Please see this updated list of COVID-19-related benefits changes from group insurance carriers AETNA, Horizon BCBSNJ, Independence Blue Cross, and UnitedHealthcare Oxford. This information is provided by our partner organization Savoy Associates, and includes expense coverage, antibody testing, and deferred group premium payment deadlines. If you have any questions about your carrier or coverage, please don’t hesitate to contact us at Kirwan Benefits & Investments.
COVID-19 ANTIBODY TESTING
All Commercial and Medicaid plans will cover serological (antibody) testing with no member cost-share, as required under recent legislation.
SMALL GROUP NEW BUSINESS SUBMISSION EXTENSIONS
EXCEPTIONS
Off Anniversary plan downgrades are available through July 31, 2020. Businesses that temporarily close will be allowed to continue their AFA plan provided premiums are paid monthly based on the assumption that the business will reopen after the COVID-19 pandemic. Business that close permanently Aetna will waive the 30-day advance termination requirement upon group request. Such a request must be received prior to the termination date. Special Enrollment period, Aetna has is offering a SEP for employees who previously waived coverage, the enrollment opportunity is being offered from April 6-17th for an April or May 1, 2020 effective date.
FURLOUGH/LAYOFFS SPECIAL RULES
Furloughed (temporarily laid-off) employees and those with reduction in hours will be temporarily allowed to stay on the medical plan provided premium payment continues and that the option to remain insured is offered to all impacted employees. Employees who are terminated, should be terminated from the group health plan and offered State Continuation/COBRA. Upon rehire, wait period will be waived. These exceptions will expire on July 31, 2020.
PREMIUM GRACE PERIODS
Aetna will work with AFA plan sponsors to extend grace periods for the months of March, April and May. Group must contact the Answer Team to establish the extension. Fully-Insured NY Small Groups: Aetna will not terminate any NY small employer group for non-payment of their health insurance premiums through June 1, 2020. During the extended grace period, claims will continue to be paid and please know your small group customers will not be sent to collections or to collection reporting agencies. Aetna is available to discuss your payment and plan options, to do so call your broker or Aetna at 1-800-297-7145.
IN-NETWORK DIAGNOSTIC TESTING FOR COVID-19
Member Cost-Share Waived.
AETNA SMALL MAINTENANCE MEDICATIONS
Waiving early refill limits on 30-day supply of maintenance medications. CVS waiving charges for home delivery of medications.
TELEMEDICINE
Member cost-share waived, through 6/6/2020
From our family at Kirwan Companies to yours, we pray that you, your family, friends, and valued employees remain safe and healthy as we work together to succeed and defeat this crisis.
COVID-19 ANTIBODY TESTING
COVID-19 Antibody tests are covered in full, with no member liability, when ordered by a doctor or provider, including telemedicine providers and submitted through an in-network laboratory (CPT Codes: 86328 and 86769). These tests must be FDA approved and the office performing the test must have a Clinical Laboratory Improvement Amendments (CLIA) waiver certification to bill for these services.
SMALL GROUP NEW BUSINESS SUBMISSION EXTENSIONS
EXCEPTIONS
Not applicable at this time.
FURLOUGH/LAYOFFS SPECIAL RULES
Horizon is waving the “actively at work” requirement applicable to fully insured commercial plans. Furloughed employees or those with reduced work hours may remain covered under the group health plan provided medical premiums are paid. Furloughed employees may remain on the plan for the next 60 days (guidance released on 3/25/2020). Employees who are terminated should be offered State Continuation/COBRA. At the employers discretion rehire wait periods may be waived for the next 60 days
PREMIUM GRACE PERIODS
As detailed in Horizon BCBSNJ’s COVID-19 Resource Guide, per the New Jersey Department of Banking and Insurance (NJDOBI) Bulletin No. 20-13, Horizon BCBSNJ will extend the health and/or dental premium payment grace period for small employer and qualifying large employer (51+) customers.
Deadlines to elect the Emergency Premium Payment Deferral Program are as follows:
April 2020 – All forms must be submitted by 4:00PM on April 30th.
May 2020 – All forms must be submitted by 4:00PM on May 15th.
Small Employer: Horizon BCBSNJ will extend the health and/or dental premium payment grace period for small employer customers from 31 calendar days to 60 calendar days. The emergency grace period may start with either the April or the May coverage, and to the premiums due for those months covered by the emergency grace period. If the small employer group already missed the April premium payment, the group is currently covered under the emergency grace period.
Repayment: If the small employer group takes advantage of the emergency grace period, the group will have six months to repay the deferred health and/or dental premiums in full.
Large Employer: Horizon BCBSNJ will extend the health and/or dental premium payment grace period for qualifying large employer customers to 60 calendar days. A large employer qualifies only if it can demonstrate financial hardship directly caused by COVID-19. The emergency grace period may be applied to the April or May premium.
Repayment: If the large employer group (51+) takes advantage of the emergency grace period, the group will have at least six months to repay the deferred health and/or dental premiums in full.
As a reminder, to be eligible to participate in the Emergency Premium Grace Period Deferral Program, all groups, regardless of size, must be in good standing as of March 1, 2020.
TESTING AND TREATMENT
Effective immediately and through June 30, 2020, all fully-insured members, including those covered through Medicaid, Medicare Advantage, Individual and Small Group policies as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP), will not pay any cost-share amounts (copay, coinsurance, deductibles) for covered services related to the testing, diagnosis and treatment of COVID-19 for:
MAINTENANCE MEDICATIONS
Waiving early refill limits on 30-day supply of maintenance medications.
