Human Resources

COVID-19 Disability Claims

Several clients have asked questions related to COVID-19 and their group disability insurance. Here’s a compilation of how carriers are administering claims.

Question: Is someone automatically disabled if he/she is placed under a quarantine related to the Coronavirus?

Answer: No. Standard policy language requires that an insured be disabled from his/her own occupation. Therefore, an insured is not automatically considered disabled if under a quarantine for any reason. However, some policies may contain quarantine provisions. It is important that you check your policy or (if self-insured) plan document, as this will dictate how claims are administered.

Question: Will a disability claim for an insured who is under a quarantine related to the Coronavirus be approved?

Answer: Possibly. Every claim is reviewed based on the disability policy language and the unique facts of the insured’s situation, including factors such as the diagnosis and medical certification; the progress of the virus/condition; the specific quarantine that the insured is subject to; and the insured’s ability to work remotely, among others.

Claims submitted listing a diagnosis of Coronavirus will be processed in compliance with all applicable contract provisions. In general, to be eligible to receive benefits, an insured must provide proof that he/she is:

  • Under the care of a Health Care Provider who is certifying the insured’s disability; AND
  • Unable to perform his/her occupation in the workplace or at home via remote access.

If the employee is symptomatic, then he/she may have a qualifying condition under FMLA (or even the ADA) which would require him/her to take leave. An important consideration is that the employee must be quarantined and not able to return to work. To the extent the quarantine is optional and the employee is symptomatic, the employee may also qualify for FMLA.

Situations involving furloughs or layoffs may be more complex. This may include eligibility for coverage for those who were actively at work prior to a furlough or layoff on a prior carrier’s policy. How will pre-existing conditions be administered? What about employees whose hours are reduced below the minimum hours required in the policy definition for eligibility? – There are many scenarios that may need to be reviewed by a broker with in-depth knowledge of contract language and claims experience.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Bringing People Back to the Workplace Safely & Efficiently

Key to bringing people back is developing and implementing industry best practice safety and wellness protocols.

Meridian’s temperature sensing Personnel Management Kiosk is designed to help protect the health and safety of both employees and guests by helping prevent anyone with a temperature or those without access from entering a facility.

Features

  • Temperature Verification
  • Facial Identification
  • Temperature Threshold Alarms
  • Pedestal & Countertop Configurations

Designed to monitor multiple kiosks in remote locations it is ideal for businesses requiring system security and remote performance management.

Temperature Management Solutions help balance the need to get back to business as quickly as possible while ensuring workplace health and safety. Easy to setup and use. Potential integration, current and development, will make this product a powerful monitoring service tool. More information available at www.meridiankiosks.com.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Florida Department of Health

The Florida Department of Health has received accolades from the Presidential Response Team during the daily briefing. Doctor Deborah Brix has mentioned several times it is an ideal resource and one that other states should try to emulate.

Florida Health 201 Novel Coronavirus Response (COVID-19) https://floridahealthcovid19.gov/. The site includes the county-specific Surveillance Dashboard I mentioned in my previously blog.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Florida’s COVID-19 Data and Surveillance Dashboard

The link below provides some very insightful data regarding the spread of COVID-19.

https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429

The chart in the lower left is particularly interesting. Obviously, one would expect an increase in cases as the number of tests increase. However, note the trend of the decrease in the number of new cases.

What does this mean? To me it says we may be getting ready, hopefully, to start the economy back up. It also suggests we should start thinking about how to restart our businesses. – Need help planning the restart? I know people, experts – people that can help. – Let me know what you need, I’ll help you find the right person.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Employers of Choice – Furlough vs. Layoff

The COVID-19 relief packages have passed based on three fundamentals; (1) providing economic support to both businesses and individuals (2) keeping people employed, and (3) keeping people insured. Financing payroll may not be possible, after all it’s generally the largest expense. Companies may to need decide between a Layoff and Furlough.

