • Clean and sanitize your work equipment every time you use it
  • Clean “high touch” areas ( Door handles, steering wheel in your car, shift knob, clipboards, laptops, etc.) of your vehicle and working space frequently to avoid spreading germs.
  • When entering someone’s home, be respectful and explain what steps you are doing to protect yourself and them.
  • While in customer’s home use a respirator, goggles, single use shoe covers, gloves and other required Personal Protective Equipment (PPE).

 Delivery of Packages or Mail to the Office

  • Designate a package drop off area away at least 6 ft. from employee workspaces
    • Example: Use a card table, or clean trashcan
  • Clean and sanitize all mail and packages as they arrive.
    • Example: Spray with Lysol and let sit for a few minutes
  • Discard outer boxes or packaging immediately.
  • Clean the drop off area after each delivery.
  • Be sure to wash or sanitize your hands after handling any delivery.

More Information:

OSHA Guidance for Preparing Workplaces for COVID-19 https://www.osha.gov/Publications/OSHA3990.pdf

OSHA Standards as theyrelate to COVID-19

https://www.osha.gov/SLTC/covid-19/standards.html

Florida Health Resources for COVID-19

https://floridahealthcovid19.gov/resources/#toolkitJump