Managing Group Health Plans & Related Legal Issues During COVID-19
Employers throughout the U.S. maintain health insurance for their employees. Certain complications can arise during the COVID-19 outbreak that could cause coverage to lapse. An employer should review the terms of the plan to find out whether employees will be covered if they stop working. Sometimes an insurer will agree to continue providing coverage during the outbreak, but otherwise coverage likely will be terminated after a certain grace period. If a plan is self-funded, the employer can choose to waive eligibility provisions related to employees performing work. The employer should check with stop-loss coverage insurance carriers to find out whether they will cover employees who would not be eligible otherwise.
An insurer also may terminate coverage if employees stop paying the premiums required under the plan. Again, some insurers may choose to waive this requirement during the COVID-19 outbreak. In other cases, an employer might arrange with the insurer to pay the employees’ premiums on their behalf, which can preserve coverage until employees return to work.
Key Features of Plans During the COVID-19 Outbreak
Certain components of group health plans may be especially useful in the current situation. These components are often overlooked, so an employer may want to inform employees about them. For example, employees who are trying to limit their exposure may want to explore telemedicine services, as well as wellness programs offered by phone. These benefits can allow an employee to handle minor medical issues and ask simple medical questions without leaving their home. Employees also can use them to find out about safety precautions to minimize the risk of contracting the virus.
Some employees may be dealing with severe anxiety and other psychological issues during this unprecedented and disturbing time. Group health plans may offer employee assistance programs, which can provide ways to relieve stress and protect mental health. If an employee has a chronic medical condition, or may be in danger of developing a chronic condition, they may face a higher risk of contracting COVID-19 or developing severe symptoms. These employees might benefit from using disease management programs, which often provide a health advisor to monitor an employee’s status and develop a personalized strategy for them.
While getting the flu shot does not protect an employee from contracting the virus, it is still a useful precaution for overall health. Employees may be able to get vaccines through preventive care programs at reasonable rates, or even at no cost.
Coverage for COVID-19 Testing
Under the Families First Coronavirus Response Act (FFCRA), health plans must provide coverage for COVID-19 testing, regardless of whether the employer or an outside insurer provides the plan. While the public emergency lasts, employees will not need to share costs related to COVID-19 testing, nor will they need to get prior authorization from insurers. These rules are implicitly incorporated in ERISA, the Public Health Service Act, and the Internal Revenue Code, even though they are not formally added to those laws.
Coverage for Temporary Employees and Independent Contractors
Temporary employees may be covered by group health plans if an employer chooses. The terms of the specific plan will provide whether they are covered. If temporary employees are included in the plan, an employer may want to think carefully before hiring them during the COVID-19 outbreak. Employers that are subject to the Affordable Care Act (ACA) must provide insurance to temporary employees who work, or who are expected to work, for 130 hours in a calendar month. Independent contractors usually are not covered by group health plans.
