Plan Documents & Eligibility

“Actively At Work” will be interpreted to include any plan participant who is granted approved leave by the policyholder due to COVID-19, remains on the policyholder’s stop loss census, and for whom premium is paid. Recognizing that there are other demands on plan sponsors at this time, amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed. HM reserves the right to review this approach after June 30, 2020.

HM’s stop loss policies are issued taking into consideration the participation requirements of the original underlying plan. Material changes to the underlying plan, such as changes to eligibility, must be reviewed and approved by HM.

If the employees for whom the waiting period was waived had continuous coverage during the temporary layoff due to COVID-19, then no waiting period would apply. If these employees did not have continuous coverage during the temporary layoff, then HM would expect the waiting period to apply in accordance with the plan documents.

Continued coverage for employees who are temporarily on non-medical leave/unable to work remotely per COVID-19 social distancing requirements, as long as said employees are included in the census and applicable premiums are paid.

Layoffs & Furloughs

See above "Plan Documents & Eligibility" section.

If an entire workforce is laid off due to COVID-19, HM's position is that in order to be eligible for a stop loss policy the group must have at least one active employee to meet the definition of employer group. If all employees are released from employment, the stop loss policy will terminate.

COBRA EEs & Return to Work

“Actively At Work” will be interpreted to include any plan participant who is granted approved leave by the policyholder due to COVID-19, remains on the policyholder’s stop loss census, and for whom premium is paid. Recognizing that there are other demands on plan sponsors at this time, amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed. HM reserves the right to review this approach after June 30, 2020.

If a policyholder offers COBRA and one person remains actively employed, qualified beneficiaries may elect to continue coverage under COBRA by following the normal notice and election procedure. Beneficiaries must continue to be included in the census, and premiums must be paid for applicable personnel. In order to be eligible for a stop loss policy the group must have at least one active employee to meet the definition of employer group. If all employees are released from employment, the stop loss policy will terminate.

Actively at Work & No Scheduled Shifts

“Actively At Work” will be interpreted to include any plan participant who is granted approved leave by the policyholder due to COVID-19, remains on the policyholder’s stop loss census, and for whom premium is paid.

Recognizing that there are other demands on plan sponsors at this time, amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed. HM reserves the right to review this approach after June 30, 2020.

Claims Reimbursements & Timely Filing

The claim notification procedures and timeframes dictated by HM's stop loss policies remain unchanged. HM remains committed to delivering the highest level of service and will continue to monitor industry developments to ensure consistent and timely administration of claims. Additionally, HM continues to monitor and adhere to applicable state mandates that are released.

Testing - HM’s stop loss policies follow the original underlying plan to determine eligible claims expenses. Should the underlying plan be amended specifically to allow COVID-19 testing, HM would honor the amendment. HM requires copies of amendments made to the plan document. Recognizing that there are other demands on plan sponsors at this time, amendments to the
plan document can be sent at a later date, but no later than at the time the claim is filed.

Treatment - HM’s stop loss policies follow the original underlying plan to determine eligible claims expenses. Should the underlying plan need to be amended specifically to allow COVID-19 treatment or to waive cost-sharing for COVID-19 treatment, HM requires review and approval of the amendment and reserves the right to revise premium and/or other terms and conditions of the policy if the amendment is deemed by HM to be a material change.

Experimental Drugs - HM's stop loss policies exclude experimental medications/treatments, and require FDA approval. HM’s stop loss policies follow the underlying plan relative to FDA approved medications/treatments to determine eligible claims expenses. Policyholders should review their plan documents to determine whether new COVID-19 treatments would be eligible claims expenses or if they would be excluded as investigational or experimental.

Federal & State Mandates

HM will honor waived cost-sharing for the COVID-19 testing and its associated medical consultation. Prior notification to HM is not required. Applicable amendments to the plan document should be submitted. However, recognizing that there are other demands on plan sponsors at this time, amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed.

HM will comply with regulatory mandates related to COVID-19, to the extent that they are applicable to stop loss carriers and self-funded health benefit plans. Any requests that exceed mandated requirements should be submitted
to HM for review and approval. State insurance bulletins do not require any changes to self-funded benefit plans – Self-funded plans are not regulated by state insurance departments. HM
expects that most self-funded plans already cover testing and treatment for acute health conditions like COVID-19.

HM’s stop loss policies follow the underlying plan to determine eligible claims expenses. HM generally expects that COVID-19 treatments will meet the policy definition of eligible claims expense.


For the purposes of COVID-19 transmission mitigation, “Actively At Work” will be interpreted as any plan participant who is granted approved leave by the policyholder, remains on the policyholder’s stop loss census, and for whom premium is paid. If the underlying plan does not cover testing and treatment related to COVID-19 and a mid-year change is desired, the stop loss policy requires that HMIG approve the change to the underlying plan.

Early Rx Refills

HM will provide stop loss coverage related to early refills of medication to ensure participants have a 30-day supply during the COVID-19 pandemic. Prior notification to HM is not required. HM reserves the right to review this approach after June 30, 2020.

Should the underlying plan be amended to allow early prescription refills for a 30 day supply, HM would honor the amendment. Recognizing that there are other demands on plan sponsors at this time, amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed.

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.

Amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed.

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.

Testing - HM will honor waived cost-sharing for tests and associated medical consultations related to COVID-19. Prior notification to HM is not required. Applicable amendments to the plan document should be submitted. However,\ recognizing that there are other demands on plan sponsors at this time, amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed.

Treatment - HM will honor waived cost-sharing for the medical consultation required for COVID-19 testing. Prior notification to HM is not required. Applicable amendments to the plan document should be submitted.

However, recognizing that there are other demands on plan sponsors at this time, amendments to the plan document can be sent at a later date, but no later than at the time the claim is filed.

HM’s stop loss policies follow the original underlying plan to determine eligible claims expenses.

Should the underlying plan need to be amended specifically to allow COVID-19 treatment by out-of-network providers or to waive cost-sharing for COVID-19 treatment by out-of-network provider, HM requires review and approval of the amendment and reserves the right to revise premium and/or other terms and conditions of the policy if the amendment is deemed to be a material change.

Rate or Coverage Changes

HM Insurance Group (HM) does not plan to amend premiums or minimum aggregate attachment points due to material changes in enrollment through June 2020, after which time this decision may be re-evaluated. HM will be analyzing experience to better understand any changes to risk as a result of the COVID-19 pandemic. The cost per treatment and impact to each group is expected to be highly variable.

Special Enrollment Period

HM’s stop loss policies are issued taking into consideration the participation requirements of the original underlying plan. Material changes to the underlying plan, such as changes to eligibility, must be reviewed and approved by HM.

HM reserves the right to revise premium and/or other terms and conditions of the policy if the amendment is deemed to be a material change.

Grace Period Extensions

HM will extend the grace period for premium collection by 30 days due to the pandemic.

During the extended grace period, claims will be paid through the “paid-to” date.

In the event that state regulatory agencies issue specific directives, we will adhere to those mandates.