Anthem - COVID19 info as of 3/25/2020
Small Group- These are the guidelines as of
today, 3.25.2020, as we all know something
could change, so stay connected to us, lots of information is being released
daily.
Benefit Changes, downgrade off of renewal- page
32 of UW guidelines. A group, including a group with multi-options, can
downgrade at any time during the year. A downgrade is defined to be a change to
lower cost benefits that were available at the time of renewal. If a group
changes benefits within the plan year, the rates applied will be based on
member ages at the time of the change. These may differ from the new proposal
rates if a member has had a birthday since the renewal.
A: The Employer decides to
temporarily (3 months or less) layoff (or “furlough”) their entire population
of employees, but at
least 1 person remains active on the group. The group will remain active and Employer will continue to
contribution (SG only)
The term active employee also includes an enrolled employee
who is not currently working due to illness, injury or leave of absence. During the disability or
leave of absence period, the employer is required to contribute to the
employee’s premium in the same amount as for other active employees.
(The employer must contribute at least 50% of the
Employee-Only cost for each enrolled employee. If multiple plans are offered,
the employer may make the contribution based on the plan of choice. However,
the contribution must be a minimum of 50% of the employee cost for the lowest priced
option that is available to the employee. Exception: Groups who fall within the
Federal Special enrollment Period)
See time restrictions for Ineligible Employee.
Employees
who have not worked full time for six months due to illness or injury (even if
the person is covered by Workers Compensation) or for 12 weeks due to leave of absence (LOA) or
temporary layoff.
- A person must be back at work full-time for 2
consecutive weeks and released by his/her attending physician to return to
full-time work before the six months recovery period can be restored.
Otherwise, any related absences that occur will be considered part of the
same absence.
- A total of 12 weeks LOA or temporary layoff
can be taken during any rolling 12 month period
B: The employer terminates employee(s)
(see below), but at least 1 person remains active on the group, the group will
remain active. State Continuation and/or Cobra is an option depending on the
group size.
Termination of Group Membership (SG page 28)
Coverage
for members can end for a variety of reasons, such as
·
an employee becomes
ineligible for regular group coverage (i.e., goes from full-time to part-time);
The
effective date of termination will be:
·
the last day of the
month in which the member becomes ineligible or requests termination
·
the date requested by
the group, if other than end of month
Continuation
of coverage options available to the member depend on the number of people the
company employs. Companies should follow the federal guidelines concerning
company size requirements when determining whether to offer qualified
beneficiaries coverage under the Consolidated Omnibus Budget Reconciliation Act
of 1985 (COBRA) or the Virginia 12 month continuation option.
Rehires – former employees who are re-hired within 91
days and who were enrolled at the time of termination can re-enroll without
serving the GIWP. The 91 days begin when coverage is actually terminated
due to change in employment status
It is the responsibility of the group administrator to
notify Anthem immediately of any change in the eligibility status of a member,
dependent, or the company itself.
Also remember: Anthem has a strict 60 day retro cancel
policy for employees – please be mindful.
C: Employer decides to lay off their
entire population of employees with no Active members. the group is not an eligible
group and therefore the group will be cancelled.
Scenario Employer
requests to change their eligibility for hours worked from 30 (or more) to
hours worked that is less than 30.
Conclusion: Underwriting will allow the employer to make the change in hours worked off renewal.
Conclusion: Underwriting will allow the employer to make the change in hours worked off renewal.
Effective immediately,
Compliance/Underwriting will accept a letter signed by a group representative
(owner, group administrator, billing contact) on company letterhead that
requests part-time employees be eligible for SG coverage. This letter must be submitted to
Underwriting.
The letter must include the group’s
definition of how many hours per week a part-time person must work to be
eligible (e.g., they will only offer to/cover those who work 20 or more hours
per week or 25 hours per week or 15 hours per week, etc.).
During this period, UW will allow this change
to be made off renewal, therefore the rule below will be suspended:
·
Part-time employees can only be made eligible either at
new sale or upon renewal. If it is a renewal, all employees must have
their number of hours worked per week listed on the most recent VEC and include
waiver reasons for those not enrolling. For new sales, the most recent
VEC with hours for everyone and waiver codes where applicable is required; for
groups in business less than a year, the Small Group Eligibility Form is
acceptable (again with all hours and applicable waiver codes listed). This will
ensure that the groups continue to meet 75% participation when including both
eligible part-time as well as full-time employees in the count.
Eligible PT employees are subject to the same waiting
period(s) as all other eligible FT employees
Regarding
SEP for Groups March 23-April 1.
At this time,
we do not have any communications. Anthem will not monitor the offering
of benefits to previously waived employees, therefore it is up to the Employers
if they want to offer the SEP or not. We can only except paper aps for
this SEP, they must be e-mails to AnthemEnrollment@anthem.com
by April 3, 2020 for a April 1, 2020 effective date
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Q. If an employee waived coverage for this plan year,
would Anthem allow a special enrollment for employer groups?
A. Yes,
Anthem will provide Fully Insured Groups a Special Enrollment Period to
enroll employees who previously did not elect to enroll in coverage at the
time of open enrollment. This Group Special Enrollment Period will last from
March 23rd through April 3rd and is for Large and Small
groups with coverage effective
4/1. State eligibility guidelines will apply.
Employees
needed to be eligible at time of open enrollment for the employer and this
Group Special Enrollment also be applicable to spouses or dependents as well.
The employer would follow standard processes of sending updated enrollment to
Anthem as they would for any qualifying event or enrollment period. This
would be through their elected format of 834s, portal, or other current
methods
This is
for Fully Insured groups. For ASO groups, it is their decision as to what
guidelines they would like to apply. In your discussions with your ASO
clients if they ask questions regarding the special enrollment period you can
share what Anthem is doing for Fully Insured Groups and inform them that
should they chose to take any action that submitting enrollment files would
follow their current process.
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Sydney App and LiveHealth Online
Visits
- Check symptoms
and visit a doctor from home. Members can download the
free Sydney
Care mobile app today for a quick and easy way to
evaluate their symptoms and see a doctor. They can check their symptoms,
and then the app will connect them to a doctor through a LiveHealth
Online video session or a Virtual Care text
session right from their phone. The doctor they’ll see can evaluate
symptoms, help understand whether they’re at risk for COVID-19, and let
them know whether they need to visit a local health care provider in
person. Their LiveHealth Online visit will be at no extra cost
through June 14, 2020. This applies to Fully Insured,
Individual, Medicare Advantage, and Medicaid members, where permitted.
- They’ll
rest easy with more flexible pharmacy benefits. Members can refill
most prescriptions early. Anthem is relaxing early prescription refill
limits, where permitted, for members who wish to receive a 30-day supply
of most maintenance medications early.
Additionally, if their plan includes a 90-day mail-order
pharmacy benefit, members should talk to their doctor about whether changing
from a 30-day supply to a 90-day supply is appropriate. They can get their
90-day supply through our home delivery pharmacy for most medications. They can
call the Pharmacy Member Services number on their ID card to learn
more.
- If
members need a COVID-19 test, it’s covered. Their Anthem health
plan covers COVID-19 testing and the visit where the test is conducted
with no out-of-pocket costs. If they are diagnosed as having COVID-19,
their health plan’s benefits apply to treatments.
LiveHealth Online: https://livehealthonline.com/
Get expert
advice, a treatment plan and prescriptions if needed for doctor visits including
Psychology and Psychiatry.