COVID-19: A guide for brokers and employers

Yes. On March 31, 2020, Harvard Pilgrim made the decision to waive member cost sharing (deductibles, copays and coinsurance) for COVID-19 treatment provided by in-network providers. Cost sharing for emergency services related to COVID-19 treatment administered by out-of-network providers will also be waived.

The updated policy applies to all Harvard Pilgrim fully insured commercial, Medicare Advantage and Medicare Supplement members.

Self-insured employers with plans administered by Harvard Pilgrim needed to notify Harvard Pilgrim by Tuesday, April 7 of their intention to opt out.

The enhanced policy is effective through September 30, 2020. Harvard Pilgrim will reassess as circumstances warrant. In addition, any claims previously received for COVID-19 treatment prior to this policy going into effect will be covered consistent with this policy.

Yes. The waiver of cost sharing for treatments of COVID-19 applies to high-deductible health plans administered by Harvard Pilgrim.

We want to help remove any potential barriers for our members seeking treatment related to COVID-19.

No. Harvard Pilgrim covers FDA-authorized antibody testing for COVID-19 only when it is medically necessary for providers to help make decisions about treating a member’s immediate medical condition.

Harvard Pilgrim is taking measures to allow for the extended deadlines affecting COBRA continuation coverage, special enrollment periods, claims for benefits, appeals of denied claims, and external review of certain claims.

According to the federal guidance, the national emergency due to the COVID-19 outbreak began on March 1, 2020. At that point, timelines associated with COBRA, making enrollment changes due to qualifying events, submitting and appealing claims, and external claims review were paused. Those timelines will resume 60 days after the federal government announces that the national emergency is over.

The following examples show how the DOL/IRS order would affect certain timelines. They assume the national emergency ends on June 30, which means that timelines would resume 60 days later on August 29. The federal government has not yet announced the end of the national emergency.

Employers should consult with their attorneys to determine the appropriate timing requirements and COBRA compliance under their plans.

COBRA election

Individuals have 60 days to elect COBRA from the date they receive an election notice from their employer.

If an employee lost group coverage and received a COBRA election notice on March 1, 2020, for example, they would normally have 60 days from the March 1 date to elect COBRA.

If the national emergency ends on June 30, the 60-day COBRA election timeline would resume on August 29. From there, the employee would then have 60 days (until October 28) to elect COBRA.

Initial COBRA premium payment

Individuals have 45 days to pay initial COBRA premiums.

If initial premiums were due during the national emergency and it was declared over on June 30, individuals would have 45 days from August 29 (until October 13) to pay the initial COBRA premium.

Current COBRA premium payment

Individuals currently on COBRA have 30 days to pay their premiums.

If they made timely payments in February and March but did not make premium payments in April, May, June or July, they would have 30 days from August 29 (until September 28) to make their past-due premium payments.

HIPAA Special Enrollment Periods

Members have 30 days to notify us about qualifying events (e.g., marriage, birth or adoption of a child, loss of employer-sponsored health insurance) for off-anniversary health plan changes.

If the national emergency ends on June 30, employees would have 30 days from August 29 (until September 28) to notify Harvard Pilgrim about a qualifying event.

Claims, appeals and external reviews

Members generally have 180 days to submit a claim or request an appeal under a group health plan.

If a member was notified 30 days prior to March 1 that a claim was denied, and the national emergency ends on June 30, they would have 150 days after August 29 (until January 26, 2021) to request an appeal.

Updated April 9, 2020

Fully insured employers in Connecticut, Massachusetts and New Hampshire

Through July 1, 2020 or the end of the declared public health emergency, whichever happens first, Harvard Pilgrim will temporarily relax the number of hours (from 20 to 0) an eligible employee currently enrolled in the plan must work to remain eligible for group health coverage. This will also apply to employees who have been furloughed (i.e., they are still employed but have been placed on a temporary leave of absence by their employer solely as a result of COVID-19 closures).

To be eligible, the employer’s group policy must be active with all premiums paid on a timely basis, including those for individuals on leave; in addition, one bona fide employee has to be and remain covered under the employer’s group policy. Coverage under these relaxed requirements is limited to current employees who, immediately prior to the date of this new requirement, were working at the employer’s premises and can no longer work due to the COVID-19 pandemic.

