To access the carrier product and rate information provided by PRISM, check the box below indicating you have read and agree to the license agreement. A button will then appear to access PRISM.
This site uses cookies to track your agreement option. If the terms of the license agreement change or if you clear the cookies from your browser, this page will appear once again during the PRISM login process.
Starting July 1, Covered California for Small Business (CCSB) is offering new Blue Shield plans, providing more options for enrollees. These plans include the Access+ HMO Network with Platinum, Gold, and Silver metal tier options, as well as the Bronze Trio HMO 7000/70. The two most popular Blue Shield High Deductible Health Plans (HDHP), Silver Full PPO Savings 2300/25% and Bronze Full PPO Savings 7000 plans, are also now available.
All of these plans offer benefits such as Wellvolution, Teladoc Mental Health, Nurse Help 24/7, LifeReferrals 24/7, and the Blue Card program for when members are outside of California.
For assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.
Login To PrismGet carrier answers to Coronavirus questions, including coverage for COVID-19 testing and treatment, expanded access to telehealth, special enrollment periods, relief for employer groups, and more. View additional FAQ topics.
Allied Benefit SuiteNo. There is no effect on the member that is out.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
EAP option with disability coverage through AXA Equitable.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Disability: are there any exclusions for pandemics?
No, there’s no exclusion for pandemics. COVID-19 is evaluated like any other medical condition.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
BeamAre there any billing grace periods or extensions available?
To assist employer groups during this time, Beam is offering a 60-day grace period for any premium invoices for the month of March. During the 60-day grace period, Beam will continue to pay claims for active groups and members. Groups will continue to receive invoices for all outstanding premiums due, but payment for the outstanding premium would not be required for those invoices until 60 days past the first missed due date.
The extended 60-day grace period at this time applies only to March premiums. Beam is working diligently with their insurance partners and will continue to evaluate this Policy as they receive more information from NGL (they are underwritten by National Guardian Life) with regards to future premiums.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Beam will allow laid-off employee(s) to retain coverage on an employer’s Policy upon the employer’s request, as long as the laid-off employee(s) was active on the Policy as of 3/1/2020. Please note that the employer will still be responsible for paying premiums for any laid-off employees that are kept on the Policy.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Any temporarily closed group should fall under 60-day grace period in terms of retaining active coverage. Please contact Claremont for more information on the proper procedure for temporarily closing businesses.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
As long as one person remains actively employed, eligible employees may elect to continue coverage under COBRA. Beam are not terminating groups who fall below the 2- member threshold at this time.
If the employer would like to keep furloughed or laid off employees on the group plan, that is allowed and is at the discretion of the employer. Beam will continue to invoice the employer for all members that are actively on the plan, therefore the group would be responsible for collecting any individual premiums from their furloughed employees.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any extensions to new group application deadlines?
Yes. Check the Carrier Responses section of our COVID-19 resource page for the latest information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Blue Shield of CaliforniaIs Blue Shield enforcing active-at-work and minimum work hours?
The terms of Blue Shield’s group service agreements continue to apply to employee eligibility for coverage. Employers should refer to the agreement and note that there are provisions in most group service agreements that may allow for continued coverage for members who are impacted by a temporary suspension of work or temporary reduction of hours in certain circumstances, such as a layoff, furlough, or approved leave of absence. This may be permitted under the employer’s policies regarding coverage, under the following conditions:
Employees who lose eligibility for coverage due to a reduction of hours or suspension of work may have the right to continue coverage under COBRA or Cal-COBRA. Employers should refer to their group service agreement for additional information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there a special open enrollment period for individuals who have previously declined coverage?
Employer groups may enroll new members off-anniversary through a Special Enrollment Period (SEP) through June 30, 2020, with July 1 as the latest effective date. This SEP is for employees who previously declined coverage for themselves or their dependents.
This applies to all fully insured Small Group (1-100) and Large Group (101+) employers, and includes enrollment for medical plans, dental plans, and vision plans.
See also: Can a group or employee change plans off-anniversary?
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Small Business (1-100): Blue Shield will allow a one-time buy-down (leaner plan design with lower premiums) change off-cycle for employers and employees to adjust their health plan selection to meet their current needs. Buy-down selections must be consistent with the current plan type offered by the group: PPO plan to PPO plan or HMO plan to HMO plan.
Note: rates for employees who choose a buy-down plan off-cycle will be based on the age of the member at the time of the change.
