There are two general strategies that the CDC has outlined. One is based on symptoms and the other on testing. Below is the direct link to the page with the CDC that is being updated in an ongoing fashion.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
For most medical carriers the COVID-19 diagnostic test, the office visit, and telehealth services are now available at no cost to members. We recommend visiting your carriers dedicated COVID 19 resource page to see how your carrier is specifically handling this unprecedented event.
Cigna Coronavirus Resource Center
Humana Coronavirus Resource Center
The IRS released Notice 2020-15 to facilitate proactive COVID-19 testing for those individuals participating in a CDHP Health Savings Account plan. This is important to note so that individuals enrolled in such plans DO NOT have to meet their annual deductible for the plan to cover such expenses as testing and vaccinations (assuming one is created for the virus) related to the virus. This will hopefully encourage individuals who feel they may have symptoms of the virus to be treated early without the fear of incurring additional out-of-pocket costs.
UPDATE 03/21/20:
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.
Please contact your TBC account team for confirmation as to how your self-insured plan will handle such claims.
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 department of insurance released this statement. Multiple insurers have already followed this directive from the DOI and have already started to refrain from canceling policies due to non-payment.
GA DOI COVID_19 Directive-3202020-1057
Please check with your account executive team before making any decisions pertaining to your plan.
Employers under a self-insured health plan should check with their providers to determine how they are addressing cost-sharing related to COVID-19 screening. These employers should also determine what actions must be taken to elect in or out of the 2019 Novel Coronavirus testing cost-sharing programs. Under a self-insured platform there is more flexibility with how such expenses will be handled.
Please contact your TBC account team for confirmation as to how your self-insured plan will handle such claims.
The IRS released Notice 2020-15 to facilitate proactive COVID-19 testing for those individuals participating in a CDHP Health Savings Account plan. This is important to note so that individuals enrolled in such plans DO NOT have to meet their annual deductible for the plan to cover such expenses as testing and vaccinations (assuming one is created for the virus) related to the virus. This will hopefully encourage individuals who feel they may have symptoms of the virus to be treated early without the fear of incurring additional out-of-pocket costs.
UPDATE 03/21/20:
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. Please contact your Account Executive for help working through these specific issues.
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.
Generally, carriers do not consider quarantined workers to be disabled unless they have a medical condition that results in restrictions and limitations that satisfy a policy’s definition of disability.
Coronavirus would be treated no differently than any other covered illness under most STD and LTD plans. If a person is diagnosed with coronavirus, a claim for STD or LTD benefits could be payable after the elimination period if the definition of disability has been met, i.e. if they are unable to work because of the coronavirus infection. If, after diagnosis, they remain able to perform work duties (even if quarantined and working from home) the employee would generally not be considered Partially or Totally Disabled. Additionally, individuals who are self-quarantined without a diagnosis and not sick would not have a payable claim situation.
Under federal and state statutory leave laws, an FML administrator can generally approve a claim when a claimant meets the definition of Serious Health Condition under the applicable federal/state statute. Under these statutory programs, there is an expectation that benefits will be administered on a consistent basis no matter the underlying illness. As with disability claims, each leave is decided on its own specific facts. In general, however, employees are not entitled to federal or state leave to stay home during a quarantine period if they are not ill. It is important to monitor legislation adopted after February 2020 for up to date information.
A Long-Term Care claim filed by individual diagnosed with coronavirus would likely be payable if they meet the policy definition and they are receiving covered services. If a claimant is quarantined and not receiving covered services, no benefits would likely be payable.
At TBC, we know there are several questions that come up regarding disability and the Department of Labor Americans with Disabilities Act (ADA). We have seen questions come up regarding personal travel (Spring Break) and how it may or may not impact disability related issues specific to the virus. For legal guidance, we recommend that you reach out to your counsel to appropriately establish guidelines and communication. To aid in those conversations with your legal team, you may find the following comments from the Law and Workplace attorneys at Proskauer Law firm a helpful tool.
According to Proskauer law firm, “while employers may implement restrictions on work-related travel to affected areas, employers should tread more carefully when attempting to police personal, non-work-related travel. “
“… it is worth noting that the EEOC has argued on at least one occasion that an employer acting on a potential future health condition may be viewed as “regarding” an employee as disabled as long as the condition otherwise qualifies as a disability under the law. For this reason, employers should consider the risks (as well as the practicalities) relating to imposing a ban on personal, non-work-related travel to affected areas. However, as discussed further below, employers may require employees engaging in travel to these areas to remain out of the workplace for at least 14 days upon their return.”
