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Delta Dental Quoting

Employer contribution entered in Dental Contribution under Group Information affects the Delta Dental plans and rates returned. Please be aware that Delta Dental will require groups with 100% employer contribution to have 100% participation.

If you need assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.

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COVID-19 Carrier FAQs

COVID-19 Carrier FAQs

Get 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 Suite

Contract Clarifications

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.

Updated 05/07/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

Beam

Relief for Employer Groups

Are 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.

Updated 04/16/2020
(View Full Answer)

If employees are required to work a reduced schedule and no longer meet the minimum hours required in the policy, will they remain eligible for coverage?

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.

Updated 04/16/2020
(View Full Answer)

If a small business has to temporarily close due to impacts from COVID-19, will their Beam Dental/Vision coverage remain active?

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.

Updated 04/16/2020
(View Full Answer)

If there is a reduction in enrollment for a group, what is the minimum number of enrollment/EEs Beam will allow to continue the Dental/Vision coverages, even if on a temporary basis?

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.

Updated 04/16/2020
(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.

Updated 04/08/2020
(View Full Answer)

Blue Shield of California

Coverage for Covid-19 Testing and Treatment

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.

Learn more.

Updated 06/02/2020
(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.

Learn more.

Updated 06/02/2020
(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.

Learn more.

Updated 06/02/2020
(View Full Answer)

If a member pays for the co-payment, either through an office visit or Teladoc, because the provider requested payment at time of service, will they be reimbursed?

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.

Learn more.

Updated 06/02/2020
(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.

Learn more.

Updated 03/25/2020
(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.

Learn more.

Updated 03/25/2020
(View Full Answer)

Do benefits and coverage plan documents [such as Summary of Benefits and Coverage (SBC), Summary of Benefits (SOB), Evidence of Coverage (EOC) documents or contracts] require any amendment or update?

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.

Learn more.

Updated 03/25/2020
(View Full Answer)

If a member becomes infected while traveling abroad, would this qualify for emergency/international coverage under their Blue Shield plan?

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).

Learn more.

Updated 03/25/2020
(View Full Answer)

General

What Coronavirus resources is Blue Shield making available for brokers, groups, employees and members?

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.

Updated 06/02/2020
(View Full Answer)

Keeping Employees Covered

Is 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:

  • If the subscriber ceases active work because of a disability due to illness or bodily injury, or because of an approved leave of absence or temporary layoff, payment of dues for that subscriber shall continue coverage in force in accordance with the employer’s policy regarding such coverage.
  • If the employer is subject to the California Family Rights Act of 1991 and/or the federal Family and Medical Leave Act of 1993, and the approved leave of absence is for family leave pursuant to such Acts, payment of dues for that subscriber shall keep coverage in force for the duration(s) prescribed by the Acts. The employer is solely responsible for notifying employees of the availability and duration of family leaves.

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.

Learn more.

Updated 06/02/2020
(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.

  • For an April 1, 2020, effective date, enrollment request must be received no later than April 15.
  • For May 1, June 1, and July 1 effective dates, enrollment requests must be received on or before the 1st of the month for which enrollment is being requested.

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?

Learn more.

Updated 06/02/2020
(View Full Answer)

Is Blue Shield allowing employer groups to change plan selections off-cycle to accommodate revenue and workforce reduction due to COVID-19?

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.

Learn more.

Updated 06/02/2020
(View Full Answer)

Is Blue Shield allowing employer groups to change plan selections off-cycle to accommodate revenue and workforce reduction due to COVID-19?

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.

Learn more.

Updated 04/14/2020
(View Full Answer)

If employees are required to work a reduced schedule (temporary layoff, furlough, reduction-in-hours, etc) will they remain eligible for coverage?

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:

  • Employees can remain on a group plan to keep them covered in the same manner as prior to COVID-19 if premium payments continue for laid-off employees.
  • Employees can elect COBRA or Cal-COBRA, if eligible, and will be liable to pay the full cost of coverage (unless their employer chooses to subsidize COBRA premiums).
  • Employees can enroll in the individual marketplace. Employees may benefit from government subsidies to help pay premiums.

Learn more.

Updated 03/30/2020
(View Full Answer)

Relief for Employer Groups

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.

Updated 07/31/2020
(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.