As a reminder, specialty benefits – dental plans, vision plans, and life insurance – may be added at any time.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Blue Shield will allow a one-time buy-down (leaner plan design with lower premiums) change off-cycle for employers and employees to adjust their health plan selection to meet their current needs.
Note: rates for employees who choose a buy-down plan off-cycle will be based on the age of the member at the time of the change.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Fully insured groups:
Blue Shield will continue to provide coverage through June 30, 2020 as long as premiums are received. Coverage must be offered on a consistent, non-discriminatory basis to all employees, and employee premium contributions must be the same or less as prior to the layoffs, furloughs or reduction of hours.
Options for continuing coverage for laid-off employees:
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any extensions to new business submission deadlines?
Yes. Blue Shield will allow new groups to be submitted up to the last business day of each month for effective dates through January 2021. Once approved, the effective date cannot be changed. Please note on the submission cover sheet that the group agrees to the requested effective date and understands the effective date cannot be changed.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is Blue Shield waiving Recertification for renewing groups?
Yes. Blue Shield has announced that the recertification process is being waived in response to the Coronavirus. All groups with an April through July 2020 renewal date will have recertification waived.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Blue Shield standard provision allows for waiving of waiting period if rehired within 6 months of cancellation of coverage. Employers should check their contract for further details.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is the “Premium Payment Plan” Program?
Blue Shield has introduced a flexible payment program for the month of April, May and June for Individual and Family Plan and Medicare Supplemental plan members, and Small Business groups.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any extensions to new group application deadlines?
Yes. Check the Carrier Responses section of our COVID-19 resource page for the latest information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Blue Shield is evaluating every decision or request from the State and Federal Government and their senior sales leaders are meeting daily to make proposals and decide on next steps. For now, they’re referring all clients back to their existing contracts and highlighting provisions that help in a time like this.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is Blue Shield of California covering the cost of testing and treatment for COVID-19?
Yes. Blue Shield is waiving out-of-pocket costs for co-payments, coinsurance, and deductibles for COVID-19 testing and treatment through September 30, 2020.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are at-home Coronavirus test kits covered by Blue Shield and will the copay be waived?
At this time, Blue Shield and Blue Shield Promise will only cover self-administered test kits that are FDA-approved, or emergency use authorized, or authorized under other guidance from the Secretary of the Department of Health and Human Services consistent with the federal CARES Act. Other self-administered tests available on in the market are not covered.
Blue Shield and Blue Shield Promise require self-administered tests be ordered by a healthcare provider, sent to the approved laboratory specified on the kit, and processed in accordance with FDA and other guidance, as applicable. This policy is in accordance with applicable legislation, including the federal CARES Act.
Blue Shield and Blue Shield Promise will not cover self-administered test kits that fail to meet the conditions specified above. Members should call the phone number on the back of their member ID card to confirm coverage.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
When did Blue Shield start to process claims with no cost-sharing for COVID-19-related services?
On March 18, 2020, Blue Shield began processing member co-pays, coinsurance, and deductibles at no cost. Any claims received between January 27 and March 18 will be readjudicated at zero dollars for COVID-19-related testing and screening services in accordance with state and federal law.
On April 1, 2020, Blue Shield announced it would also waive member co-payments, coinsurance, and deductibles for treatment, effective March 1 through May 31 for fully insured plans.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
If a member is improperly charged for a co-payment, the member should call the number on the back of their member ID card and Customer Care will work with them to get a reimbursement issued.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any prior authorizations required for COVID-19 treatment – and if so, will they be waived?
Blue Shield will not require prior authorization or cost-sharing for medically necessary COVID-19 testing and related screening, including a related hospital, office, emergency room, or urgent care visit, in accordance with state and federal requirements.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
How much do tests and test kits cost?
Blue Shield of California is waiving the need for prior approval and all cost-sharing for COVID-19 testing prescribed by a physician and administered by a health care professional for all members enrolled in Blue Shield’s fully insured commercial and Medi-Cal plans. Until recently, COVID-19 testing was only available from the CDC and was free. Private labs are now beginning to provide testing when ordered by a physician.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Blue Shield of California typically does not update Summary of Benefits and Coverage (SBC), Summary of Benefits (SOB), Evidence of Coverage (EOC) documents or contracts for a specific disease. However, they will evaluate the impact to contracts with direction from state regulators and Blue Shield of California’s mandates team.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Under the global care provisions of their plan, Blue Shield of California members are provided emergency medical assistance when traveling out of the country, This includes telephonic support, finding a provider, and assistance with subsequent claim payments. Should a member become infected with COVID-19, they would qualify for emergency international coverage. The approval for any coverage is subject to their covered benefits. (i.e. repatriation is not a covered expense).
