Dear Integrity HRM Family,

We know that right now, you may have more questions than you have answers. We understand that times of uncertainty can cause feelings of uneasiness, which is why we want to help provide some clarity on how the carriers are responding to this time of change.  The following is a snapshot of how each carrier is accommodating the needs of their members.

Humana

Out-of-pocket costs associated with COVID-19 testing and treatment (copays, coinsurance and deductibles) have been waived.  This includes related visit costs in a range of clinical settings such as a physician’s office, urgent care center or emergency department.

Member cost-sharing has been waived for all telehealth services delivered by participating/in-network providers.

Early prescription refills are allowed, so members can prepare for extended supply needs – an extra 30- or 90-day supply as appropriate.

Requirements have been lifted for members infected with Coronavirus and for all patients in settings where capacity is stretched by the needs of those infected by Coronavirus.  The change allows for unencumbered movement from inpatient hospitals to safe, medically appropriate post-acute care settings, including home health, long-term acute care hospitals, skilled nursing facilities, etc.

*Effective through May 31, 2020, Humana has relaxed their requirement that employees be actively at work in order to be eligible for coverage.  As long as one person remains actively employed, employees who have been laid off as a result of the COVID-19 pandemic can continue to be covered. This coverage must be offered on a uniform, non-discriminatory basis.

*Humana will proactively send an email and/or postcard to members most at-risk for COVID-19.  These outreach emails and postcards will provide information on the virus, how they can protect themselves and detail resources available to them in response to COVID-19.

*Humana will waive the waiting period for rehired employees who were laid off temporarily as a result of COVID-19.

Blue Cross Blue Shield (BCBS)

Out-of-pocket costs associated with COVID-19 testing and treatment (copays, coinsurance and deductibles) with in-network providers have been waived.  This includes related visit costs in a range of clinical settings such as a physician’s office, urgent care center, emergency department, or telehealth.

Restrictions have been temporarily lifted on getting early prescription refills. Refills will be for the same quantity as the last prescription the member filled.  Pharmacists have approval to provide an early refill on most medications.  Members can use their 90-day supply benefits for covered non-specialty medications at select retail pharmacies or home delivery.

*Effective through April 30, 2020, employers can maintain employees who were enrolled on their plans as of March 20, 2020, regardless if an employee’s hours have been reduced, or if they have been furloughed or laid off.

*An optional special enrollment period is being offered from March 30, 2020 to April 30, 2020.  This applies to eligible employees and their dependents who previously declined coverage and now want to enroll, or currently enrolled employees who wish to add an eligible spouse or dependent to their existing coverage.  Applicable enrollment changes must be received on or prior to May 1, 2020.  The effective date of coverage will be April 1, 2020.

*BCBS will waive the waiting period for rehired employees who were laid off temporarily as a result of COVID-19.

United Healthcare

Out-of-pocket costs associated with COVID-19 testing and treatment (copays, coinsurance and deductibles) have been waived.  This includes related visit costs in a range of clinical settings such as a physician’s office, urgent care center or emergency department.

Restrictions have been temporarily lifted on getting early prescription refills.  The member should look at their current supply of medications, as well as what they might need in the near future, to decide if they should refill early.

*United Healthcare is providing a Special COVID-19 Enrollment Opportunity to enroll employees who previously did not enroll in coverage.  This chance will be limited to those employees who previously did not elect coverage for themselves (or their spouses or children) or waived coverage.  This opportunity will extend from March 23, 2020 to April 13, 2020.  The effective date of coverage will be April 1, 2020.

*United Healthcare will waive the waiting period for rehired employees who were laid off temporarily as a result of COVID-19.

Options Plus (SBMA)

Out-of-pocket costs associated with COVID-19 testing are covered at 100%.  Unlimited Telehealth visits will continue to be covered at 100%.

 

Sedera

COVID-19 treatment will be covered the same as any other respiratory illness.  Cost of treatment will be paid at 100% after the Initial Unshareable Amount (IUA) of $1,500 has been satisfied. 

All Sedera members have access to the most up-to-date information on COVID-19 through 2nd.MD.  This is a dedicated toll-free support line that is manned by trained 2nd.MD care team nurses providing COVID-19 information, education, and support to individuals.  While they cannot provide a diagnosis, they can assist with education on potential exposure risks, help direct the member to seek medical care, and provide expert consults for those directly impacted by COVID-19.  Details for how to access this resource are available on the COVID-19 Resources page in the member’s Member App.

*The following options can be offered to employees of groups who are having to either temporarily close their businesses or have been laid off as a result of the group experiencing financial loss:

*The first option is to transfer the employee’s membership from SELECT to ACCESS, then move back to SELECT once the group has recovered.  The employee must take this step so they can continue to make contributions to their membership while they are unemployed.

*If the first option is not feasible for the member, Sedera is willing to suspend an individual’s membership for April and May.  When the member wants to reinstate their membership, Sedera will bridge their membership from their original start date.  The benefits of this option are:

·         Typically, if a member does not continue contributions within 30 days, time as a member as it relates to any pre-existing conditions start over.

·         Member will continue to have access to Teladoc.

·         Member will continue to have access to 2nd.MD.

·         Member will continue to be able to use Sedera’s Medical Concierge to shop for facilities, diagnostics, and procedures.

·         While Sedera cannot share medical expenses incurred during suspension, Sedera will help negotiate any medical bills in excess of $1,000.

·         For active Needs opened prior to the suspension, bills for services received in April and/or May can be shared IF and only IF both months are paid in full upon re-activation of the account.

