Plan Documents & Eligibility

Partners MGU's Stop Loss policy does defer to the Plan Document when determining eligible benefits.

As such, a Plan Amendment is required to accommodate any deviations from the Plan Document such as waiving of deductibles/copays/etc. Signed amendments will be reviewed with priority to minimize any potential disruption to plan members.

Losses for eligible expenses will be subject to the terms of the Policy. Plan Amendments related to the above may come in the form of a Plan Amendment, letter on Policyholder company letterhead, or an email from the Policyholder.

Please send Amendments, letters, and emails to your SLIS representative.

Actively at Work & No Scheduled Shifts

In regard to Actively at Work (AAW) provisions, employee furloughs, and leave of absences, we will consider Plan members who were AAW the day before the closure of the business as satisfying AAW requirement through May 31, 2020.

Employees on furlough or leave of absence will be considered AAW through May 31st as well provided we receive an Amendment, letter, or email as outlined above indicating that the Policyholder is implementing this provision.

Federal & State Mandates

As Federal guidelines may change rapidly, Partners will honor any mandated coverage without requiring a Plan Amendment.

Early Rx Refills

Plan amendments that will be honored include enabling Plan participants to obtain up to 30 days' supply of prescriptions in advance.

Telemedicine & Virtual Visits

Plan amendments that will be honored include no Specific Limitations on telemedicine visits.

Cost Share

Plan amendments that will be honored include no Preauthorization requirement for testing, and coverage of physician-ordered testing with no deductible/copay/coinsurance required from the Plan participant.

Rate or Coverage Changes

Partners has agreed not to change rates or factors mid year due to the waiving of copays, etc. as it relates to COVID-19 testing.

Important Note

Important Note: Any items that groups put into expiring temporary amendments should be readdressed with secondary amendments / extensions (as Partner's policy mirrors the plan doc).