“the ADA prohibits employers from making disability-related inquiries and requiring medical examinations, unless (1) the employer can show that the inquiry or exam is job-related and consistent with business necessity, or (2) where the employer has a reasonable belief that the employee poses a direct threat to the health or safety of the individual or others that cannot otherwise be eliminated or reduced by reasonable accommodation.”
The regulatory definition sections that most likely apply in the COVID-19 context (assuming a mild case) are the following:
Because some individuals will not seek health care treatment unless they need urgent medical attention or they are at a higher risk for complications from COVID-19, some cases of COVID-19 will not qualify as a serious health condition simply because the employees will not have visited a doctor/healthcare provider for any treatment.
In response to the spread of the 2019 Novel Coronavirus (COVID-19), President Trump signed the Family First Coronavirus Response Act (Act) on March 18, 2020 and it is set to go into effect on April 1, 2020. The Act is an economic stimulus plan that affects coverage and cost sharing for COVID-19 testing and provides expanded federal family and medical leave and a new federal paid sick leave law. The Act also addresses other issues such as coverage and cost sharing for COVID-19 testing under Medicare and Medicaid, emergency grants to states for unemployment insurance, tax credits for paid sick and paid family and medical leave, and federal funding for various programs.
You have fewer than 500 employees if, at the time your employee’s leave is to be taken, you employ fewer than 500 full-time and part-time employees within the United States, which includes any State of the United States, the District of Columbia, or any Territory or possession of the United States. In making this determination, you should include employees on leave; temporary employees who are jointly employed by you and another employer (regardless of whether the jointly-employed employees are maintained on only your or another employer’s payroll); and day laborers supplied by a temporary agency (regardless of whether you are the temporary agency or the client firm if there is a continuing employment relationship). Workers who are independent contractors under the Fair Labor Standards Act (FLSA), rather than employees, are not considered employees for purposes of the 500-employee threshold.
Typically, a corporation (including its separate establishments or divisions) is considered to be a single employer and its employees must each be counted towards the 500-employee threshold. Where a corporation has an ownership interest in another corporation, the two corporations are separate employers unless they are joint employers under the FLSA with respect to certain employees. If two entities are found to be joint employers, all of their common employees must be counted in determining whether paid sick leave must be provided under the Emergency Paid Sick Leave Act and expanded family and medical leave must be provided under the Emergency Family and Medical Leave Expansion Act.
In general, two or more entities are separate employers unless they meet the integrated employer test under the Family and Medical Leave Act of 1993 (FMLA). If two entities are an integrated employer under the FMLA, then employees of all entities making up the integrated employer will be counted in determining employer coverage for purposes of expanded family and medical leave under the Emergency Family and Medical Leave Expansion Act.
A part-time employee is entitled to leave for his or her average number of work hours in a two-week period. Therefore, you calculate hours of leave based on the number of hours the employee is normally scheduled to work. If the normal hours scheduled are unknown, or if the part-time employee’s schedule varies, you may use a six-month average to calculate the average daily hours. Such a part-time employee may take paid sick leave for this number of hours per day for up to a two-week period, and may take expanded family and medical leave for the same number of hours per day up to ten weeks after that.
If this calculation cannot be made because the employee has not been employed for at least six months, use the number of hours that you and your employee agreed that the employee would work upon hiring. And if there is no such agreement, you may calculate the appropriate number of hours of leave based on the average hours per day the employee was scheduled to work over the entire term of his or her employment.
On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief and Economic Security Act (CARES) Act. It delivers $2 trillion in financial stimulus to the economy including preferred loans to small businesses, capital for distressed industries, direct cash payments to many Americans, unemployment insurance enhancements, as well as various provisions affecting employee benefit plans. The article will focus on the key employee benefit provisions of the CARES Act.
The recently enacted Families First Coronavirus Response Act (FFCRA) requires group health plans and insurers to provide coverage of certain diagnostic COVID-19 testing and related services without cost sharing and without preauthorization. The CARES Act expands on these provisions in the following ways:
If a COVID-19 vaccine, immunization, etc. is developed, the Act mandates coverage without employee cost sharing for such preventive services. To qualify for this treatment, the preventive item or service must meet certain criteria as defined by the U.S. Preventive Services Task Force and/or the Advisory Committee on Immunization Practices.
The Act includes a safe harbor allowing a high deductible health plan (HDHP) to cover telehealth or other remote care services, with no cost-sharing, prior to the participant’s satisfaction of the plan deductible. This ensures the participant will maintain Health Savings Account eligibility. This safe harbor is only for plan years beginning on or before December 31, 2021.