Layoff (noun) – temporary or permanent separation of employment
Furlough (noun) – considered an alternative to a layoff, generally a short-term temporary layoff from employment
COVID-19 has forced many workers to either be laid-off(v) or furloughed(v).

When considering Furlough vs. Layoff, there are three reasons a furlough is viewed more favorable, especially under these circumstances.

      • Flexibility – because business reality is changing day to day and sometimes hour to hour, a furlough allows an employer the ability to reduce work days and/or hours of its employees all the way down to not working at all once it gets to that point.  But for those employers that are not yet at the point of having to make a final decision on cuts across the board, a furlough is a good option.
      • Employee Centric – employees who are laid off are cut off from benefits as per plan rules (which could be from the date of notice), once they are laid off. With a furlough being considered more like a leave of absence then a termination of employment, employers are able to provide benefits at a minimum for 30 days and can even opt to continue to pay for benefits throughout the duration of the furlough. In light of how this pandemic is affecting workers finances and health, doing so certainly signals that the Employer is making decisions with the employee impact in mind and not simply considering the bottom line.
      • Ability to Regain Ground Quickly – Once the crisis ends, and businesses are able to reopen, it’s going to be critical for businesses to be able to quickly staff back up to meet demands and furloughing employees rather than laying employees off and risking them seeking other employment due to the “permanency” that layoffs signal, would allow an employer to quickly bring back experienced, already trained employees to restart operations and servicing customers.

    Special thanks to Ivelices Thomas, HR & Beyond www.hrandbeyond.com, for her input.

     

    Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Small & Midsize Employers – two new refundable payroll tax credits

IR-2020-57, March 20, 2020

The U.S. Treasury Department, Internal Revenue Service (IRS), and the U.S. Department of Labor (Labor) announced that small and midsize employers can begin taking advantage of two new refundable payroll tax credits, designed to immediately and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirus-related leave to their employees. This relief to employees and small and midsize businesses is provided under the Families First Coronavirus Response Act (Act), signed by President Trump on March 18, 2020.

The Act will help the United States combat and defeat COVID-19 by giving all American businesses with fewer than 500 employees funds to provide employees with paid leave, either for the employee’s own health needs or to care for family members. The legislation will enable employers to keep their workers on their payrolls, while at the same time ensuring that workers are not forced to choose between their paychecks and the public health measures needed to combat the virus.

Key Takeaways

Paid Sick Leave for Workers

  • For COVID-19 related reasons, employees receive up to 80 hours of paid sick leave and expanded paid child care leave when employees’ children’s schools are closed or child care providers are unavailable.

Complete Coverage

Employers receive 100% reimbursement for paid leave pursuant to the Act.

  • Health insurance costs are also included in the credit.
  • Employers face no payroll tax liability.
  • Self-employed individuals receive an equivalent credit.

Fast Funds

Reimbursement will be quick and easy to obtain.

  • An immediate dollar-for-dollar tax offset against payroll taxes will be provided
  • Where a refund is owed, the IRS will send the refund as quickly as possible.

Small Business Protection

  • Employers with fewer than 50 employees are eligible for an exemption from the requirements to provide leave to care for a child whose school is closed, or child care is unavailable in cases where the viability of the business is threatened.

Easing Compliance

  • Requirements subject to 30-day non-enforcement period for good faith compliance efforts.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

 

COVID-19 and Medicare

Employee Benefit Advisors recommends communicating the following to you employees. Odds are your company has either employees on Medicare, family members on Medicare, or both.

Copays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.

Telehealth – CMS announced that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement. Email and texts to docs will be possible! Read the CMS details here

Cost of testing – Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). https://www.medicare.gov/coverage/coronavirus-test

3 Day Hospitalization Waived for Skilled Nursing Facilities – The waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities). Click here to download the full CMS memo.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Coronavirus – do the 5

I’ve been seeing this advice on Google the past few days. I think it’s simple and easy for employees t grasp. Pass it on.

