COVID 19 Q&A PT 5: Does our group health insurance cover Coronavirus?

This is Part V of our COVID-19 Q&A series. We’re gonna be talking about health insurance applications over the coronavirus, including layoffs and furloughs. We’re going to talk about specific coverages that are being offered new enrollment periods, all kinds of fun stuff. As we dive in or before we do, do me a favor, please subscribe. It makes such a difference to our ability to continue to produce long-form free content like this. You can find us on iTunes, Google podcasts, Spotify, Stitcher, any pod catcher of your choice. Also if you subscribe at peopleprocesses.com we have subscriber only content, including sample communications that you can use to send out to your employees, edit them, run by your attorney if you’d like. And everything from communicating furloughs to how these benefits change or work. We want to help you communicate those, peopleprocesses.com to subscribe. 

Now let’s dive right in. The first question and I apologize if I sound a little funny, I’ve got a really bad allergies here at the beginning of April, late March. It is not Coronavirus, but just quite allergic, I apologize.

First question we’re getting which is a lot is, 

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

So what happens when I terminate someone or lay them off? The answer depends. The answer is, Not Necessarily. Are they entitled to group health plan coverage? You need to check your 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. Most of the time, it’s through the end of the month in which they are terminated or become ineligible due to an hour reduction. Once this period expires, active employee coverage must be terminated (unless the insurance carrier or self-funded plan sponsor agrees to temporarily waive this eligibility provision), and you must send your Cobra notice. If your plan is self-funded and you’d like to waive the coverage because you can, that’s cool, but make sure that your stop-loss coverage carriers agree to cover claims related to participants who would otherwise be ineligible for coverage. That’s a big deal. 

As of late March, many fully insured plans are WAIVING minimum hour requirements and generating a new special enrollment period. So if you’re cutting someone who’s full time down to 20 hours a week, normally, that would be a life event in their coverage on whatever day your plan document says. Normally, at the end of the month you do that. However, most of the fully insured companies, the large ones out there, HUMANA, Aetna, Cigna, United have decided, “Hey, you ‘re going to waive that minimum coverage requirement if you choose to do so. If you choose to do so you have to do it for everybody. Keep that in mind.” And that would allow you to continue insurance for employees who’ve had major hour reductions. 

Well, that leads to the next question.

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

In the normal everyday stuff, if they can’t pay the premium, then group health plan coverage would cease when that employee’s share premium 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 this disaster is sorted out. Like I said, most of them have and until an employee reopens their doors. More likely, the employer will make an arrangement with the insurance carrier to provide health coverage to pay the employees’ share premiums to keep coverage in place (at least temporarily) and that’s actually what’s going on. The insurance carriers are fine with the employer picking up a whole cost until the employer can reopen its doors or the employees start working enough hours to cover it. If you choose to do so, each separate situation is different, depending on the insurance carrier and the relationship between the employer and the insurance carrier. It’s just going to have different results. You got to talk to your insurance broker or your insurance carrier so that these needs can be individually assessed.

In our furlough letters for subscribers that peopleprocesses.com we spell out the different scenarios to recoup that cost. One important note under the FFCRA (Families First Coronavirus Relief Act. If the employee is being paid that Emergency Paid Sick Leave (EPSL) or Emergency Paid Family Medical Leave Act (EPFMLA) and you’re making that employer contribution on their behalf, the government will repay you not just the cost of the leave but also the employer contribution, super important to remember. 

Other questions we’re getting.

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

Yes. If your plan is fully insured, you want to contact your insurer to confirm coverage and call sharing parameters but like, it’s not law that they have to do so. As of March 24th, all plans must cover COVID-19 testing at no cost to its members. That includes copays, deductibles, coinsurance, for whether you get the test on at your primary care, a drive through an emergency room or Urgent Care Clinic, Diagnostic testing is covered 100%. Self-funded plans to my knowledge are not required to provide that coverage, but we could see an amendment to the federal laws regulating group health plans that would change that. A self-funded plan’s stop-loss carrier and TPAS should be consulted before coverage changes just to make sure your stop-loss is going to cover those issues. I think they will but they take a look at that.

Coinsurance or copay waivers for testing can be problematic or they should have been problematic just to kind of give you a little background in people in high-deductible health plans (HDHP) with health savings accounts (HSAs). Because one fundamental requirement on an HDHP/HSA plan is that it may not provide benefits in any plan year until the deductible for that plan year is satisfied. However, the IRS provides an exception to that general rule for certain types of “preventative care.” Like under the ACA, your kind of annual woman exam. On March 11, the IRS issued notice 2015, it’s on our website if you wanna check it out. That clarifies that vaccines are considered preventative care. They also clarified that until further notice, health benefits medical services and item purchased in association with the treatment for or testing of COVID-19 must be provided by a health plan without a deductible, or at a reduced or no cost to participants and it would not disqualify the HDHP or covered individual for making HSA contributions. So, basically don’t worry about the HSA parts of this

Alright, one more kind of thing that comes up. 

