Plan Documents & Eligibility

Plan Amendments effective immediately include:

Waiver of cost-sharing obligations for COVID-19 testing, including telemedicine and or/virtual office visits.

Revision of maintenance medication refills up to a 90-day supply. Only medication costs up to the end of the Stop Loss policy year will be considered eligible.

TMS Re is requesting that any amendment to the Plan Document for reasons specified in the above section be submitted by May 15,2020, or prior to the end of the Plan year, whichever is earlier.

Actively at Work & No Scheduled Shifts

Nationwide (TMS Re) recognizes some policyholders need to close their businesses or layoff/furlough staff due to governmental mandate or other
COVID-19 specific impacts.

If submitted by May 1, 2020, the following administrative considerations will be accommodated under the Stop Loss Policy:

If business closure or staff layoff/furlough occurs as a result of COVID-19, Plan members must be “Actively at Work” the day prior to the closure or staff layoff/furlough.

If the Plan member(s) is quarantined due to COVID-19, the member must return to work immediately following the end of quarantine period.

Failure of any Plan member to return to work under these scenarios will follow Plan Document terms regarding continuation of coverage for purposes of the stop loss policy.

Rate or Coverage Changes

Nationwide reserves the right to re-underwrite or re-price the policy upon receipt and review of the signed Plan amendment should benefits be extended due to any reason noted above.

All claims will continue to be evaluated based on their individual facts and relevant laws and regulations. All policy terms and conditions remain in force.

Generally, TMS Re's preference will be to re-rate accounts at renewal, but will review each account individually if the change in enrollment exceeds the stop loss contract percentage trigger.

Grace Period Extensions

If a customer indicates they are unable to make their March 1st premium payment on or before April 1st, TMS Re will extend the stop loss contract grace period of 31 days by an additional 30 days, or until May 1, 2020.

Special Enrollment Periods

TMS Re would address any employer’s one-time or special open enrollments due to COVID-19 to allow employees to make plan changes on a case by case basis. Please submit any Plan changes to TMS Re for review.