Employee Benefits

Health Insurance Coverage Under the FFCRA

A group health plan must provide coverage without any cost-sharing requirements, such as deductibles, co-payments and co-insurance, or prior authorization or other medical management requirements, for:

  • The costs of a test to detect or diagnose the virus that causes COVID-19; or
  • Health care provider visits, including telehealth visits, urgent care and emergency room visits, that result in an order for or administration of a test to detect or diagnose the virus that causes COVID-19.

Employee Benefit Questions

What are the costs associated with COVID-19 testing and treatment?

The Families First Coronavirus Response Act mandates that all private insurers cover the cost of COVID-19 testing and treatment. That means that if you have or suspect you have the Coronavirus, are tested and treated; you will not need to meet a deductible or make co-payments. You also do not need to get referrals or prior authorization.

Where will I be covered for Coronavirus testing for if I think I have symptoms?

COVID-19 Testing Site Locator

The Test Location tool will show test locations within a certain mile radius of the desired zip code. Most test locations will ask for a script from a provider.

Here are the links to the tools:

Use this online symptom checker to assess your risk for COVID-19 and get treatment options.

Use our online tool to find a COVID-19 testing location in your area.

Last updated: 4/15/2020

Will my benefits waiting period be waived when I come back to work?

Your employer sets the policy for waiting periods. In most cases, we’ve seen the employer waive it for returning employees. In addition, any portion of the waiting period met prior to the furlough / lay off is credited and applied when you return to work.

What will happen to my voluntary benefits with MetLife if I am terminated or furloughed?

If you are furloughed: Voluntary Benefits (Critical Illness, Hospital, Accident, Voluntary Life, MetLife Legal) will continue until the end of the month.

Portability options will then be available for Critical Illness, Hospital, Accident and Metlife Legal to continue the coverage on a direct bill basis.

    • Life portability will be provided once coverage is terminated.
    • LTD and STD will terminate at the end of the month in which employment terminates and claims in process will not be affected.

How long can I stay active on my benefits if I am furloughed?

You can remain on benefits (medical, dental, vision) until the end of October 2020 or for up to 20 weeks, whichever is later, providing premiums are paid in full.

  • MetLife- Life, LTD, STD and Voluntary benefits, you can remain on coverage until the end of the month.

How long can I stay active on my benefits if I am laid off?

Your benefits will terminate on the last day of the month your employment ended. Cobra notification will be provided.

How long can I stay active on my benefits if I am active with reduced hours?

  • If employment is considered furloughed with reduced hours then you can remain on benefits (medical, dental, vision) until the end of October 2020 or for up to 20 weeks, whichever is later, providing premiums are paid in full.
  • If employment is not considered furloughed and hours are reduced below the threshold to be eligible for benefits, then benefits will terminate on the last day of the month and Cobra notification will be provided. Portability and direct pay options will be offered for MetLife plans.

Will my TransitChek benefits be terminated?

As companies move to remote work in response to COVID-19, your employees may have questions about their Commuter benefit election options. With TransitChek it is business as usual. You can manage and/or suspend your account by logging into the website. There are no refunds, so plan carefully.
Fulfillment for upcoming commuter benefits will go forward as usual. With this in mind:

  • Regular established pass return and refund policies remain in effect, so we recommend that your employees reach out to the agency associated with their election if they have questions about returns or refunds.
  • Please note there are no credit or refund options for the Premium TransitChek MetroCard product.
  • If your employees, for example, need to make changes to their pending July benefit, they should log in to their account at https://tams.transitchek.com and make updates by June 30th, 2020.

What if I need to go to the Doctor before I enroll on COBRA?

Typically, your offer of cobra is processed fairly quickly. However, in the event the processing of your enrollment is not complete you contact your Benefit Specialist and they will assist you.

If we want to continue to provide medical coverage during a furlough, can we just continue to treat the furloughed employees as active employees, or must we offer COBRA? Some of our employees will have hours and pay reduced.

As an employer, you have two options:

  1. Keep the furloughed employees on the medical plan as active employees for up to 20 weeks. After the 20 weeks, if the employee has not returned to work, COBRA would need to be offered.
  2. Treat the furlough as a COBRA qualifying event (i.e., a loss of coverage due to a reduction in hours).  Employees with active coverage will be offered COBRA beginning the first of the month following the date of the furlough.

Must I pay for a terminated (or reduced hours) employee’s COBRA coverage?

