COVID-19 Q&A for Self-Funded Employers

While none of us could have exactly predicted the COVID-19 pandemic, the stop-loss industry is nothing if not prepared for emergencies. We know that a lot of self-funded employers are scrambling right now to figure out what happens next. Stop-loss carriers have mobilized to increase flexibility that allows policyholders to maintain coverage, and to make sure that policyholders have all the resources they need to weather this storm. Here are answers to some of the most common questions we’re hearing right now.

Will testing and treatment costs be covered under my stop-loss policy?

Rest assured that your stop-loss policy will cover costs associated with testing for and treating COVID-19 as long as they’re covered under your plan and meet the same terms as any other eligible claim. There are no pandemic exclusions that would automatically disqualify COVID-19 expenses from being covered under your stop-loss policy. If/when FDA-approved immunizations become available, they would be considered preventative care and would also be covered.

Should we expect delays with our stop-loss reimbursements?

We understand that your ability to manage your healthcare spending depends on your stop-loss claims being processed and reimbursed quickly. Because these procedures can be effectively managed by teams working remotely, you shouldn’t anticipate any significant changes to the reimbursement process. If you’re concerned about delays forcing you to submit late claims outside of your normal filing limit, reach out to your stop-loss team.

What will happen to our stop-loss policy if we have to lay off employees or change their employment status?

As some businesses are forced to temporarily close, many self-funded employers will see their staffing needs change in the coming weeks and months. It may be necessary to lay off, furlough or reduce the hours of employees who are currently covered under your stop-loss policy, potentially making these employees ineligible for coverage. Claims for employees whose statuses change due to COVID-19 may still be eligible for stop-loss reimbursement this policy year, as long as their premiums are paid.

Depending on how much of your workforce is affected by staffing changes, some of the provisions in your plan related to enrollment numbers may kick in. Refer to your specific plan documents and consult your stop-loss team for more information about how significant layoffs may affect your policy.

Do we have to get approval for any plan amendments related to COVID-19?

Self-funded employers may need to make changes to their plans in the coming months. Things are moving quickly, and you may not be required to get prior approval on a plan amendment related to COVID-19. To be safe, policyholders should still verify their carriers’ requirements around amendment approvals. Because stop-loss teams are working as usual, albeit remotely, you can expect to get answers to these questions quickly.

Can we sign plan documents electronically? What if we’re not in the office?

Your stop-loss carrier will work with you to make submitting plan documents as easy as possible, even if your team is working remotely and doesn’t have access to its usual setup. Carriers are accepting electronic signatures whenever possible, allowing policyholders to make any necessary policy changes from wherever they’re working right now.

Is anything else changing around our stop-loss policy?

Stop-loss carriers have committed to making some adjustments and exceptions during these trying times, out of concern for policyholders and their employees. For example, you may be allowed to take advantage of longer grace periods for premium payments. Carriers are willing to make other exceptions, too, like counting early prescription refills as eligible expenses.

We know that this is an unusual and stressful time for self-funded employers, and we’re here to help make it a little easier. The team at Stop Loss Insurance, Inc. is working as usual. Don’t hesitate to reach out with any questions about your stop-loss coverage!


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