Plan Documents & Eligibility

If a business closes due to COVID-19, Unum will consider employees who were actively-at-work the day before the closure to be eligible under the plan through April 30th, 2020, at which time, Unum will determine whether to extend timeframe

For layoffs and leaves of absence, Unum’s Stop Loss policy will continue coverage in accordance with Policyholders’ respective plan documents at the effective dates of their policies. Should Policyholders decide to make changes to their underlying plans’ eligibility requirements as a result of COVID-19, Unum’s Stop Loss policy will honor those changes as long as premiums continue to be paid. We ask to be notified of the changes in order to process claims accordingly.

Should a Policyholder’s layoff actions trigger the change in enrollment percentage thresholds outlined in the Stop Loss Policy, Unum will defer our right to re-rate the Policyholder’s Stop Loss coverage until further notice.

In this instance, we will work with the Policyholder to understand if, when, and how enrollment levels will normalize.

Please email any proposed plan document changes on Employer letterhead to your SLIS representative. 

Please use the subject line, “Eligibility Requirements Change” in your email and copy your broker/advisor

Layoffs & Furloughs

For Group Coverage:

  • UNUM will consider furloughed employees to be on a temporary layoff or leave of absence
  • Employees on a temporary leave of absence or layoff will remain eligible for coverage for 90 days, or the length of the temporary layoff / leave of absence provision in the policy, whichever is greater.
  • Premium payments should be based on the employee's earnings prior to the change in hours or work status.
  • During the COVID-19 pandemic, UNUM will not strictly apply minimum hours worked requirements for an employee to be considered actively employed.

See above "Plan Documents & Eligibility section for additional information.

Claim Reimbursements & Timely Filing

Unum plans to follow contractual claim filing time limits but will handle requests for exceptions on a case by case basis.

Actively at Work & Quarantines

For Group Coverage:

  • If an employee is quarantined based on a government order, or if the quarantine is an approved leave as defined by the Policy's leave provisions, the individual will be considered "actively employed". They would thus be eligible to maintain their coverage, provided premiums are paid.
  • People who self quarantine will be considered to be actively employed for the length of time recommended by the CDC (currently two weeks).
  • If an employee is affected by a state or local government "shelter at home" order, UNUM will consider them to be actively at work and eligible for coverage as long as premiums continue to be paid. They can maintain their coverage for as long as the order lasts, or for 90 days, whichever comes first.
Early Rx Refills

Removal of prescription refill limitations on “maintenance medications” to assure a 60-day supply in the event of potential quarantine situation will be an acceptable plan amendment effective immediately. Does not apply to prescription drugs with high likelihood of abuse, which are restricted to a 7 day prescription (such as  opioids). Precertification and step therapy procedures can be waived but limited to a 30 day supply

Unum will revisit this change on April 30th, 2020.

Telemedicine & Virtual Visits

Policyholders who decide to waive cost-sharing for telemedicine and virtual healthcare visits for covered participants will be allowed to apply these costs as eligible expenses under their Stop Loss policy without prior notification.

This change will be in effect through June 30th, 2020, at which time Unum will determine whether to extend this timeframe.

Cost Share

Policyholders who decide to waive the cost of deductibles, copays, and costsharing for COVID-19 testing for covered participants will be allowed to apply these costs as eligible expenses under their Unum Stop Loss Policy without prior notification.

"While we have previously confirmed that we would include charges for treatment under the stop loss policy, we would expect that any employer that is looking to change their plan to eliminate deductibles and co-pays for the treatment contact us for review and potential re-rating prior to doing so. We recognize that there could be potentially modest impact to the risk on the agg, but would want to review on a case by case basis."

Policy Exclusions

Unum does not have any exclusion as it relates to pandemic events. Unum will continue to administer our Stop Loss contract as per the stated language in their existing policy and any applicable administrative agreements that already are in place as they relate to policy coverage exclusions, terms and conditions.

Coverage for Treatment

Expenses associated with COVID-19 treatment will be covered under the Unum Stop Loss policy as long as these expenses are covered under the plan and meet the policy terms, as with any other claim.

Grace Period Extensions

Unum will extend the grace period for Premium payments by 30 days.

This change will be in effect through June 30th, 2020, at which time Unum will determine whether to extend this timeframe.

Rate & Coverage Change

Unum has not formally amended their Right to Recalculate at this time. However, they will work with all customers on a case by case basis based on
their particular circumstances.

Special Enrollment Periods

Unum would be agreeable to this change when the plan/employer offers a midyear enrollment option to move from a low deductible/high coinsurance plan to a high deductible plan. We would expect that the employer notifies us of this enrollment.