As the COVID-19 outbreak continues to unfold, the impact is being felt by both business owners and employees alike. Each day that passes, Fred C. Church can provide critical updates from the Federal and State governments related to the health and well-being of your employees. Today’s updates cover health insurance coverage, short term disability, and guidance from the Department of Labor.

Fully Insured Health Plans- Coverage for Diagnosis and Treatment of COVID-19

The Divisions of Insurance in Massachusetts and New Hampshire have released bulletins regarding COVID-19 coverage for fully insured health plans written in these states. The goal of the bulletins is to provide comprehensive coverage without financial barriers.

Massachusetts’ Bulletin 2020-02 and New Hampshire’s Order outline the expectations of the insurance carriers, summarized below:

  • Create helplines to keep members informed
  • Promote telehealth options
  • Relax site of service and network limitations to provide access to testing and care
  • Provide for no-cost coverage for the testing and treatment of the virus

The carriers have outlined their plans and available benefits and resources:

NOTE: Self-funded employers are not subject to state mandates. Plan sponsors can amend plan documents to allow for similar (or better) coverage. Employers should speak with their third-party administrator and stop-loss carrier to address the changes. COVID-19 and High Deductible Health Plans:

Qualified High Deductible Health Plans (QDHP) have strict requirements for reimbursing medical expenses before a participant satisfies the deductible. Recognizing that this could be a barrier for many people participating in QHDPs to seek the proper care, the IRS released Notice 2020-15. This notice informs that QHDPs can cover the diagnosis and treatment of COVID-19 before the deductible, without losing its qualified status.

Short Term Disability Plans- Is COVID-19 covered?

Generally speaking, a Short-Term Disability (STD) policy requires an individual to be unable to work due to illness or injury. The inability to work extends to both an office setting and a home environment. There is a required “loss of earning” to prove disability and trigger short term benefit payments.

Individuals that are unable to perform their job duties because of symptoms related to COVID-19 may be eligible for STD benefits, subject to the provisions of the Group Policy. Currently, those under quarantine without symptoms, may not be eligible for STD benefits. We will continue to monitor the situation with the states and the insurance carriers.

Department of Labor Releases Wage/Hour and FMLA Guidance

Following the World Health Organization’s declaration of pandemic status, the Department of Labor has provided guidance on Fair Labor Standards (FLSA) and Family Medical Leave (FMLA).

As this is a continually evolving situation, you should consult your local health agency for the latest information in your community. If you wish to discuss your risk management plan or your insurance coverage, please get in touch with your Fred C. Church representative.

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