Plan Documents & Eligibility

COVID-19 Testing: No plan amendment is required when adding coverage for COVID-19 testing at 100% with no deductible, coinsurance or co-payment. No prior authorization or other medical management requirements will apply.

COVID-19 Treatment: We will accept policyholder amendments to waive plan member deductibles, coinsurance and/or copayments for Medical treatment of COVID-19. Amendments are required and can be retroactive to March 1, 2020 if received by August 30, 2020. All other plan provisions will continue to apply.

Actively at Work

Plan members considered actively-at-work, or otherwise covered pursuant to the terms of the plan, the day prior to closure of the business may be considered AAW no earlier than March 1, 2020 through the current Policy Year. For the purposes of this provision, "closure" includes temporary furloughs or reduction in hours of some or all members.

Policyholders are required to provide notification of closure or furloughs. Notices must be received within 60 days of the closure or furlough. Stop loss claim reimbursement requests will require documentation of coverage eligibility.

  • Premium must be paid for all plan members considered by the policyholder to be covered and actively-at-work during the billing month. No plan amendment is required.
Early Rx Refills

Removal of prescription refill limitations on maintenance medications to assure an adequate supply in the event of potential quarantine situation will be an acceptable plan amendment effective immediately or retroactive to March 1, 2020.

Telemedicine & Virtual Visits

Telemedicine with no deductible, coinsurance or co-pay for any reason will be an acceptable plan amendment effective immediately or retroactive to March 1, 2020.

Cost Share

No plan amendment is required when adding coverage for COVID-19 testing at 100% with no deductible, coinsurance or co-payment. No prior authorization or other medical management requirements will apply.

We will accept policyholder amendments to waive plan member deductibles, coinsurance and/or copayments for Medical treatment of COVID-19 Amendments are required and can be retroactive to March 1, 2020 if received by August 30, 2020. All other plan provisions will continue to apply.

Special Enrollment Periods

If policyholders elect to hold a Special Enrollment Period (SEP) due to COVID-19 for an effective date no later than May 1, 2020, Swiss Re will accept SEP new entrants pursuant to all other terms of the plan. Stop loss claim reimbursement requests will require documentation of coverage eligibility. No notification will be required.

Grace Period Extensions

Premium payment may be made within 60 days of the due date until further notice. No notification will be required.

Suspension of utilization management review and notification requirements

Certain states have requested that insurance companies suspend certain utilization management review and notification requirements in order to free up medical personnel to assist in caring for patients. In any such state, we will accept payment of claims without penalty for failure to comply with such plan utilization management requirements. This will apply for the timeframe determined necessary by the plan, not to exceed the period of time requested by a given state.

COBRA Extension Guidelines

Swiss Re will follow the federal rules related to COVID 19, including mandated extensions for COBRA and FMLA.