Fully insured employers in Maine

The same policy above applies to Maine employers; however, in accordance with the March 12 Supplemental Order Regarding Continuation of Group Health Coverage issued by Gov. Janet T. Mills (24-A M.R.S. § 471), no date has been specified for this policy to be terminated.

Self-insured employers

Coverage for furloughed employees depends on the employer’s decision; it would need to be permitted by the terms of the plan or the plan would need to be amended to allow for coverage. Employers should also check with their stop loss carrier to confirm that the stop loss carrier will permit such coverage.

Note: This answer clarifies and replaces the answer from our 3/24/20 email.

Fully insured employers

Small groups (fewer than 20 employees): We will provide benefits to small employers in accordance with applicable “mini COBRA” under state continuation.

Large groups (more than 20 employees): We will provide benefits to large employers in accordance with federal COBRA law.

To be eligible, the employer’s policy must remain in effect and cover at least one employee for whom a COBRA qualifying event has not occurred. Harvard Pilgrim will not provide COBRA coverage unless there is at least one employee covered under the policy as a result of currently satisfying all applicable eligibility requirements, including, but not limited to, working the required number of hours.

Self-insured employers

Employees of self-insured businesses who lose their group coverage can elect COBRA in accordance with applicable law. COBRA eligibility decisions under self-insured plans are made by the employer as the plan administrator. Neither Harvard Pilgrim nor its affiliates are the plan administrator. Questions about COBRA under a self-insured plan should be addressed to the employer as the plan administrator.

Please note: Employees that lose group health coverage may in certain cases also obtain health coverage through the state Exchange program and may be eligible for premium assistance through the Exchanges.

Yes. Harvard Pilgrim will allow these employers a one-time special enrollment period during the employer’s current plan year and until the announced end of the national emergency.

• New plan elections will be limited only to less-rich plan designs or “buy downs” (e.g., the employer’s current plan with a higher deductible)
• Employers who want to offer a special enrollment period must notify Harvard Pilgrim 10 days in advance
• The special enrollment period must be only for 30 days

Small Group: Following normal underwriting policies, benefit buy-downs are allowed once per year for small group employers.

Large Group: If an employer has a single plan offering and would like to replace it with a new offering (a benefit-buy down), that will be permitted so long as the group maintains the same effective date. A buy down will be permitted off-anniversary through May 31, 2020.

Please note: Benefit buy-downs are not currently permitted in the individual market.

Yes, for our fully insured clients we would allow the waiver of the waiting period when an individual is rehired after a layoff due to COVID-19, as long as the employer applies it in a consistent and non-discriminatory manner. This waiver will apply through September 1, 2020.

We will also allow groups to waive or modify their new hire waiting periods as long as the employer applies it in a consistent and non-discriminatory manner.  This will also apply through September 1, 2020.

Yes, if an employer temporarily lays off a member and then rehires the member, a deductible consumption will be credited to the member’s “account” if the rehire occurs within the same plan year as the date of lay off.

Through August 1, 2020 Harvard Pilgrim will relax its policy which states that a change in membership of +/-10% may require a reevaluation of the group’s premium rates. During this period, Harvard Pilgrim reserves the right to rerate an employer that sees a change in enrollment of +/-50%.

On a case-by-case basis, Harvard Pilgrim will consider a one-time extension of the statutory grace period for the payment of premiums to 30 days. In addition, Harvard Pilgrim is in compliance with all state specific regulations and published guidance in each of our markets. Your Account Executive is available to address your questions.

Harvard Pilgrim has launched a series of complimentary virtual offerings to support members’ well-being–from webinars filled with useful, relevant tips, to live mindfulness sessions led by our team of expert instructors. Classes will be added each week covering subjects from stress to sleep. Learn more.

Members experiencing anxiety or stress related to the COVID-19 pandemic can call the Optum/United Behavioral Health emotional support help line toll free at (866) 342-6892. This service is free, open to anyone and available 24/7. Information and resources are also available at liveandworkwell.com.