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Does the standard employer group plan contract cover telemedicine?
Telemedicine services are covered under Blue Shield’s standard plan designs for fully insured and self funded (ASO and Shared Advantage/Shared Advantage+), as follows:
In addition, Blue Shield is expanding access to telehealth services in response to COVID-19 by allowing providers to provide services using an expanded range of telehealth platforms. This applies to all telehealth services, including medical-related and behavioral health services, performed appropriately during the COVID-19 public health emergency.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Will Blue Shield waive copays for calls to Teladoc?
Copays and co-insurance for Teladoc visits, medical and behavioral health, will be waived for members enrolled in all Blue Shield commercial plans through September 30, 2020, whether or not related to COVID-19.
Members enrolled in Blue Shield’s Trio and Tandem plans already enjoy $0 out-of-pocket costs for Teladoc services.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Teladoc’s protocols regarding COVID-19 diagnostic testing services is as follows: Teladoc providers will notify the Teladoc leadership team of suspected cases and contact the appropriate public health departments in accordance with local reporting requirements. The public health department will take the lead to initiate diagnostic testing and guide individuals on any at-home self-monitoring, at-home supervised isolation, or quarantine requirements.
As this is an evolving situation, Teladoc will adjust their protocols, as appropriate, based upon evolving CDC and WHO guidance.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What services does Blue Shield offer for members with anxiety over this outbreak?
Through September 30, 2020, Blue Shield is making Teladoc health, including behavioral health services, available with no member cost sharing for all members with access, including all Blue Shield fully insured commercial plans.
During this time, all Teladoc behavioral health services will be exempt from copays, regardless of the reason for the visit, including encounters with psychiatrists, psychologists, licensed clinical social workers, and marriage family therapists.
Mental health services also continue to be available from providers other than Teladoc. If the Evidence of Coverage (EOC) or Certificate of Insurance (COI) states that mental health services are available through Mental Health Services Administrator (MHSA) network, members can search for providers in the MHSA network through the provider directory. The standard office visit copay applies to MHSA Tele-behavioral health appointments.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
For the duration of the public health emergency, Blue Shield and Blue Shield Promise will waive early refill limits on prescription medications. Blue Shield does not recommend stockpiling medications. However, early refill limits have been adjusted so that members can refill an extended supply of their medication according to their benefit. For any questions regarding early refills, members may call the Members Services number on the back of their Blue Shield member ID card.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is Blue Shield doing to make it easier for members to receive their prescriptions?
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
You can find Blue Shield’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Chinese Community Health PlanYou can find Chinese Community Health Plan’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Choice BuilderAs long as the group and employees are current on their monthly payments, ChoiceBuilder will allow employees that would otherwise have lost eligibility to remain on the plan. COBRA is available to employees where there is an active employer policy.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
As long as the group and employee are current on their monthly payments, ChoiceBuilder will allow employees that would otherwise have lost eligibility to remain on the plan. COBRA is available to employees where there is an active employer policy.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
If an employer wants to reduce their contribution mid-year to save money will you allow it?
Employers may make a one-time, “mid-plan year” change to their contribution or plan to reduce their premiums and maintain coverage for the balance of the contract year. Employees may also make a one-time “mid-plan year” change to downgrade from the current plan they are on to a lower cost plan as long as they remain with the same Ancillary Carrier.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Will you waive any rehire waiting period for re-hired employees who were terminated due to COVID-19?
ChoiceBuilder will allow the group to define the waiting period when the employee returns to work.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
If an employee loses eligibility and the group will not cover the employer contribution, the employee is encouraged to explore COBRA, their state based individual exchange, or the federally facilitated marketplace, based on a qualifying life event (per existing standard business practices and applicable law).
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
If premiums have been remitted for the month, coverage will continue through the end of that month (per existing standard business practices and applicable law).
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there a Special Enrollment Period (SEP) for employees who have previously waived coverage?