Eliminating a prohibition from the Affordable Care Act, HSAs, FSAs, and HRAs can now be used to purchase over the counter medications without a prescription (previously allowed only if prescribed drugs or insulin). Further the act mandates that menstrual care products will be treated as qualified medical expenses and can also be purchased using an HSA, FSA, or HRA. These provisions are effective for expenses incurred and amounts paid after December 31, 2019.
The CARES Act makes several minor changes and clarifications to the FFCRA:
As of February 27th, only one drug shortage due to COVID-19 has been reported by the FDA. The agency did not identify the particular drug but stated that alternatives were available. The FDA has asked over 180 drug manufacturers to evaluate their entire supply chain. With increased attention to the potential for shortages, employers should be aware of the risk and consider strategies to ensure their members’ well-being. Members are also encouraged to discuss therapeutic alternatives with their physician should disruption to the supply chain occur.
Employers should evaluate the all the potential barriers in place that may restrict pharmacists and patients from filling prescriptions. Depending on the capability of their PBM, employers can implement these strategies: make edits to their plan’s “refill too soon” utilization percentage, permit emergency refills, allow maximum extended day supply at the time of the refill, and/or waive processing restrictions for out-of-network pharmacies.
This paper from Gateway Health Partners highlights some of the known vaccines, novel drugs and existing drugs in development to fight COVID-19.
If your company does not currently have a Work From Home (WFH) policy it can be a daunting task to establish at “the last minute”. We think the attached sample policies may be of help while you plan to implement such a policy. One is more of a temporary implementation and the other one long-term.
In addition to your accessing your personal health provider, and even mental health resources through some telemedicine the CDC put out the following link with helpful hints.
Alok Desphande of SmartPath Financial has provided a free recording of a webinar Coronavirus – What’s Your Next Financial Move? This is an excellent resource to share with employees. The webinar is approximately an hour long and addresses many of the common questions employees are asking about handling their finances in this turbulent season. The webinar addresses:
Blog posts to share with your employees:
Nine Ways to Keep Active When Working From Home
Downloadable PDF from the American College of Sports Medicine: Staying Active During the Coronavirus Pandemic
According to the EEOC Guidance, whether the Coronavirus will rise to the level of a “direct threat” under the ADA will depend on it if reaches pandemic levels versus current epidemic levels and the severity of the illness/risk. Employers who are considering temperature scans or other medical inquiries should consult with labor and employment counsel to ensure that the medical inquiry is permitted under the ADA.
You should send home all employees who worked closely with that employee for a 14-day period of time to ensure the infection does not spread. Before the employee departs, ask them to identify all individuals who worked in close proximity (three to six feet) with them in the previous 14 days to ensure you have a full list of those who should be sent home. When sending the employees home, do not identify by name the infected employee or you could risk a violation of confidentiality laws. You may also want to consider asking a cleaning company to undertake a deep cleaning of your affected workspaces. If you work in a shared office building or area, you should inform building management so they can take whatever precautions they deem necessary.
New unemployment claim (and partial claim) rules were adopted by the Georgia Department of Labor on March 16, 2020, and they provided an update on March 17, 2020. Here is a link to those changes: https://dol.georgia.gov/blog/new-information-filing-unemployment-partial-claims-and-reemployment-services
According to attorney Davis, Wright and Tremaine, LLP – Any travel policies should be narrowly focused and apply only with regard to specific geographic areas identified by the CDC and WHO as high-risk. In addition, travel policies should be in writing and distributed to all employees, not just to employees who the employer believes is or may be considering travel to high-risk areas. By so doing, the employer can avoid the appearance of discrimination and limit potential race, national origin, or other discrimination claims, while helping to protect the health and well-being of employees.
The ADA prohibits discrimination in the workplace against employees and applicants with disabilities and requires employers to provide reasonable accommodations when necessary. The ADA also limits the type of medically related inquiries that an employer can ask of an applicant or employee, and imposes strict confidentiality requirements relating to any medical information that is obtained. A medical inquiry or examination during employment is permissible only if it is job-related and consistent with business necessity. If an employer has a reasonable belief based on objective evidence that an employee will pose a direct threat to other employees due to a medical condition, then medical inquiries concerning that condition will be job-related and consistent with business necessity. According to the Equal Employment Opportunity Commission (EEOC), taking an employee’s temperature to determine if he or she has a fever is an example of a medical inquiry.
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