Help Stop Coronavirus

1. Hands – Wash them often
2. Elbow – Cough into it
3. Face – Don’t touch it
4. Feet – Stay more than 3ft apart
5. Feel sick? Stay home

 

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Coronavirus – easy to understand info for employees

Symptoms people may experience:
1. runny nose (Not to be confused with allergies)
2. sore throat
3. cough (develop the habit of coughing into your sleeve or handkerchief – never your hand!)
4. fever
5. tightening of chest / difficulty breathing (severe cases)

What can you do?
• Emergency Room – very expensive
• Urgent Care – less expensive than ER but more cost-effective options exist
• Primary Care Physician – generally a low flat copy; at most the contracted rate between the physician and insurance company
Because COVID-19 is highly contagious to prevent contaminating health care service workers, it is not recommended you go directly to the              ER, UC or PCP.
Telemedicine – no cost! – If you need emergency care or any additional care the doctor will advise you.
(According to the Centers for Medicare & Medicaid Services (CMS), Essential Health Benefits (EHB) coverage generally includes coverage for the diagnosis and treatment of COVID-19.)

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

2020 EMPLOYEE BENEFITS UPDATE

As we head into a new year, there will be some noticeable changes in employee benefits that you and your clients should be made aware of. The following list encompasses a few of the items you may expect to change:

Required Reporting
Effective January 1, 2020, Medicare Secondary Payer reporting will now include prescription drug coverage. Right now, this is an optional procedure. It is handled by insurance carriers and third-party administrators. Employers should be aware that they may get requests for information from those carriers and third-party administrators. A more detailed explanation can be found here.

PCORI Fee Elimination
The PCORI fee will be eliminated for plan years ending before October 1, 2019. If an employer’s plan year ends between October 1, 2018 and December 31, 2018, then the last PCORI fee for that plan should have been paid by July of 2019. This would generally include plans that have plan years beginning November 1, December 1, or January 1. All other plans will make their last PCORI fee payment by the end of July 2020.

Out-of-Pocket Maximum Increase
In 2020, out-of-pocket maximums will increase to $8,150 for self-only coverage and $16,300 for family coverage. This represents an increase of about 3.20% from last year. HHS requires that the individual out-of-pocket maximum be embedded for each individual within the family OOPM. You can refer to the 2020 Benefit and Payment Parameters found here.

Health Insurance Tax
The Health Insurance Tax (HIT) which has been on a moratorium for 2019, will make a return in 2020 unless Congress acts on pending legislation to delay or repeal. This would result in increased premiums ranging from 2.7% to 4% according to actuarial experts.

Employer Mandate Affordability
The affordability percentage used in the safe harbors will be reduced to 9.78% in 2020. Employers should review their contribution levels to make sure they are within the new percentage requirement.

Individual Mandates in the States
Effective January 1, 2020, California and Vermont will have an individual mandate that will require employer reporting to be completed in 2021. New Jersey, which already has an individual mandate in place, will have to complete the employer reporting in 2020.

Self-Funded Plans
Employers that self-fund may have different benefits that cannot be subject to annual and lifetime limits. Self-insured employers should reevaluate which state plan they use as their benchmark for purposes of determining which benefits cannot be subject to annual and lifetime limits.

2020 Employer Mandate Penalties
As they do each year, the Department of Health and Human Services (HHS) calculates the health insurance premium growth rate. That rate is then used to adjust the amount of the ACA employer mandate penalties. Although not finalized, the 2020 employer mandate penalties could be $2,570 for the (a) penalty and $3,860 for the (b) penalty.

There is a lot of pending legislation that Congress could still take up before the recess. Issues pertaining to a Cadillac Tax repeal, transparency in prescription drug prices (H.R.3), redefining a full-time employee, surprise billing, and employer reporting can all be potentially addressed in the coming weeks.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Back to top

Submit your Feedback

      Sending...
x