No. An employer can subsidize (in part or in full) the cost of COBRA for a terminated employee, but they are not required to do so. If the employer chooses to subsidize the cost, they should clearly communicate the time period and the amount they will subsidize.

Can an employee elect COBRA if the employee was not enrolled in our medical plan at the time of termination of employment?

No, an employee must already be enrolled and covered for up to one day for a COBRA offer to be extended.

What happens if our company goes out of business? Who offers COBRA?

If your employees are enrolled in one of the PrestigePEO sponsored medical plans, then PrestigePEO will offer COBRA to the employees with active coverage as their employment is terminated.  If your employees are covered by a medical plan that is not sponsored by PrestigePEO, then COBRA can only be offered to an employee while the company is active, and at least one employee is still actively at work and is covered on the plan.

Where can I send my employees for emotional support?

1) NEW! American Well® is a Designated Virtual Vendor

American Well®, also known as AmWell, is available for Oxford members to schedule online doctor visits. Members can sign into the Oxford Health member website to access a code for an online doctor visit with an Amwell provider. There is no charge for online visits.

Members can find this code after signing into the member website in the COVID-19 section. Click here for instructions on how to access AmWell for Oxford members.

2) Optum’s Emotional-Support Help Line

Professionally trained mental health staff are available to provide support to people who may be suffering from fear or stress as a result of COIVD-19. The service is free of charge and available to anyone. A public toll-free emotional-support helpline is available (866) 342-6892.

3) Optum’s COVID-19 Resources for Employee Wellbeing

The Optum COVID-19 site has frequently updated facts and resources as well as tips for keeping employees educated, healthy, and engaged. You’ll also find educational videos with subject matter experts.

The content is appropriate for audiences worldwide and sourced from the World Health Organization and the U.S. CDC. Click here to go to the Optum COVID-19 site.

4) NEW! Sanvello On-demand Support

Employees may find the Sanvello mobile app to be a helpful resource for those needing support in coping with the mental health impacts of COVID-19. Sanvello is an app that offers clinical techniques to help dial down the symptoms of stress, anxiety, and depression.

UnitedHealth Group, in response to the COVID-19 situation, is extending free premium access to the Sanvello app for its members. Please see press release for more details.

Additional resources for those who may be experiencing stress, anxiety, or depression during the COVID-19 crisis:

Flexible Spending Account (FSA) Questions

Are masks FSA-eligible?

No. Surgical masks and those designed to prevent the spread of pathogens like the N95 mask are currently not FSA-eligible.

Are surgical gloves FSA-eligible?

No. Surgical gloves are also not FSA-eligible.

Is hand sanitizer FSA-eligible?

Hand sanitizer may be FSA-eligible, but it likely falls under a class of products that require a prescription to purchase with FSA funds. In accordance with regulations put forth in the Affordable Care Act (ACA), over-the-counter products that contain “medicated ingredients” require an Rx to purchase. The most common active ingredient in hand sanitizer is alcohol, and products must contain at least 60 percent alcohol to be considered antibacterial.

Other products such as rubbing alcohol and hydrogen peroxide are may also be FSA-eligible, but could also require a prescription to be reimbursed through an FSA.

Updates from UHC/Oxford

Does UHC/Oxford Health have an online symptom checker for COVID-19?

Go to myuhc.com to find the COVID-19 symptom checker.

The symptom checker assesses members based on their response and triages them into one of five levels:

  1. Self-isolation;
  2. Physician evaluation;
  3. Same day care;
  4. Emergency care;
  5. Call 911.

Last updated: 4/15/2020

Is there any help I can get through my health plan if I suspect I have symptoms associated with COVID-19 and where can I find test locations in my area?

UHC/Oxford Health has an online symptom checker. You can access it on the pre-login page of myuhc.com and it assesses members based upon their response and triages them into five levels: self-isolation; physician evaluation; same day care; emergency care; and, call 911.

UHC/Oxford Health also provides a test location tool which will provide test locations available to members within a certain mile radius of their zip code.  Here are the links to these invaluable tools:

Will Oxford suspend or change premiums?

Unfortunately, premiums will not be suspended. Your employer will continue to have to pay premiums to keep your coverage active.

What are the available resources and services for Oxford/UnitedHealthcare members?

  • All COVID-19 testing and treatment is covered without the need to meet a deductible or make co-pays.
  • Telehealth and Virtual visits are available for Oxford and UHC members for COVID-19 screenings.

What if I need early refills of my prescriptions? UnitedHealthcare has removed the refill too soon policy.

