Plan Documents & Eligibility

Supporting Plan amendments must be submitted to the Managing General Underwriter as a condition of receiving the corresponding Excess Loss contract payments.

Amendments may be retroactive to March 1, 2020, but should be executed and delivered to Pan-American's MGU Evolution Risk by August 31, 2020.

Layoffs & Furloughs

Pan-American (Evolution Risk) will extend Excess Loss coverage with respect to furloughed employees or employees on a leave of absence for a period not to exceed 90 days while a National Emergency remains declared with respect to COVID-19, or longer when required by law.

The above applies provided the contract holder continuously provides health plan coverage for the plan participant during the furlough or leave of absence
period, and premium is timely paid for the Excess Loss coverage as required by the Excess of Loss contract.

Approved leave of absence must be offered to all Plan participants who were previously covered prior to the COVID-19 event.

IRS Notice 2020-29

In regards to mid-year health plan election changes, Pan American would not be inclined to allow it without re-underwriting.

With regards to our position on the IRS Final Rule issued on May 4th, PALIC would view the extended timeframes as an extension of the normal eligibility period of the plan document.  In addition, we would not require rate or factor adjustments in the current plan year nor require plan document changes.

Claims Reimbursements & Timely Filing

In terms of timely filing limits for claims, Evolution Risk may allow on a case by case basis as a result of the pandemic. A request in writing by the client or SLIS must be provided to Evolution Risk for individual case consideration.

Early Rx Refills

Removal of Prescription refill limitations on maintenance medications to assure up to a maximum 90-day supply is available in the event a potential quarantine situation may arise, as long as they have been recommended or prescribed by a Physician.

Only supplies up to the end of the Stop Loss policy year will be considered for eligible claims under stop loss.

Telemedicine & Virtual Visits

Telemedicine visits related to COVID-19 symptoms are approved with no deductible, coinsurance or co-payment.

Cost Share

COVID-19 testing will be covered under the contract holder's underlying plan document effective immediately at 100% coverage (network, usual and customary, or referenced based price as applicable) with no deductible, coinsurance or co-payment, upon a doctor's order (this will be required under the Families First Coronavirus Response Act).

Rate or Coverage Changes

Evolution Risk is agreeable to non-rate implication to the excess loss policy if the plan sponsor chooses to waive member cost share under the plan, as long as the contract holder continuously provides health plan coverage for the plan participation and premium is timely paid for the Excess loss coverage.

Grace Period Extensions

Evolution Risk will consider a grace period as requested by the client or SLIS in writing, however, claims will not be paid until the stop loss premium is received for the period that the claim relates to. A request in writing by the client or SLIS must be provided on a case-by-case basis.

Membership Reduction Additional Q&A

What happens to when groups lay off or furlough parts of its workforce?

We previously indicated we would extend excess loss coverage with respect to furloughed employees or employees on a leave of absence for a period not to exceed 90 days while a National Emergency remains declared with respect to COVID-19, or longer where required by law, provided the contract holder continuously provides health plan coverage for the plan participants during the furlough or leave of absence period, and premium is timely paid for the Excess Loss coverage as required by the Excess of Loss Contract.

It should be noted that this must be offered to all plan participants. If the employee does not return to work at the end of the 90 days, standard COBRA and/or continuation notices of the right to continue coverage will need to be sent by the Plan sponsor according to their regulatory and legal obligations as an employer.

The same rules would apply to claims for employees not actively at work.

What happens to a policy if the enrollment drops by X%? Would we enforce or adjust the right to recalculate premium?

If enrollment decreases, we will not look to perform mid-year re-calculations for a period of 90 days while a National Emergency remains declared with respect to COVID-19. If a group is renewing during this period, the underwriter should rate the group based on what is known at the time of renewal also taking into consideration the group’s intent to re-hire employees.

Would we enforce or adjust the minimum aggregate attachment points for decreases in enrollment?

As we are allowing decreases in enrollment without requiring re-rating, we will not adjust the minimum aggregate attachment points.

Would a waiting period or new underwriting apply for current employees that were laid off and then return to work that were not on COBRA?

We will not apply a waiting period to employees or re-underwrite employees that return to work after being laid off as long as the employee returns to work within 30 days upon the business re-opening or else standard waiting periods and eligibility requirements would apply.

Plan Changes Additional Q&A

Will Plan Sponsors need to amend plan docs to include mandated benefits? To include other non-mandated changes such as the Rx refill accommodations, a temporary layoff provisions or can it be done retroactively?

Plan changes may be retroactive to March 1st.

We previously indicated that under ERISA, the employers should amend their plan document for the mandated benefits, and send notices to participants, but that is really just between the employer and the DOL. The LOA and the Rx accommodations are not required by law, so the plan does not need to be amended. We do not require to have an amendment in hand but it is something that the reinsurers had requested. Additionally, it is good practice to have something that is written and agreed upon. To avoid issues at claim time, all modifications to benefits and eligibility should be clearly documented.

Will we contemplate providing advance funding in the final 30-60 days of the contract?

We would be open to allowing advance funding on a case-by-case basis up until the end of the contract period while a National Emergency remains declared
with respect to COVID-19. We would still require the plan to show it has funded up to the specific deductible.

Will we allow mid-year enrollments or plan changes (for groups with multiple plan options)?

We will not allow mid-year enrollments or plan changes.

Will we waive pre-authorization requirements for COVID-19 treatment?

We will waive any pre-authorization requirements for COVID-19 treatments.

How will the stop loss policy respond if the Plan Sponsor wants to mirror actions taken by many BUCAs for fully insured plans and remove member cost sharing for COVID-19 treatment?

If the Plan Sponsor wants to cover COVID-19 treatment at no cost sharing and wants it to be considered an eligible excess of loss claim we reserve the right to re-rate the group.