Plan Documents & Eligibility

In order to process claims accurately and timely, if a group amends their plan or eligibility provisions, Anthem asks that they are notified as soon as possible, with a normal standard of 30 days notice. If the loss of enrollment is a result of COVID-19, rates and premiums will not change.

Through September 30, 2020, Anthem will not require that policy or plan amendments for these provisions be submitted for Anthem’s formal review, subject to the following:

  • Payment of stop loss premium is required to continue coverage for laid off employees who
  • are not actively at work
  • Coverage must be offered on a uniform non-discriminatory basis to all employees and
  • employee premium contribution must be the same or less prior to the layoffs
  • Employees rehired by July 31, 2020 will not be subject to a waiting period

These considerations apply to:

  • Emergency Leave
  • Extended Leave
  • Temporary Lay Offs
  • Furloughs
  • Not Actively at Work due to No Scheduled Shifts
Plan Changes and Amendments

If you amend your plan or eligibility provisions, including mid-year elections made in the calendar year 2020, we ask that you notify Anthem Stop Loss as soon as possible, with a normal standard of 30 days’ notice. Please send any amended plan document(s) or an email with the plan changes to your SLIS representative.

Layoffs & Furloughs

If Anthem is notified in writing of a change to the Leave Policy, Anthem will mirror the underlying Medical plan document with no cost impact. If the Employer chooses to lay off Employees or severs the employment relationship, it may trigger a qualifying event under COBRA, if the Employer’s plan is subject to COBRA. Anthem recommends that Employers check their benefit booklet for details. An Employer can subsidize the Employee’s COBRA premium.

Changes to COBRA Timelines

On April 29, 2020, the U.S. Departments of Labor (Employee Benefits Security Administration, “EBSA”) and Treasury (IRS) issued regulatory guidance during the COVID-19 national emergency extending various timeframes for employees to elect health coverage retroactively. During this challenging time, Anthem will follow federal guidance on the extended dates for COBRA payments.

Claims Reimbursements & Timely Filing

Anthem allows six (6) months after the current contract year ends for timely filing. At this time, there are no plans for extension.

Families First Coronavirus Response Act & Government Mandates

Reasonable accommodations made in response to, or as a consequence of, guidance or requirements from duly authorized federal, state or local government entities will not result in the denial of an otherwise eligible stop loss claim. Anthem will abide by any applicable government mandates.

Mid-Year Deductible Changes

Mid-year deductible changes will not be considered. Anthem will entertain deductible changes at time of renewal.

Early Rx Refills

Policyholders who decide to allow covered participants to receive early prescription refills to ensure they have a 30-day supply will be allowed to apply these costs as eligible expenses under their Stop Loss policy, without any prior notification.

Telemedicine & Virtual Visits

Policyholders who decide to waive cost-sharing for telemedicine and virtual healthcare visits for covered participants will be allowed to apply these costs as eligible expenses under their Stop Loss policy, without any prior notification.

Cost Shares

Policyholders who decide to waive the cost of deductibles, copays, and costsharing for COVID-19 testing and treatment for covered participants will be allowed to apply these costs as eligible expenses under their Stop Loss Policy without prior notification