TELEMEDICINE
Access to telehealth will be provided 24/7 and member cost share will be waived through June 13, 2020. In addition, 24/7 access to licensed nurses who can assess and assist members with symptoms that are consistent with suspected COVID-19 infection. Those service are available through the company’s free “Horizon Blue” app, the www.HorizonBlue.com online portal, or by phone at 1-888-624-3096.
COVID19 ANTIBODY TESTING
COVID-19 diagnostic and antibody testing approved by the FDA and performed in an approved health care setting are both covered with no cost sharing for members, for the duration of the COVID-19 pandemic. Like the COVID-19 diagnostic testing, self-funded customers must also cover the COVID-19 antibody testing at no cost share for their covered employees and their families.
SMALL GROUP NEW BUSINESS SUBMISSION EXTENSIONS
Not applicable at this time.
EXCEPTIONS
IBC is waiving prior authorizations for all in-network, inpatient acute care treatment for COVID-19. To further support members in getting access to care, IBC has expanded this change to waive all prior authorizations for in-network, acute inpatient admissions for any diagnosis from the emergency room. This change is being extended through June 4, 2020.
FURLOUGH/LAYOFFS SPECIAL RULES
Independence will honor employer requests to continue coverage for employees furloughed or temporarily laid off as a result of impacts of COVID- 19. This exception applies to fully-insured and self-funded business This exception is in effect until June 30, 2020. This exception will not be valid on or after July 1, 2020. Waiting Periods for furlough or laid off EEs: Groups may waive the waiting period for employees with a lapse in coverage due to a furlough or lay off if the waiver policy is applied consistently to all eligible employees. Please refer to the 3/31/2020 INDEPENDENCE EDGE for additional details.
PREMIUM GRACE PERIODS
Fully-insured groups under 500 may elect to defer May premium payments. To be eligible, premium payments must be current through April. Deferred payment installments for May can be paid over three monthly installments for those who qualify. The signed Payment Agreement must be submitted to your Savoy sales team no later than 4:00PM on May 15, 2020.
TESTING AND TREATMENT
IBC is waving member cost-share for in-network, inpatient, acute care treatment of COVID-19. This means members will have no out-of-pocket costs for COVID-19 related hospitalizations, and for emergency room visits that result in a member being admitted for COVID-19 treatment. These changes are in effective from March 30, 2020 through May 31, 2020.
MAINTENANCE MEDICATIONS
Waiving early refill limits on 30-day supply of maintenance medications.
TELEMEDICINE
MDLive telemedicine benefit is available to all fully-insured groups April 1 to June 4, MDLive telemedicine benefit will be added to all fully-insured group customers that previously did not have this benefit. There will be no impact to premiums as a result of this addition, and member cost sharing will be waived during this time period.
COVID-19 ANTIBODY TESTING
For the duration of the emergency period, UnitedHealthcare will cover antibody detection tests (Serology – IGG/IGM/IGA for SARS-nCOV2 (COVID19) at no cost-share to the member when ordered by a physician or health care provider. UnitedHealthcare strongly supports the need for reliable testing and encourages employers and members to consider tests that either have FDA approval or an emergency use authorization from the FDA.
SMALL GROUP NEW BUSINESS SUBMISSION EXTENSIONS
EXCEPTIONS
UHC is providing fully-insured Small Business and Key Accounts clients with a Special COVID-19 Enrollment Opportunity to enroll employees who did not previously enroll in coverage. The opportunity will allow employees who previously did not elect coverage for themselves (spouses, children) or waived coverage to enroll. The opportunity will extend from March 23 to April 13, 2020. The effective date of coverage will be April 1, 2020. Buy down to a leaner plan, employers have options to downgrade current plan design or add a leaner plan option. Please discuss available options with your Savoy sales team. Plan buy downs and additions to leaner plan design options are available through May 31, 2020.
FURLOUGH/LAYOFFS SPECIAL RULES
Furloughed employees and those with reduction in hours will be temporarily allowed to stay on the medical plan premium provided payment continues and that the option to remain insured is offered to all impacted employees. Employees who are laid-off, should be terminated from the group health plan and offered State Continuation/COBRA. Upon rehire, wait period will be waived.
PREMIUM GRACE PERIODS
For insureds (individual /group) who are experiencing financial hardship as a result of COVID-19 and need assistance, please contact Oxford using the following instructions:
For Groups (small and large) that are experiencing financial hardship as a result of COVID-19 and need assistance, they can request an extension or discuss alternative payment arrangements by calling Oxford Financial Operations team at 1-800-366-4148, TTY 71.
PREMIUM GRACE PERIODS
Individual insureds must confirm their intent for an extension of premium payment(s), to do so, please send an email to billing_team@uhc.com with one of the following three responses:
Please note that this is simply an extension to pay premium for those in need and not a waiver or forgiveness of the premium.
IN-NETWORK DIAGNOSTIC TESTING FOR COVID-19
Member Cost-Share waived for testing and treatment related to COVID-19.
MAINTENANCE MEDICATIONS
Waiving early refill limits on 30-day supply of maintenance medications.
TELEMEDICINE
Telemedicine is available at no cost. For groups enrolled on the Oxford platform, members should contact member services to request an online access code for telemedicine services.