Updated 06/02/2020
(View Full Answer)

If an employee is laid off and then re-hired, how long is the waiting period before they can join the medical plan?

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.

Updated 06/02/2020
(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.

Learn more.

Updated 06/02/2020
(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.

Updated 04/08/2020
(View Full Answer)

For groups in industries affected by COVID-19 closures, will Blue Shield of California provide a grace period other than the usual 30 days for premium billing?

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. 

Learn more.

Updated 03/26/2020
(View Full Answer)

Pharmacy

Are members allowed to fill their prescriptions earlier or have larger fill or refill amounts to offset difficulties with getting medications?

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.

Learn more.

Updated 06/02/2020
(View Full Answer)

What is Blue Shield doing to make it easier for members to receive their prescriptions?

  • Early refill limits have been waived.
  • 90-day supplies of maintenance medications are available through mail-service pharmacy CVS Caremark.
  • No fee mail service is available through CVS Caremark.
  • Free home delivery is also available through several pharmacy chains.

Learn more.

Updated 06/02/2020
(View Full Answer)

Access to Telehealth/ Virtual Care/ Teladoc

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:

  • For all plans, telemedicine services are available as a covered benefit through those network providers that offer such services, including Mental Health Service Administrator participating providers.
  • For fully insured plans, telemedicine services are also available through Teladoc and Nurse Help 24/7.
  • For self-funded plans, telemedicine services may also be available through Teladoc and Nurse Help 24/7, if the plan sponsor has elected to offer those programs.

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.

Learn more.

Updated 06/02/2020
(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.

Learn more.

Updated 06/02/2020
(View Full Answer)

Since Teladoc cannot actually run testing since it’s a virtual visit, what is the protocol if the provider decides that the member should be tested?

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.

Learn more.

Updated 03/28/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

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.

Updated 06/02/2020
(View Full Answer)

What emotional, behavioral and mental health services and benefits does Blue Shield provide for employees and their families?

  • Teladoc costs waived, including for tele-behavioral services. 
  • Tele-behavioral benefit the same as in-person visits. 
  • Sanvello, a mental and wellness health app, available in Wellvolution, free to members. 
  • Virtual programs such as nutrition and fitness support also available in Wellvolution. 
  • LifeReferrals 24/7 EAP available to fully insured large groups (101+). 

Contact Claremont for more information.

Updated 06/02/2020
(View Full Answer)

Chinese Community Health Plan

General

What Coronavirus resources is Chinese Community Health Plan making available for brokers, groups, employees and members?

You 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.

Updated 05/07/2020
(View Full Answer)

Choice Builder

General

What Coronavirus resources is ChoiceBuilder making available for brokers, groups, employees and members?

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.

Updated 05/07/2020
(View Full Answer)

Keeping employees covered

Will ChoiceBuilder allow employees who are currently furloughed, not working, or whose hours have been reduced below 30 hours per week to keep their insurance?

As 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.

Learn more.

Updated 04/21/2020
(View Full Answer)

Are customers able to continue employee ancillary benefits if the entire workforce is laid off in response to the COVID-19 crisis?

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.

Learn more.

Updated 04/21/2020
(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.

Learn more.

Updated 04/21/2020
(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.

Learn more.

Updated 04/21/2020
(View Full Answer)

What continuation of coverage applies if my plan is fully-insured and one or more employees are terminated as a result of COVID-19?

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).

Learn more.

Updated 04/21/2020
(View Full Answer)

If I terminate employees in the middle of the month as a result of COVID-19, will my fully-insured coverage extend for the terminated employees until the end of the month?

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).

Learn more.

Updated 04/21/2020
(View Full Answer)

Is there a Special Enrollment Period (SEP) for employees who have previously waived coverage?

Yes:

  1. Open through April 10. 
  2. Individuals who previously declined coverage for themselves or their dependents can enroll for benefits. 
  3. Employers may make a one-time, “mid-plan year” contribution change. Employees may make a one-time “mid-plan year” plan downgrade within the same Health Plan.

Learn more here. 

Updated 04/08/2020
(View Full Answer)

Relief for Employer Groups

If an employer group cannot make their premium payment due to impacts to their business from COVID-19, will the ChoiceBuilder consider extending the current 30-day grace period prior to termination?

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.

Learn more.

