Plan Amendments and Eligibility

In the event that a covered plan wishes to include coverage for one or more of the following in response to the COVID-19 pandemic:

  • Waive deductibles, co-pays and cost sharing related to testing for COVID-19
  • Waive pre-authorization requirements for treatment of infected individuals
  • Allow early refills of maintenance meds to ensure a 30-day supply
  • Cover any immunizations that become available for COVID-19 at 100%
  • If in-network testing not available, pay as-if lab was in-network
  • Cover Telemedicine and/or virtual office visits at 100%

These will be covered under stop loss with no changes to rates or factors. A formal plan amendment is not required but we do ask for written confirmation of the plan’s intent.

Other coverage, underwriting and eligibility issues (the positions as described below are subject to review on an ongoing basis and may be extended, amended or retracted with reasonable notice):

  • Treatment of COVID-19 will be reimbursed under the stop-loss policy as long as the expenses are covered by the plan and meet the provisions of the stop loss policy. No amendment required.
  • Furloughed employees may be covered under the plan and stop loss so long as stop loss premiums are paid for them. We should be advised in writing ASAP.
  • Employees whose hours fall below minimum for eligibility may be covered under the plan and stop loss so long as stop loss premiums are paid for them. We should be advised in writing ASAP.
  • Laid off employees may not be covered under the plan. They would be eligible for COBRA.
  • Waiver of waiting period for temporarily laid off employees that are rehired This will be case by case and will require an amendment for approval in order to be covered under the stop loss policy. If approved, and if it occurs in the same stop loss policy period, only one specific deductible will be required.