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Q&A with Tim Finnell: Health Insurance Coverage and COVID-19

Employers are working to produce strategic plans to survive during this crisis. Maintaining insurance coverage for employees is a top priority.

Employers and employees alike have questions – and answers are rapidly changing. Below are answers to common questions, as of the end of March. Check with your insurance carrier or attorney for specifics regarding your personal situation.

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Employer questions

Q: What happens if my business must totally or partially suspend operations, lay off, furlough employees or reduce hours to less than 30/week? Can their health insurance be continued? How?

A: Many carriers have temporarily waived the full-time work requirement contained in most policies. This could allow the employer to continue coverage for furloughed employees, but may require an amendment to your contract.

Q: Can the business continue premium cost sharing?

A: Yes, employers can develop a payment system for employees using pay-in-advance, pay-as-you-go or pay-upon-return. The new Emergency FMLA law is following the original FMLA rules.

Q: Will rehired employees have to start a new deductible/out-of-pocket maximum if they elected COBRA?

A: Deductible and out-of-pocket expenses are typically per calendar year. This would apply whether a person is an active employee, on COBRA or rehired (if there is no break in coverage).

Q: Will insurance companies extend the late payment grace period for premiums?

A: Many carriers are offering an extended grace period for premium payment of 60 days versus the standard 30 days. However, some require a request in writing.

Q: If my group’s enrollment drops significantly, will the insurance company change my premium?

A: Most insurance carriers are not going to change premium until the renewal.

Q: How does this crisis impact non-medical benefits such as dental, vision, life, disability and voluntary coverage if there are layoffs?

A: As with medical carriers, many companies are allowing grace periods to be extended to 60 days. If terminations occur, dental and vision are subject to COBRA. Many other policies have portability provisions allowing the employee to continue coverage if terminations occur.

Employee Questions

Q: Where can I get answers about my coverage?

A: Your insurance company. For specifics, call the toll-free number on the back of your ID card.

Q: If I am laid off or furloughed, can I continue my coverage?

A: Check with your employer. Typically, full-time hours are required to retain coverage. Exceptions may apply. COBRA (or state continuation) or The Marketplace provide options. All require you to elect within certain time frames.

Q: How is COVID-19 covered under my medical plan?

A: Most plans are covering COVID-19 testing at no cost to the individual. Many insurance companies are also waiving the cost for in-network treatment. How treatment is covered at an out-of-network facility varies by carrier.

Q: How can a telehealth service help me?

A: Many local physicians are available to patients via phone or video. Commercial telehealth services may also be accessed to provide care recommendations. Some carriers are waiving the consultation cost.

Q: Is being quarantined, as a result of COVID-19, covered under short-term disability?

A: Short-term disability plans require that you are unable to work as a result of an illness or injury. If you test positive and required quarantine, you may or may not be disabled. A doctor will have to determine if your symptoms render you unable to work, versus a doctor or employer barring you from work.

Q: Where can I get tested?

A: If you are experiencing COVID- 19 symptoms, contact your primary care physician. If you do not have a primary care physician, contact the local health department.