Plan Documents & Eligibility

Symetra will continue coverage under the stop loss policy for claims from employees that no longer meet the plan’s eligibility requirements as a result of the impact of COVID-19 on the employer’s workforce (including claims from employees experiencing a furlough or reduction in hours), provided that the employer continues to treat such employees as eligible under the plan, and premiums for such employees continue to be paid.

Symetra is not requiring the employer to amend their plan document to continue this coverage.

However, if Symetra receives a claim with respect to an employee whose coverage has been continued in this manner, Symetra will require documentation showing that the employer continued to treat the employee as eligible under the plan. Please note that this accomodation does not extend to terminated employees. An employee who has been terminated would be eligible to continue coverage under COBRA.

Please note that claims related to treatment of COVID-19 will follow the benefits outlined in the Plan Document accepted by Symetra.

Symetra will not require employers to amend their plan documents in order to implement the following changes: Waiving deductible and/or out-of-pocket charges for COVID-19 testing, treatment and Telemedicine or virtual doctor visits.

Waiving prior-authorization requirements on diagnostic testing of COVID-19 that may have otherwise applied.

Paying for out-of-network COVID-19 testing as in-network lab claims, if access for in-network COVID-19 testing is unavailable.

Allowing early refills of prescription medications.

Symetra will accept these charges as covered expenses under the Stop Loss Policy, and will not require mid-year changes to aggregate factors or premiums.

 

IRS Notice 2020-29

At this time, Symetra will not extend stop loss coverage for employees or dependents that were permitted to enroll in the plan through a midyear election, including a midyear election that complies with Notice 2020-29. Midyear election changes currently allowed by the plan and by applicable Treasury Regulations (for example, when an employee experiences a "life event" such as a marriage, birth, adoption of a child, and various employment status changes) will continue to be permitted.

Symetra will accept all extensions of timeframes required by the final rule on May 4th by the US Department of Labor and Treasury without a plan amendment or any further action on the part of the employer.

Cost Share

For information on Early Rx Refills, Telemedicine, and Cost Share, please see "Plan Documents & Eligibility" section above.

Grace Period Extensions

For premium due in March, April, or May 2020, Symetra will extend the date premium is due by one month, or longer, if required by state mandates.

For example, premium due on April 1 is now due May 1, plus the grace period as outlined in your policy.

COBRA Extension Guidelines

Symetra will accept all extensions of timeframes required by the final rule without a plan amendment or any further action on the part of the employer.

Extended Options for Continuation of Coverage

We are willing to extend coverage on employees who become ineligible solely for one or more of the reasons stated below as a result of the COVID-19 crisis until the earlier of 120 days from the date the employee would otherwise have become ineligible, or through September 30, 2020:

  • Not working enough hours to meet “minimum number of hours” requirements
  • Being temporarily laid off
  • Taking a leave of absence
  • Changing from full-time to part-time status

Premium will still be due for these employees for all periods during which coverage is in-force, although the due date for such premium may be extended as noted in our COVID-19 FAQs. We also require that you treat all eligible employees consistently with regard to continuing coverage that would otherwise lapse. Please note that we will follow the continuation provisions in your policy if they are more generous than what’s listed above.

Employees who are terminated will lose coverage unless the coverage is continued in accordance with the policy. Therefore, you should offer conversion rights, portability (if applicable) or other extension of coverage benefits to all employees once they lose coverage. Standard policy conversion and portability timeframes and rules will apply.

Special Enrollment Periods

We understand employers’ desire to allow employees to elect health coverage in light of COVID-19. However, employers should understand that their section 125 cafeteria plan could lose its tax-advantaged status if employees are allowed to make midyear election changes, other than changes that are consistent with the occurrence of a permitted election change event, as provided in applicable Treasury Regulations (for example, when an employee experiences a “life event” such as a marriage, birth, adoption of a child, and various employment status changes). Because the circumstances surrounding COVID-19 do not, by themselves, constitute a permitted election change event, Symetra will not permit a Plan to allow midyear election changes as a result of COVID-19.

If you have any questions or need additional assistance, please contact your Symetra stop loss representative.

Additional Claims Q&A Responses

Will Symetra allow a plan to extend the time for filing a benefit claim due to COVID-19?

Symetra will accept the employer's decision to extend the time allowed under the plan for filing a benefit claim up to an additional 60 days (or any longer time period required by the Department of Labor). An employer may extend this timeframe on an administrative basis (without amending the plan document) provided that the  employer treats all claimants consistently with regard to extending benefit claim deadlines, and notifies Symetra of this administrative practice.

Will Symetra accept the employer's decision to extend the time for appealing a denied claim under the plan due to COVID-19?

Symetra will accept the employer's decision to extend the time allowed under the plan for appealing a denied claim up to 12 months from the claimant's receipt of the adverse benefit determination notification (or any longer time period required by the Department of Labor). An employer may extend this timeframe of up to 12 months on an administrative basis (without amending the plan document) provided that the employer treats all claimants consistently with regard to extending appeal deadlines, and notifies Symetra of this administrative practice.

Will Symetra extend the time for submitting reimbursement requests due to COVID-19?

Typically, the employer's stop loss policy requires the employer to submit a reimbursement request within one year after the date the reimbursement request was first required under the policy. Symetra will allow an employer impacted by COVID-19 an additional 30 days in which to submit a reimbursement request. If you anticipate having any issues with being able to provide a timely reimbursement request due to circumstances surrounding COVID-19, please contact your Symetra stop loss representative.

Will Symetra require a plan amendment if an employer elects to extend the COBRA grace period under the plan by 30 additional days?

Symetra will accept an employer's decision to extend the COBRA premium payment grace period under the plan by 30 days without requiring a plan amendment, provided that the employer continues to treat the COBRA enrollees as eligible under the plan, and stop loss premiums for the COBRA enrollees continue to be paid.
If Symetra receives a claim with respect to a former employee or eligible dependent whose coverage has been continued in this manner, we will require a copy of the COBRA election form and documentation showing that all COBRA premiums due have been paid to the plan accordingly.