Yes:
Learn more here.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
ChoiceBuilder realizes these are unprecedented times and want to help and support their customers where possible. If customers are having trouble making payments they should reach out to their account manager or customer service. ChoiceBuilder will evaluate payment extensions on a case-by case basis.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
You can find ChoiceBuilder’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Covered California for Small BusinessAre there any extensions to new business submission deadlines?
Yes. CCSB is extending new business submission deadlines to provide relief to employer groups and their brokers. See here for the updated deadlines, and the New Business Late Submission Acknowledgement form.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can a group or employee change plans off-anniversary?
CCSB is not allowing groups to drop or downgrade plan offering off-anniversary. However CCSB has indicated that they will work with an employer on a case by case basis for consideration.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there any additional grace period for the payment of premiums?
Yes, there’s a 60 day grace period for April and May premium payments.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can employers use credit cards to pay premiums?
No. The available methods of premium payment have not changed; checks and ACH. No credit card payments.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is the “Premium Deferral Program”?
Covered California for Small Business has introduced a flexible premium payment plan to employers who have not yet paid their premiums for April or May.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any extensions to new group application deadlines?
Yes. Check the Carrier Responses section of our COVID-19 resource page for the latest information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there a Special Enrollment Period for individuals who previously waived coverage?
Yes. CCSB is offering a Special Enrollment Period (SEP) for individuals who previously waived coverage:
Learn more.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
If employee’s hours are reduced or if they are temporarily furloughed, but still considered employees, then so long as the monthly premium is paid coverage will stay in place.
Employers must ensure that any changes they make in this area of eligibility are equitable across all employees and employee classes. Employers must not make changes that could be considered discriminatory.
If employees are formally terminated, then COBRA is the only group coverage option.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
You can find Covered California for Small Business’ Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Health NetContact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is Health Net doing to make it easier for members to receive their prescriptions?
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
You can find Health Net’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
HumanaAre there any extensions to new group application deadlines?
Yes: 4.10.20 for April effective dates. 5.12.20 for May effective dates.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is Humana extending grace periods for premium payment?
Yes. Humana is extending its usual 30 day premium payment grace period to 60 days for California employers.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What Coronavirus resources is Humana making available for brokers, groups, employees and members?
You can find Humana’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
KaiserContact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is Kaiser doing to make it easier for members to receive their prescriptions?
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What Coronavirus resources is Kaiser making available for brokers, groups, employees and members?
You can find Kaiser’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
MetLifeIs MetLife providing any rate passes?
MetLife has announced for groups with fewer than 500 lives and have a renewal June – September of 2020 that they will be having a rate pass. MetLife will be reaching out to employer groups renewing during June – September this week to notify them of the rate pass.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there any relief to employers who have furloughed employees or reduced their hours?
Yes.
For group life, dental, AD&D, vision, accident & health and legal coverage, MetLife is willing to allow employees who are furloughed, temporarily laid-off or have reduced hours/salary to continue their coverage for 12 months from the date of the furlough, temporary lay-off or reduced hours/salary (collectively, “temporary salary reductions”). Premiums need to be remitted for coverage to remain active.
For purposes of group life, the coverage amounts will not be reduced as a result of temporary salary reductions and will remain in effect just as they were prior to the furlough, temporary lay-off or reduced hours/salary. Accordingly, premium needs to be remitted based on the volume for the regular (non-reduced) coverage amounts.
For group disability, MetLife is willing to allow employees who experience a furlough, temporary lay-off or have reduced hours/salary between March 1, 2020 and May 31, 2020, to continue their coverage for 60 days from the date of the furlough, temporary lay-off, or reduced hours/salary. Coverage amounts will not be reduced as a result of temporary salary reductions and will remain in effect just as they were prior to the furlough, temporary lay-off or reduced hours/salary. Accordingly, premium needs to be remitted based on the volume for the regular (non-reduced) coverage amounts.
In all instances, if the group policy allows for longer periods of continued coverage under any of the circumstances outlined above, MetLife will honor the longer period of time.
Premiums need to be remitted for coverage to remain active.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is MetLife issuing premium credits to employer groups?
Yes. Employers with fully insured dental PPO plans will receive a premium credit on a future bill in the amount of 25% for the months of April and May, 2020.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is MetLife waiving the usual waiting period requirement for re-hires?