Updated 04/21/2020
(View Full Answer)

Covered California for Small Business

General

What Coronavirus resources is Covered California for Small Business making available for brokers, groups, employees and members?

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.

Updated 06/02/2020
(View Full Answer)

Relief for Employer Groups

Are 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.

Updated 06/05/2020
(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.

Updated 06/02/2020
(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.

Updated 06/02/2020
(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.

Updated 06/02/2020
(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.

Learn more.

Updated 06/02/2020
(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.

Updated 04/08/2020
(View Full Answer)

Keeping employees covered

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:

  • Enrollment period through end of June, 2020
  • Intended for employees and dependents of employees who previously waived coverage.
  • Effective Date of the coverage will be first of the month following the date the enrollment was submitted, ending with July 1st effective date for the SEP.
  • 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.

Learn more.

Updated 06/02/2020
(View Full Answer)

If employees are required to work a reduced schedule (temporary layoff, furlough, reduction-in-hours, etc) will they remain eligible for coverage?

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.

Updated 06/02/2020
(View Full Answer)

Health Net

General

What Coronavirus resources is Health Net making available for brokers, groups, employees and members?

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)

Pharmacy

What is Health Net doing to make it easier for members to receive their prescriptions?

  • Early refill limits waived have been waived.
  • Home and mail delivery restrictions have been relaxed.

Contact Claremont for more information.

Updated 04/20/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

What emotional, behavioral and mental health services and benefits does Health Net provide for employees and their families?

  • 24/7 access to MHN, Health Net’s behavioral health subsidiary, for referrals. 1-800-227-1060. Available to members. 
  • Teladoc costs waived, including for tele-behavioral services. 

Contact Claremont for more information.

Updated 04/20/2020
(View Full Answer)

Humana

General

Are there any extensions to new group application deadlines?

Yes: 4.10.20 for April effective dates. 5.12.20 for May effective dates.

Updated 04/23/2020
(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.

Updated 04/23/2020
(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.

Updated 04/16/2020
(View Full Answer)

Kaiser

General

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.

Updated 05/07/2020
(View Full Answer)

Pharmacy

What is Kaiser doing to make it easier for members to receive their prescriptions?

  • A 3-month supply for most prescriptions is available at 1/3 off regular price.
  • Kaiser is recommending mail delivery to members.

Contact Claremont for more information.

Updated 04/20/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

MetLife

General

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.

Updated 04/29/2020
(View Full Answer)

Relief for Employer Groups

Is 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.

Learn more.

Updated 04/29/2020
(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.

Learn more.

 

Updated 04/29/2020
(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.

Learn more.

Updated 04/29/2020
(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.

Learn more.

Updated 04/29/2020
(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.

Learn more.

Updated 04/29/2020
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Contract Clarifications

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.

Updated 04/29/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

What emotional, behavioral and mental health services and benefits does MetLife provide for employees and their families?

  • COVID-19 Hotline by LifeWorks. 1-866-307-1405. Free for ERs with <500 EEs. 
  • EAP option is available to all MetLife groups. Through LifeWorks. 

Contact Claremont for more information.

Updated 04/29/2020
(View Full Answer)

Oscar

General

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.

Updated 05/07/2020
(View Full Answer)

Pharmacy

What is Oscar doing to make it easier for members to receive their prescriptions?

  • Early refill limits have been waived.
  • No fee mail service is available through CVS Caremark.
  • Free home delivery is also available through several pharmacy chains.

Learn more.

Updated 04/20/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

What emotional, behavioral and mental health services and benefits does Oscar provide for employees and their families?

  • Optum 24/7 emotional support helpline. 1-866-342-6892. Free of charge to anyone, not just members. 
  • Doctor on Demand for in-network virtual mental health services. Optum for in-network mental and behavioral services. 
  • Calm app: 40% member subscription discount.

Contact Claremont for more information.

Updated 04/20/2020
(View Full Answer)

Principal

General

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.

Updated 04/22/2020
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Coverage and Benefits Extensions and Clarifications

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. 

Learn more.

Updated 04/22/2020
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Does Principal have a pandemic-specific exclusion in their insurance policies?

No, Principal evaluates COVID-19 as they would any other medical condition.

Learn more.

Updated 04/22/2020
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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.

Learn more.

Updated 04/22/2020
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Relief for Employer Groups

If an employer group has to temporarily close due to impacts from COVID-19, will its Principal coverage remain active?