  • This applies to both UnitedHeathcare and Oxford members.
  • The change allows members with active eligibility to obtain an early refill of their prescription medications if they have refills remaining on file at a participating retail, specialty or mail-order pharmacy. Contact your doctor immediately if you see that you need refills.
  • The refill obtained will stay consistent with the standard days’ supply previously filled by the member as allowed by their plan (e.g., 30- or 90-day supply).
  • Your pharmacist can contact the Pharmacy Manager at Oxford.
  • Members should call the number on the back of their ID card if they need assistance.
  • Delivery is available at select pharmacies. Walgreens and CVS deliver and have suspended charging.

Will diagnostic testing be covered under our benefit plans?

UnitedHealthcare /Oxford has confirmed that they are waiving member cost sharing, including copays, coinsurance and deductibles, for COVID-19 diagnostic testing provided at approved locations in accordance with CDC guidelines. You may be aware that recently the IRS sent out a press release recommending those covered on a high deductible health plan get tested and treated with no member cost sharing.

  • However, at the present time there is no specific treatment plan or vaccine available for 2019-nCoV. So, it would be premature for carriers to render any decision pertaining to the IRS recommendation.
  • The COVID-19 situation continues to evolve and change, so we will continue to provide you with additional details as we receive them.

Where can I send my employees for emotional support?

NEW! American Well® is a Designated Virtual Vendor

American Well®, also known as AmWell, is available for Oxford members to schedule online doctor visits. Members can sign into the Oxford Health member website to access a code for an online doctor visit with an Amwell provider. There is no charge for online visits.

Members can find this code after signing into the member website in the COVID-19 section. Click here for instructions on how to access AmWell for Oxford members.

Additional resources for those who may be experiencing stress, anxiety, or depression during the COVID-19 crisis:

How long can I stay active on my benefits if I am active with reduced hours?

  • If employment is considered furloughed with reduced hours then you can remain on benefits (medical, dental, vision) until the end of October 2020 or for up to 20 weeks, whichever is later, providing premiums are paid in full.
  • If employment is not considered furloughed and hours are reduced below the threshold to be eligible for benefits, then benefits will terminate on the last day of the month and Cobra notification will be provided. Portability and direct pay options will be offered for MetLife plans.

Updates from EmblemHealth

What are the available resources and services for EmblemHealth members?

24/7 Nurse Line

All members can call our 24-Hour Nurse Hotline at any time free of charge to speak to a nurse about health concerns. Experienced, licensed nurses can provide confidential, one-on-one health counseling and accurate information to help you make informed health care decision.

Call at 877-444-7988.

ACPNY Virtual Visits with Zoom

For AdvantageCare Physicians (ACPNY) and BronxDocs patients experiencing symptoms of COVID-19 including a fever over 100.4 and shortness of breath—you can speak with one of the practice’s medical providers through Zoom, a leader in video conferencing. When you call to schedule your appointment, you will be asked a few questions so the team can assess your symptoms, risk, and need for a virtual visit.

Contact ACPNY at 646-680-4227.

Contact BronxDocs at 646-680-5200.

Teladoc

For members with a plan that includes Teladoc, you have 24/7 access to board-certified, state-licensed doctors by phone or video, every day of the week. They can send a prescription to your local pharmacy. Services are available in English, Spanish, and Chinese. Call 800-835-2362 to get started.

Telehealth

Connect with your in-network health care professional, virtually. These virtual visits are $0 during the outbreak, whether or not the visit includes testing for COVID-19. Contact your doctor directly about their specific offerings.

Updates from AFLAC

Aflac Hospital and Disability Coverage for Current Participants:

For policyholders with concerns about coverage for disabilities or hospitalizations due to COVID19 infections, rest assured, the answer is yes, you are covered. No policy language would cause these policies not to pay. These policies will pay full benefits directly to the member regardless of any other insurance and regardless of the pandemic.

Plans are portable and pay cash directly to the member for a hospitalization (Hospital Plans) or because the member could not work due to a diagnosis of COVID19 (Disability).

If anyone is interested in hearing about the plans or have questions about coverage should call Alvaro Montenegro at 201-628-4924.

Updates on High Deductible Healthcare Plans & Health Savings Accounts

IRS Relaxes Some Rules:

Over the counter drugs, menstrual care products that are not normally covered or that require a prescription are retroactive to 1/1/20, are now considered eligible expenses. These may be reimbursed through a Health Savings Account, Health Reimbursement Account, and a Flexible Savings Account.