For Group Life, AD&D, Accident and Health, Dental and Vision, if the employee’s employment is terminated and coverage lapses due to non-payment, and they return to work or are re-hired within 6 months, MetLife will reinstate their prior coverage amount without needing to provide evidence of insurability, where applicable, or satisfying benefit eligibility waiting periods. For accident and health coverage, any limitations for pre-ex conditions will be applied from the reinstatement date.
For disability coverage, if the employee’s employment is terminated and coverage lapses due to non-payment, and they return to work or are re-hired within 3 months, MetLife will reinstate their prior coverage amount without needing to provide evidence of insurability, where applicable, or satisfying benefit eligibility waiting periods. In addition, the pre-ex provision will be applied as if there was no interruption in coverage.
MetLife will continue to review the needs of their clients during this time and if additional flexibility is needed based on the duration of this pandemic, they may modify our reinstatement position.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Will MetLife be making any changes or having leniency for premium payments?
MetLife understands these are challenging times for many businesses. As an accommodation to their clients, In the event premiums cannot be paid during the contract grace period, MetLife will be extending grace periods for the lesser of 90 days from premium due date or July 31, 2020, unless a different grace period is required by law. This policy will be applied for all premiums due 3/1/2020 and forward, as well as apply to any premium within the current 30-day grace period. MetLife will continue to monitor the situation and will provide additional guidance as it becomes available. MetLife is also monitoring state specific mandates and will comply with those mandates. As the coronavirus situation continues to evolve, MetLife will review this guidance for necessary actions and provide updates where the guidance or process has changed.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Disability: are there any exclusions for pandemics?
No, there’s no exclusion for pandemics. COVID-19 is evaluated like any other medical condition.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What Coronavirus resources is MetLife making available for brokers, groups, employees and members?
You can find MetLife’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
OscarContact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is Oscar doing to make it easier for members to receive their prescriptions?
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What Coronavirus resources is Oscar making available for brokers, groups, employees and members?
You can find Oscar’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
PrincipalYes, coverage remains active through May 31, 2020, if the employer continues to pay premiums.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Principal’s standard practice is to continue coverage until the end of the month. However, as an administrative exception due to impacts from COVID-19, any employee no longer eligible due to reduced hours or furlough/layoff on or after March 1, 2020, through May 31, 2020, may continue coverage for 90 days, provided premiums continue to be paid. For employees whose coverage terminates and are rehired within six months of the termination date, benefits are reinstated without a new hire waiting period..
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can a group downgrade off anniversary?
Please contact Claremont and we can assist with this process.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there any extension available to the grace period for premium payments?
Yes. Principal understand this might be a financially challenging time. So they’re extending grace periods to 60 days for monthly bills through June 1, 2020. Plus, they’re actively monitoring grace period changes at a state level and will implement those requirements that have a grace period longer than 60 days. This is a rapidly changing situation. Principal will continue to monitor and adjust information. Contact Claremont for the latest information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any rate passes for upcoming renewals?
Yes. For employers with less than 500 employees and policy anniversary dates of May 1, 2020 through Aug. 15, 2020, there won’t be any rate increases at renewal.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any extensions to new group application deadlines?
Yes. Check the Carrier Responses section of our COVID-19 resource page for the latest information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Do employees qualify as Disabled if they fall ill due to COVID-19?
Claims for COVID-19 will be evaluated the same as any other illness. As with all claims, one must satisfy the definition of disability and all other provisions outlined in the policy.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Does Principal have a pandemic-specific exclusion in their insurance policies?
No, Principal evaluates COVID-19 as they would any other medical condition.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What support is available for employees feeling overwhelmed or anxious about Covid-19?
Principal and Magellan are extending telephonic EAP support for all group benefit clients that may have employees who are feeling overwhelmed or anxious about COVID-19. Employees can contact Magellan Healthcare 24/7 at 800-450-1327 for free, confidential consultation services.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What Coronavirus resources is Principal making available for brokers, groups, employees and members?
You can find Principal’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Reliance StandardIs Reliance Standard providing any relief to employer groups?
Yes. Reliance Standard is providing relief in a number of ways, including temporarily:
More information of these new actions can be found on Reliance Standard’s Coronavirus Response page, with links to general FAQs and Dental and Vision FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Reliance Standard will allow the employee to maintain insurance coverage during the time period that the temporary reduction in hours occurs. The employer must maintain the employee’s same employment status as prior to the work hour reduction [e.g. active, full time etc.]. Additionally, at this time, Reliance Standard has determined that a temporary hour reduction is one that occurs for up to 30 calendar days. This means that if the employee continues to work a reduced scheduled on the 31st calendar day from the date the reduced schedule began, the employee will need to meet the eligibility requirements in the applicable policy to maintain coverage. As the pandemic situation develops Reliance Standard will evaluate the 30-day time frame to determine if modification is warranted.
