Plan Documents & Eligibility

For any plan changes that may be occurring to deal with the crisis, a request on employer letterhead is acceptable for Berkley to review and accept a change in place of a signed plan document change.

In terms of eligibility/plan document changes, if the employer wants to change their leave policy they should send in the amendment to the plan that outlines the changes. The amendment does not need to be more than the change on the company’s letterhead.

Berkley's policy does not speak to employee contributions so that has no bearing on our decisions and if the employer is going to waive employee contributions during a leave that should be reflected in the PD amendment. Berkley believes it is in the employers best interest to have a PD that outlines the accurate eligibility under the Plan.

If an active, enrolled employee working 30 hours or more per week as of March 1, 2020 is temporarily furloughed or is reduced below 30 hours per week due to COVID-19, we can, at the request of the employer, accept a plan amendment that allows an employee to remain on the plan as long as premium payments are made. Plan document amendments with temporary changes in eligibility may be granted through May 31, 2020. Policyholders must confirm that the employees who remain on the plan, as a result of the accepted plan amendment, were active and covered by the plan as of March 1, 2020. Berkley Accident and Health reserves the right to audit any such eligibility change.

Plan document amendments with temporary changes in eligibility may be granted through foreseeable future. Policyholders must confirm that the employees who remain on the plan, as a result of the accepted plan amendment, were active and covered by the plan as of March 1, 2020. Berkley Accident and Health reserves the right to audit any such eligibility change.

To request this change, the employer must:

  • Continue to pay premium on those individuals. Employees whose plan eligibility is temporarily affected by COVID-19 related actions can still be considered covered by the Stop Loss policy as long as premium is received for them.
  • Send Berkley documentation that the plan has been amended. In the event a claim is submitted on a laid off or furloughed employee (or covered dependent), Berkley needs documentation of the plan change in their files. Please send a clear description of the change you are making to plan eligibility to your SLIS Sales or Account Management Representative.
Layoffs & Furloughs

As it relates to what happens if a client lays off a certain percentage of their work force - Berkley will be as flexible as possible during this outbreak. While not seeing an increase in exposure, Berkley does have minimum premium guidelines and state laws/filings to comply with, and states have not given any relief in this area at this time.

As it relates to temporary layoffs - If an employer has to lay off employees temporarily, and they choose not to elect COBRA before returning to work, Berkley would defer to the Plan language and any amendment that was done by the employer. There is no waiting period under Stop Loss, so no waiting period would apply. A simple statement on employer letterhead will suffice as a Plan Amendment to be submitted to Berkley for approval.

COBRA Extension Guidelines

Berkley will assist our employers to comply with this law.  Under our policy an incurred and paid claim during the policy period can be submitted a  couple of years after the paid date and it would be considered for reimbursement. Incurred and paid dates are not extended however the time to submit a claim to us is.  As with any claim submitted for reimbursement, premium must be paid. Follow up response from Lee: We plan on assisting our clients with the required compliance On this new rule.  We understand that there is no extension of coverage without an actual election of COBRA. 

We also understand that Congress is considering a COBRA subsidy of 100% in the current bill.

Actively at Work & No Scheduled Shifts

This will be compared to the leave policy in the SPD. Berkley believes the employer should amend the Plan to ensure consistency and nondiscrimination issues among their workforce. Berkley will review these plan amendments quickly. A simple statement on employer letterhead will suffice as a Plan amendment to be submitted to Berkley for approval.

Claims Reimbursements & Timely Filing

For timely filing limits, Berkley will be willing to extend filing limits until the end of the COVID-19 crisis. However, any extension to incurred and paid periods have to be approved by underwriting.

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 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 prior notification.

Treatment and Cost Share

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

Berkley's Policy / Reinsurance agreements do not contain an exclusion for pandemic outbreaks. Therefore, medical treatment for COVID-19 would be subject to the terms of the Policy / Reinsurance agreements, as with any loss.

Claims Reimbursements

For timely filing limits, Berkley will be willing to extend filing limits until the end of the COVID-19 crisis. However, any extension to incurred and paid periods have to be approved by underwriting.

Through Berkley's Automated Clearing House (ACH) service, Berkley can transfer funds electronically into the account without manual intervention. This means that you can receive Stop Loss reimbursements even if your business is closed or employees are working from home.

Berkley and SLIS encourage policyholders to enroll in this service, offering timely and secure payments.

Grace Periods

Berkley will address a group's inability to make a scheduled premium payment for a current policy on a case by case basis.

Berkley will also endeavor to make reasonable accommodations when required by a specific state insurance department, or if not required, when possible to avoid the cancellation or non-renewal of a current insurance policy.