·         Any medical event incurred during suspension would be subject to pre-existing sharing restrictions.

Memorial Hermann

Out-of-pocket costs associated with COVID-19 testing are covered at 100%.  Unlimited Telehealth visits will be covered at 100%.  Cost of COVID-19 treatment will be applied towards deductible, coinsurance, and/or copays.

Gold’s Gym

Corporate club locations are currently closed and will remain closed based on local and state guidelines.  Payroll deductions for existing members have been paused.  When plans are secured to reopen facilities, communication will be distributed and membership fees will be reinstated.

As a reminder, all Gold’s Gym members have FREE premium access to the GOLD’S AMP digital personal training app as well as on-demand and live streaming video workouts.  Activation details are available at www.goldsgym.com/anywhere.

Flexible Spending Account (FSA)

During these unprecedented times, regulations and laws may evolve quickly in the coming weeks and months.  Members may be unable to spend FSA funds as initially intended.  The inability to spend funds, for example, may be due to the number of childcare closings, in addition to specialty health clinic closings, such as optometry, dental and chiropractic care, due to COVID-19.  Current FSA regulations do allow for plan changes due to a change in employment, such as a reduction in hours.

At this time, IRS guidance has not made any changes related to FSA regulations as a result of COVID-19.  The situation will continue to be monitored and updates will be sent out as news becomes available.

 

Dependent Care Flexible Spending Account (DCFSA)

Members have existing options to modify their pre-tax elections to support their needs at this time.  Examples include:

·         Suspending an election: If the member’s daycare has closed and is not billing for services, the member may consider suspending their election.  Should they choose to do this, they may re-elect once their daycare services resume.

·         Modify an election: The member may increase or decrease their election if their daycare provider has adjusted its fee schedule during this time.

If a child is switched from a paid provider to “free care” (i.e. neighbor or relative) or no care, an election change will be permissible whenever there is a change in provider.  Should a member’s family needs require that they seek new provider services that have a cost, they may add an election. 

For example, the member could consider hiring a babysitter for their children while they are working in their home.  This will qualify as long as the babysitter is over the age of 19 and is not their spouse, the parent of the child, or anyone they can claim as dependent on their tax returns.

Health Savings Account (HSA)

An HSA election change can occur at any time, for any reason.  However, the limit is one change per month.

Transamerica

Term Life: If included in the plan design, the Waiver of Premium Rider waives the premium for up to 6 months per 12-month period if the member is involuntary laid off.  Layoff of an insured spouse or child does not qualify for waiver.  This rider terminates when the owner reaches age 65.

Whole Life & Universal Life: If included in the plan design, the Waiver of Premium Rider waives the premium for up to 6 months per year if the member is involuntary laid off.  Layoff of an insured spouse or child does not qualify for waiver.  Rider is available through age 55 and terminates on the member’s 60^th birthday or when the coverage is assigned to another party, whichever is earlier.

For all other products (other than life insurance) that do not have a Waiver of Premium due to Layoff Rider:

A member may choose to keep the policies on direct bill and the policies remain active.  Once they return to work, the member can request that their policies be moved off of direct bill and back onto the group’s invoice, and deductions would then resume.  If the member did not set up direct bill and the policy terminated, Transamerica will allow members who have canceled coverage beginning 04/01/2020 through 06/01/2020 to re-enroll when they are able to begin payroll deductions again within a 6-month window.

MetLife

Life/AD&D, Dental, Vision Coverage – MetLife is willing to allow members who are furloughed, temporarily laid off or have reduced hours/salary to continue their coverage for 12 months from the date of the furlough, temporary layoff or reduced hours/salary.  Premiums still need to be remitted for coverage to remain active.

For purposes of Life/AD&D coverage, the coverage amounts will not be reduced as a result of temporary salary reductions and will remain in effect just as they were prior to the furlough, temporary layoff or reduced hours/salary.  Accordingly, premium will still need to be remitted for coverage to remain active.

Disability – MetLife is willing to allow members who experience a furlough, temporary layoff or have reduced hours/salary between March 1, 2020 and May 31, 2020, to continue their coverage for 60 days from the date of the furlough, temporary layoff, or reduced hours/salary.  Coverage amounts will not be reduced as a result of temporary salary reductions and remain in effect just as they were prior to the furlough, temporary layoff or reduced hours/salary.    Accordingly, premium will still need to be remitted for coverage to remain active.

For Life insurance, there are no policy limitations that would limit a claim payment resulting from COVID-19.  For Accidental Death & Dismemberment (AD&D), this policy does not cover diseases.  Therefore, death due to COVID-19 is excluded, as are all deaths caused by disease.  For Disability insurance, there are no policy limitations that would apply for COVID-19. 

Texas Department of Insurance (TDI)

The Texas Department of Insurance has announced an emergency rule to make it easier for Texans with TDI-regulated health insurance to get early refills and to get prescriptions at more locations, including by home delivery.

The temporary emergency rule requires health plans regulated by TDI to:

·        Pay for a 90-day refill of covered medications regardless of when the prescription was last refilled, unless specifically prohibited by law as in the case of controlled substances.

·        Allow prescriptions to be filled at out-of-network pharmacies at no additional cost to the consumer if the drug isn’t available quickly through mail order or at an in-network pharmacy within 30 miles.

·        Allow for substitutions if the plan’s preferred drug isn’t available due to shortages or distribution issues.

·        Waive any requirement for a consumer’s signature unless specifically required by law.

Kelley “KB” Bendele
Benefits Director