Please note that all other policy provisions still apply, including the standard policy requirement that all income related changes are effective on the date that change occurs. For example, this means that if an employee’s income is reduced and the employee files a disability claim, the employee’s income immediately prior to the employee’s date of disability will be used to determine the employee’s benefit amount.
Employer groups should check their policy: certain policies may not allow this extension of coverage or certain policies may allow changes in income to be effective on dates other than the date the change occurred; if so, that information will be specifically listed.
Helpful Resources
Reliance Standard Coronavirus Response page, with links to general FAQs and Dental and Vision FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Certain policies (e.g. the standard life contract) have specific continuation of coverage provisions, which will be followed. Without such a provision, standard policies (for example, disability policies) do not allow an employee to maintain insurance coverage once the insured is no longer in an eligible class. Groups should check their policy; certain policies may allow extension of coverage in compliance with applicable laws, and if so, that will be specifically listed.
Helpful Resources
Reliance Standard Coronavirus Response page, with links to general FAQs and Dental and Vision FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can an employer group get an extension of time to pay its premium?
Reliance Standard understands the coronavirus outbreak has impacted everyone. They will work in good faith with all their clients impacted to extend reasonable accommodation with regard to timely payment of premium. In addition, the group may be covered by a local, regional, state or federal relief program or proclamation; Reliance Standard will cooperate fully with these requirements.
Helpful Resources
Reliance Standard Coronavirus Response page, with links to general FAQs and Dental and Vision FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
For policies without a continuation of coverage provision, including standard disability policies, Reliance Standard will allow an employee to maintain insurance coverage for 60 consecutive calendar days if an employer temporarily
For policies with a continuation of coverage provision, including standard life policies, Reliance Standard will follow the applicable contract provision. In instances where the provision allows coverage to continue for less than 60 consecutive calendar days, they will administratively extend the timeframe to 60 consecutive calendar days.
In all instances:
As the pandemic situation develops, Reliance Standard will evaluate the 60 calendar day time frame to determine if modification is warranted.
Helpful Resources
Reliance Standard Coronavirus Response page, with links to general FAQs and Dental and Vision FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Reliance Standard follows all applicable regulations related to billing grace periods in all states that have released specific guidelines tied to the COVID-19 pandemic.
Additionally, each policy contains a grace period which allows for continued insurance coverage for a defined period of time. We are adhering to grace periods outlined in each client-specific policy at this time and will continue to monitor market changes as appropriate. After a grace period ends, Reliance Standard will communicate and work with clients before coverage might lapse to better understand ability to remit premium prior to termination.
Helpful Resources
Reliance Standard Coronavirus Response page, with links to general FAQs and Dental and Vision FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Disability: are there any exclusions for pandemics?
No, there’s no exclusion for pandemics. COVID-19 is evaluated like any other medical condition.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
You can find Reliance Standard’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
How are Coronavirus claims considered across the Reliance Standard Product line?
Short Term Disability
If a person is diagnosed with COVID-19, a claim for fully-insured STD benefits would likely be payable after the elimination period if the definition of disability has been met. Individuals who are quarantined without a diagnosis would not have a payable claim.
Long Term Disability
If a person is diagnosed with coronavirus, a claim for fully insured LTD would likely be payable after the elimination period if the definition of disability has been met. As with STD, individuals who are quarantined but not sick generally would not have a payable claim.
Group Term Life Insurance
A life claim following a COVID-19 diagnosis would likely be payable assuming all other provisions of the policy are met.
Accidental Death & Dismemberment
A COVID-19 diagnosis is not a covered condition under Reliance Standard’s Accidental Death & Dismemberment product.
Accident Insurance
Accident insurance does not provide benefits for the diagnosis or treatment of COVID-19.
Critical Illness Insurance
COVID-19 is not a covered condition under Reliance Standard’s Critical Illness product.
Hospital Insurance
Admission/confinement due to a positive diagnosis of COVID-19 may be considered for eligible benefits provided all other provisions of the policy are met.
