Plan Documents & Eligibility

QBE will accept on company’s and/or administrator’s letterhead, the COVID-19 plan for extended leave and/or reduced work hours to ensure the appropriate eligibility remains in place for participants of the plan.

Please specify a timeframe rather than indefinite.

This concession assumes all premium payments continue for eligible participants of the plan.

Testing - In determining coverage, QBE will refer to the medical necessity provision of the underlying plan. In the event a policyholder elects to expand coverage and the underlying plan requires an amendment to modify provisions (i.e. waiving member cost share or considering payment of out-of-network benefits at the in-network level), please send a copy of the proposed amendment to QBE for review.

Please await confirmation that the plan change will be considered eligible under the QBE issued excess loss policy.

Policy Administration & Wet Signatures

QBE will allow policyholders/producers to forgo “wet” signatures on policy forms and use electronic signature services, such as DocuSign or Adobe PDF.

QBE will also allow the use of a scanned signature of a policyholder/producerauthorized party. If these tools or methods are not available, please contact your underwriter.

Claims Reimbursements & Timely Filing

QBE does not expect delays in mailing reimbursement checks. We have the necessary resources, staffing and appropriate business continuity measures in place to ensure our processing remains timely.

However, we strongly encourage ACH payment for all policyholders. Direct deposit reimbursements are the fastest method to receive excess loss reimbursements.

Federal & State Mandates

In partnership with customers and in alignment with the Family First Coronavirus Response Act, QBE is agreeable to maintaining no rate impacts to our QBE-issued excess loss policies, waiving member cost share under the plan.

QBE can confirm that they are compliant with all emerging state mandates, even if a release regarding such mandate is not distributed to clients automatically.

Early Rx Refills

QBE will allow for the additional costs to apply under the stop loss coverage with no rate impact for early refills with out-of-medication to ensure participants have at least a 30-day supply.

Cost Share

With respect to COVID-19 treatment, QBE refers to the medical necessity provision of the underlying Plan. In the event the underlying Plan requires an amendment to modify plan language (i.e. waiving member cost share or considering payment of out of network benefits at the in network level), please send a copy of the proposed amendment to QBE for review and await confirmation that the Plan change will be considered eligible under the QBE issued excess loss policy.

While we understand policyholders may want to look at the option of waiving employee cost share for COVID-19 in-network inpatient and/or outpatient treatment or even for out-of-network inpatient and/or outpatient treatment; we believe it’s important that the policyholders are provided an indication of potential plan cost impact by their network partners before making a determination. As noted above, QBE will require a review in advance to confirm rates, terms and reimbursement under the Excess Loss Policy.

Rate or Coverage Changes

QBE understands that policyholders may need to manage enrollment drops due to temporary layoffs or furloughs resulting from this pandemic.

QBE’s standard policy provision provides the right to recalculate the premium rates and/or the monthly aggregate excess loss factors retroactively for the policy period if there is more than 10% variance between:

  • The number of covered units on any premium due date; and
  • The number of covered units on the policy effective date

QBE will temporarily allow for up to a 25% enrollment variance for the items referenced above.

As such, we will not exercise our right to re-underwrite terms mid-year due to enrollment shifts unless the variance is greater than 25%. This expanded excess loss provision is available through the June 2020
enrollment reporting. After June 30, 2020, QBE’s standard enrollment variance policy provision will apply.

In Summary - in relation to adjusting the Right to Re-Calculate and Minimum Aggregate Attachment Point provisions in the Stop-Loss policy based on decreases in enrollment due to COVID-19, QBE will increase the change in enrollment allowance to 25%. There will be no reduction in the minimum attachment point mid policy.

Special Enrollment Periods

In relation to the need for a special period in which enrolled individuals were given the opportunity to change plans mid-year, QBE would not be agreeable to allow changing from one plan design to another plan design mid-policy.

Grace Period Extensions

Should QBE policyholders have any workflow interruptions with respect to premium accounting operations, QBE is extending our stop loss policy premium grace period by 30 days through June 2020 payments.

COBRA Extension Guidelines

QBE will allow the COBRA election rules per the DOL/IRS.

Important Note

IMPORTANT NOTE: As plans that have sent QBE amendments or letters stating what they want to offer and for how long, as the deadlines get close to expiring, they must send updated amendments and letters. QBE will review as they want to extend. All federally mandated extensions will be adhered to.