Yes, coverage remains active through May 31, 2020, if the employer continues to pay premiums.

Learn more.

Updated 04/22/2020
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If employees are required to work a reduced schedule and no longer meet the minimum number of hours of eligibility in the policy, will they remain eligible for coverage and how long can they be covered?

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..

Learn more.

Updated 04/22/2020
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Can a group downgrade off anniversary?

Please contact Claremont and we can assist with this process. 

Updated 04/22/2020
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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.

Updated 04/22/2020
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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.

Updated 04/22/2020
(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.

Updated 04/22/2020
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Access to Emotional/ Behavioral/ Mental Health

What emotional, behavioral and mental health services and benefits does Principal provide for employees and their families?

  • 24/7 telephonic EAP support by Magellan. 1-800-450-1327. Free to members. 

Contact Claremont for more information.

Updated 04/22/2020
(View Full Answer)

Reliance Standard

General

What Coronavirus resources is Reliance Standard making available for brokers, groups, employees and members?

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.

Updated 04/23/2020
(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.

Updated 04/23/2020
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Relief for Employer Groups

Is Reliance Standard providing any relief to employer groups?

Yes. Reliance Standard is providing relief in a number of ways, including temporarily:

  • allowing coverage to continue in the event of a reduction in hours or furlough.
  • maintaining benefit levels in the event of salary reductions
  • adjusting the administration of waiting periods

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.

Updated 04/23/2020
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If an employer group remains open and temporarily reduces the hours for certain employees because of coronavirus, are its employees still considered actively at work?

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.

Updated 04/07/2020
(View Full Answer)

If an employer group has to temporarily lay off employees because of coronavirus, are its employees still insured?

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.

Updated 04/07/2020
(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.

Updated 04/07/2020
(View Full Answer)

How long can an employee remain covered by STD, LTD or Group Life in the event they are subjected to temporary reduction in hours, or sent home as a result of a temporary layoff, furlough or facility closure?

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

  • Reduces an employee’s hours; or,
  • Sends the employee home as part of a lay-off, furlough or facility closure.

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:

  • The employer must maintain the employee’s same employment status and continue all premium payments.
  • The 60 calendar days will be counted from the effective date of the change.
  • On the 61st consecutive calendar day from the effective date of the change, Reliance Standard will consider the change permanent if the employee’s hours continue to be reduced, or the employee continues to be part of a layoff or furlough, or the facility does not reopen. The employee will then need to meet the requirements in the applicable policy to maintain coverage.

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.

Updated 04/07/2020
(View Full Answer)

Is Reliance Standard offering premium grace period extensions to avoid unintentional lapse/cancelation of coverage?

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.

Updated 04/07/2020
(View Full Answer)

Contract Clarifications

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.

Updated 04/23/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

What emotional, behavioral and mental health services and benefits does Reliance Standard provide for employees and their families?

Contact Claremont for more information.

Updated 04/23/2020
(View Full Answer)

Sharp

General

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.

Updated 05/07/2020
(View Full Answer)

Pharmacy

What is Sharp doing to make it easier for members to receive their prescriptions?

  • Early refill limits have been waived.
  • No fee mail service is available through CVS Caremark.

Learn more.

Updated 04/20/2020
(View Full Answer)

UnitedHealthcare

Coverage for Covid-19 Testing and Treatment

Can a member self-refer for the test?

Get the answer in UnitedHealthcare’s COVID-19 Testing FAQs.

Updated 05/07/2020
(View Full Answer)

Will drive-up testing be an option?

Get the answer in UnitedHealthcare’s COVID-19 Testing FAQs.

Updated 05/07/2020
(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.

Learn more.

Updated 04/01/2020
(View Full Answer)

What is the process if an employer group requests to opt out of covering the test or test related expenses?

Based on federal legislation passed on March 18, 2020, all plans are required to cover these services without cost-sharing during the emergency period.

Learn more.

Updated 03/25/2020
(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.

Learn more.

Updated 03/25/2020
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What should a client do if they wish to cover more than just the test and test related expenses at no cost share?

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.

Updated 03/25/2020
(View Full Answer)

Special Enrollment Period

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).