Wellness Benefits
COVID-19 testing is not a covered test under our Wellness Benefit; however, most major medical plans and many government programs provide free COVID-19 testing.
EAP Services
For any individuals experiencing panic, anxiety or fear, or are in need of community resource referrals for child care or life management needs, an EAP provides work-life referrals that can help. This value-added service is optional on Reliance Standard’s LTD and Group Life contracts. Contact Claremont to confirm coverage.
Helpful Resources
Reliance Standard Coronavirus Response page, with links to general FAQs and Dental and Vision FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
SharpWhat is Sharp doing to make it easier for members to receive their prescriptions?
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What Coronavirus resources is Sharp making available for brokers, groups, employees and members?
You can find Sharp’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
UnitedHealthcareWhere can I find information on the recent COVID-19 Special Enrollment Period for medical plans?
UnitedHealthcare’s FAQs on the Special Enrollment Period has answers to many questions.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there a Dental & Vision Special Enrollment Opportunity?
Yes.
UnitedHealthcare has announced a Dental & Vision Special Enrollment Opportunity to enroll employees who previously did not enroll in Dental and/or Vision coverage. The one-time opportunity will be limited to those employees who previously waived coverage or did not elect coverage for themselves or their dependents (e.g., spouses or children).
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is there a special open enrollment period in response to the COVID-19 National Emergency?
To assist members in accessing care in light of COVID-19, United Healthcare is providing its fully insured small and large employer customers with a Special COVID-19 Enrollment Opportunity to enroll employees who previously did not to enroll in coverage. The opportunity will be limited to those employees who previously did not elect coverage for themselves (spouses or children) or waived coverage. See Notice of Special COVID-19 Enrollment Opportunity (English) and Notice of Special COVID-19 Enrollment Opportunity (Spanish) document for details.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Which products are in scope for the SEP?
The SEP is limited to medical, pharmacy, dental and vision. All other products are not part of the special enrollment program.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Yes. Between March 23rd and May 31st, employers have one chance to buy down their benefit plan. The group’s effective date will not change, and the new plan will become effective between April 1 – June 1, depending on timing of plan change request. Follow standard off-cycle plan change process.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Yes, between March 23rd and May 31st, UnitedHealthcare will not impose any fully insured policy limitations on employer /plan sponsors who want to:
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What can the employer offer during the special open enrollment?
UnitedHealthcare has extended the COVID-19 Special Enrollment Period (SEP) to April 13, and employers* with multiple plan options also can buy down to a leaner plan. Options include:
Add a special open enrollment for members who previously waived coverage, including dependents, to provide additional access to care. Employers can do this without introducing any new plans from March 23 -April 13 (extended from April 6). Employers will continue to contribute to the cost of the coverage, and coverage will be effective April 1.
1. Buy down to a leaner plan:
2. Add a lean plan design but no SEP: Consistent with the buy-down approach, employers will have until May 31 to add a lean benefit. In that instance, existing members can move to the new lean plan design. No other benefit changes are permitted. New enrollees previously waiving coverage are excluded beyond the April 13 cutoff for SEP.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can California extend the Open Enrollment for CA HMO products to April 13?
Yes. This date extension only applies to United Healthcare group CA HMO products.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
No. The Special Open Enrollment period is NOT intended to allow members to change plan options. The Special Open Enrollment is merely waiving policy restrictions on adding new enrollees outside of open enrollment or the normal special enrollment period. The employer-sponsored group health plan will decide if they want to offer the option for new entrants to the plan. Learn more.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Yes. During the next 90 days, and one time only, if an employer wishes to buy down their benefit plan, UnitedHealthcare will allow it. The group’s effective date will not change. Learn more.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can an insured employer add an additional leaner plan and have a Special Open Enrollment?
An employer can add the leaner plan, but only new members can join that plan during the Special Open Enrollment – they will not allow movement across plans mid-year. Learn more.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can employers use credit cards to pay premiums?
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any extensions available to new business submission deadlines?
Yes. Groups with 4/1 effective dates can be submitted in SAM until the last business day of the month. These groups must be clean and complete. Once the group has been approved, the effective date cannot change.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Are there any extensions to new group application deadlines?
Yes. Check the Carrier Responses section of our COVID-19 resource page for the latest information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Does UnitedHealthcare have some information related to employer groups returning to their worksites?
Get the answer in UnitedHealthcare’s COVID-19 Back to Worksite FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Can a member self-refer for the test?