How can we better leverage existing group health benefits?

So like, you guys have people now teleworking. People are calling about their health insurance a lot. What can you do? Well, first of all.

• Telemedicine services. Telemedicine is an ideal option for people seeking medical consultations for non-emergency care. If most plans now offer telemedicine care as part of a group health plan, most companies, larger insurers are offering it for free now during this crisis. So that includes coordination of diagnosis, treatment plans, specialist referrals, they can write prescriptions. It’s a very good service and they’ll also be able to give you that referral needed if you need a medical diagnosis to go get a test. So highly recommended. You will often need a thermometer and a scale. These are the things you need at home to take care of those. You should send your employees out information about how they can access the telemedicine. So they’ll do that. 
• Employee Assistance Programs. You probably have an employee assistance program. If not, you should contact your broker. But those provide great benefits that are not just physical but mental health – stress management, elder care, personal finance, substance abuse consultations are just some of the commonly provided services. This is a good time to start getting people involved in that if they’re at home with kids and they’re getting angry. They have an employee that they’re trying to tell remotely and it’s giving them trouble. Those are all great reasons to call your employee assistance program. 
• Wellness Program Services. If your employees have had a major disruption in their life working from home, wellness programs are often a rich resource of education related to disease prevention. They offer basic education on a variety of pertinent topics such as basic hygiene, traveling tips. They include a nurse phone line program, normally, that can be utilized to obtain confidential responses to various health topics if you’re concerned about something. And it’s a good time to talk to me about standing up at their desk and walking around and doing those sorts of things from home because a lot of them are working from home for the first time in a major thing.
• Disease Management Programs. Some plans have what are called disease management programs. Those are tailored programs for employees or families at risk of developing chronic medical conditions, such as high blood pressure or diabetes. Individuals with those sorts of diagnosis may be more susceptible to adverse results from COVID-19. So ensure that they have the opportunity to consult with their coach or case monitor to manage their health conditions. The number one thing someone with diabetes can do to keep from having a bad result from COVID-19 is treat the diabetes. Okay. 
• Free or Discounted Preventive Care. Flu shots and other vaccines as well as diagnostic testing are often provided at no or low cost for most group health plans and wellness programs. So it’s worth checking that out. If they haven’t had their flu shot, it’s still worth doing. 

In addition to what is currently available under your plan, plan sponsors may consider permitting the plan to offer a larger range of preventative care benefits. For example, last year in Notice 2019-45, the IRS and HHS expanded the types of preventative care that will not interfere with HSAs. Those are specifically for people diagnosed with asthma, heart attack and diabetes – individuals that are at a very higher risk of getting sick from the COVID-19 could fall under those things. The FFCRA also updated so that copays, er visits, and urgent care visits are not owed and do not interfere with those HSA/HDHP provisions. As we talked about before, you want to permit the plan that you have to cover those and other specified preventative care at no costs. So with the bare minimum cost sharing, if you’re doing a self insured plan, this is obviously a good investment to get your people’s diagnostics rather than have them hospitalized. So if you’re self-insured, you have to do a little work fully insured. 

The insurers are just all over this on our website, peopleprocesses.com. You can subscribe, get more information, we have links to the notices we talked about. I’d love to see you there. Thank you for tuning in. I hope this answered some of your questions and gave you some ideas about what you can do about your health plan here during this COVID-19 crisis. Next up, we have another episode on our last Q&A. For now, they’re a little difficult to do podcasts. Take about a week for me to do them and then put them out. So they’re a little outdated a lot of times by the time we get to the actual editing, so I’m trying to turn these around a lot quicker. It’s really much better to subscribe on our site so you can get our newsletter with our updates that come out daily or every other day with all of our sample documents and reference material. It’s better to read on some of this stuff. Nevertheless, thank you for tuning in. Thank you for subscribing. My name is Rhamy Alejeal and I hope you have a great day. Now it’s time for you to go out there and get your work done.

Reference links here:

IRS issued Notice 2020-15, Notice 2019-45

COVID-19 Q&A Part I, II & III links here:

Part I – Should we send everyone to work from home with this Coronavirus?

Part II – I think an employee may be sick… what do I do?

Part III – Can an employee refuse to come to work because of fear of Coronavirus?

Part IV – If I layoff an employee, do I have to pay this new sick leave?