  • The enrollment opportunity will extend from May 18, 2020 through May 29, 2020, for a June 1st effective date.
  • Employers are not required to adopt the SEP, so no opt-out action is required.
  • Dependents such as spouses and children, can be added if they are enrolled in the same coverage or benefit option as the employee.
  • This SEP is not intended to allow current members to make a change in plan options.

Get the details.

Updated 05/15/2020
(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.

  • The enrollment opportunity will extend from March 23, 2020, to April 13, 2020. Effective date is April 1.
  • Customers are not required to adopt the Special COV/D-19 Enrollment Opportunity. Because of this, no opt out action is required on their behalf. United Healthcare realizes each situation is unique, and each customer must make their own decisions on the enrollment opportunity.
  • Dependents, such as spouses and children, can be added if they are enrolled in the same coverage or benefit option as the employee. (Includes domestic partners in states where covered).
  • Standard waiting periods will be waived; however, existing eligibility and state guidelines will apply.

Learn more.

Updated 05/07/2020
(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.

Learn more.

Updated 04/21/2020
(View Full Answer)

If an insured employer has only a single benefit plan, but wants to change the plan mid-year to a leaner plan design to save money will UnitedHealthcare allow it?

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.

Learn more.

Updated 04/21/2020
(View Full Answer)

Can a multi-option employer add an additional lean plan design and conduct a Special Open Enrollment?

Yes, between March 23rd and May 31st, UnitedHealthcare will not impose any fully insured policy limitations on employer /plan sponsors who want to:

  1. allow new enrollees (i.e. eligible individuals that previously declined group coverage during open enrollment) the opportunity to enroll in any plan option available under the employer/plan sponsor’s benefit offerings, and/or
  2. allow existing enrollees (i.e. those who are currently enrolled in a benefit offering) the opportunity to change their prior election and enroll in a newly added leaner plan design. As always, UnitedHealthcare encourage plan sponsors to review any changes to their plan with their employee benefit plan counsel and/or tax advisor. 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.

Learn more.

Updated 04/21/2020
(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:

  • Employers with a single-benefit offering that wish to buy down to a leaner plan may do so between now and May 31. They also can re-enroll their population to the leaner plan design.
  • Employers with multi-option plan designs can temporarily buy down to a leaner plan. If employers decide to conduct a SEP when adding the plan, new enrollees who previously waived coverage can select from any of the plans offered by the employer provided they are eligible and the employer contributes to the cost of coverage. Existing members can also move to the lean plan design, but no other benefit changes are permitted.

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.

Learn more.

Updated 04/21/2020
(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.

Learn more.

Updated 04/01/2020
(View Full Answer)

If an insured customer has multiple plan options and opts into the Special Open Enrollment, can current members change plans?

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.

Updated 03/25/2020
(View Full Answer)

If an insured employer has only a single benefit plan, but wants to change the plan mid-year to a leaner plan design to save money will UnitedHealthcare allow it?

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.

Updated 03/25/2020
(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.

Updated 03/25/2020
(View Full Answer)

Relief for Employer Groups

Can employers use credit cards to pay premiums?

Get the answer in UnitedHealthcare’s COVID-19 Business Disruption Support FAQs.

Updated 05/07/2020
(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.

Updated 05/07/2020
(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.

Updated 05/07/2020
(View Full Answer)

General

What Coronavirus resources is UnitedHealthcare making available for brokers, groups, employees and members?

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.

Updated 05/07/2020
(View Full Answer)

Access to Telehealth

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.

Learn more.

Updated 03/27/2020
(View Full Answer)

Pharmacy

What is UnitedHealthcare doing to make it easier for members to receive their prescriptions?

  • Early refill limits waived have been waived.
  • No fee mail service is available for Optum Rx members.
  • Free home delivery is also available through several pharmacy chains.

Learn more.

Updated 05/07/2020
(View Full Answer)

Contract Clarifications

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.

Updated 05/07/2020
(View Full Answer)

Access to Emotional/ Behavioral/ Mental Health

What emotional, behavioral and mental health services and benefits does UnitedHealthcare provide for employees and their families?

  • Optum 24/7 emotional support helpline. 1-866-342-6892. Free of charge to anyone, not just members. 
  • In-network tele-behavioral costs waived. 
  • Free on-demand emotional support mobile app from Sanvello. 

Contact Claremont for more information.

Updated 05/07/2020
(View Full Answer)

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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.