Get the answer in UnitedHealthcare’s COVID-19 Testing FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Testing FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
If the test comes back positive for COVID-19, will the member’s treatment be covered?
Get the answer in UnitedHealthcare’s COVID-19 Testing FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Get the answer in UnitedHealthcare’s COVID-19 Testing FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Will drive-up testing be an option?
Get the answer in UnitedHealthcare’s COVID-19 Testing FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Does UnitedHealthcare cover treatment for COVID-19?
Get the answer in UnitedHealthcare’s COVID-19 Coverage and Benefits FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Does UnitedHealthcare cover the test for COVID-19?
UnitedHealthcare will waive cost sharing (copayment, coinsurance, and deductible) for COVID-19testing during this national emergency. We are also waiving cost sharing for COVID-19 testing related visits during this same time, whether the testing related visit is received in a health care provider’s office, an urgent care center, an emergency department or through a telehealth visit. This coverage applies to Medicare Advantage, Medicaid and fully insured and self-funded employer-sponsored plans.
Testing must be provided at approved locations in accordance with U.S. Centers for Disease Control and Prevention (CDC) guidelines including FDA approved testing at designated labs around the country.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Based on federal legislation passed on March 18, 2020, all plans are required to cover these services without cost-sharing during the emergency period.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Does UnitedHealthcare cover the test for COVID-19?
UnitedHealthcare and its self-funded customers will waive cost-sharing for COVID-19 testing during this national emergency. They are also waiving cost-sharing for COVID-19 testing related visits during this same time, whether the testing related visit is received in a health care provider’s office, an urgent care center, an emergency department or through a telehealth visit. This coverage applies to Medicare Advantage, Medicaid, and fully insured and self-funded employer-sponsored plans.
Testing must be provided at approved locations in accordance with U.S. Centers for Disease Control and Prevention (CDC) guidelines.
Other costs beyond the test and test-related physician office, urgent care, emergency room, Virtual Visit and telehealth visit, and items and services related to the visit will be covered based on terms in the medical plan and applicable state and federal mandates. Therefore, deductibles, copayments, and coinsurance would apply to care, and certain services or supplies beyond the test itself and test-related provider visit.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
UnitedHealthcare is able to accommodate a client that wishes to cover certain services above and beyond cost-share on diagnostic testing or test-related visit or to cover COVID-19 treatment. The client should discuss it with the UnitedHealthcare account team. Learn more.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is UnitedHealthcare policy on telehealth services?
Get the answer in UnitedHealthcare’s COVID-19 Virtual Visits and Telehealth FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Is UnitedHealthcare providing expanded access to telehealth?
Yes. UnitedHealthcare expanded access to telehealth to help members stay at home and reduce exposure to the virus.
24/7 Virtual Visits through designated telehealth providers: While these visits cannot be used to test for or treat COVID-19, they can be useful in determining if members should call their local health care provider regarding COVID-19 testing. These visits are also ideal for urgent care treatment of other illnesses, like the seasonal flu, allergies, pink eye and more.
Cost sharing for members with a telehealth benefit through their employer-sponsored plan will be waived through June 18, 2020.
To access their benefit, members should sign in to their health plan account.
Local telehealth visits with a member’s medical provider: Many medical providers can provide a telehealth visit. Telehealth visits with a member’s health care provider can be used for both COVID-19 and other health needs, keeping members in their home while still receiving the care they need.
For COVID-19 testing related telehealth visits with a health care provider, cost-sharing is waived during this national emergency.
For other health related telehealth visits, cost sharing and coverage will apply as determined by the member’s health benefits plan, through June 18, 2020.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Will pharmacy coverage or treatment be impacted by COVID-19?
Get the answer in UnitedHealthcare’s COVID-19 Pharmacy Coverage FAQs.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
What is UnitedHealthcare doing to make it easier for members to receive their prescriptions?
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
Disability: are there any exclusions for pandemics?
No, there’s no exclusion for pandemics. COVID-19 is evaluated like any other medical condition.
Contact Claremont for more information.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
You can find UnitedHealthcare’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)
If you have any questions that we haven't covered yet, we'd love to hear from you. Please click the button below and complete the form. A member of our team will be in touch.
Not finding what you're looking for? Ask a question.
The answers provided are a best interpretation of the information available as of the date posted. The answers are for informational purposes and should not be construed as tax or legal advice.