Small Business Benefits

COVID-19 and Self-Funded Health Benefit Plans

 

The Coronavirus and Comprehensive Employer-Sponsored Major Medical Benefit Plans

We remain committed to members’ health and well being. As the coronavirus continues to spread, we are taking a proactive approach to making sure employers sponsoring a self-funded group health benefit plan administered by Star Marketing & Administration, Inc., and their covered employees receive the best support possible. The exceptional, personal service that you have come to know and expect from us will continue.
Corona virus
The Coronavirus Aid, Relief, and Economic Security (CARES) Act  — 3/30/2020
On March 27, 2020, President Donald Trump signed The Coronavirus Aid, Relief, and Economic Security (CARES) Act in response to the COVID-19 pandemic. Here are some highlights of the legislation that impact employer-sponsored, self-funded health benefit plans:
 
Free Testing Coverage for COVID-19
Individual and group health plans1, including both fully-insured and self-insured, must cover COVID-19 testing, whether or not that testing is FDA-authorized. This provision is an update of the previous stimulus package that required coverage for FDA-authorized tests only.
 
Payment Amount for COVID-19 Testing and Related Services
Self-insured health plans1 and insurance carriers must pay the provider performing the testing for COVID-19 (along with costs incurred during the medical visit when testing is performed) at an amount equal to their in-network negotiated rate for the testing and related services. 
 
If the carrier or self-insured plan does NOT have a negotiated payment rate, or does not then negotiate a specified price with the provider, the payment amount should equal the cash price of the service, which the provider is required to post on the provider’s publicly available Internet site.
 
No Required Payment for COVID Treatment
This legislation does NOT require coverage for treatment of COVID-19 (only for testing and related services), so benefits will be administered in accordance with the terms of the health benefit plan document. However, further legislation on this issue could be forthcoming.  
 
Free Coverage for COVID-19 Vaccine
Once a COVID-19 vaccine is developed and “recommended” as a preventive service, insurance carriers and self-insured plans must cover the cost of the vaccine without any cost-sharing. This requirement would go into effect 15 business days after the U.S. Preventive Service Task Force rates it an “A” or “B” or after it is recommended by the Advisory Committee on Immunization Practices of the CDC. 
 
HSA-Eligible HDHP Exemption for Telehealth
An HSA-eligible HDHP is allowed to pay for the costs associated with a telehealth visit before the deductible is met. The member would also continue to be eligible to make tax-free contributions to their HSA. This exemption is only available for plan years beginning on or before December 31, 2021. 
 
HSA/FSA Payments for Feminine Hygiene OTC Products without Prescription
A patient may use funds from a HSA or FSA to purchase over-the-counter menstrual care products. 
 
We’re closely watching the decisions in Washington and at the state level as this situation continues to evolve. We’ll ensure that COVID-19 claims are processed and paid in compliance with all applicable federal and state laws.
 
For continuing updates on COVID-19, please visit the CDC website.
 
1Does not apply to self-insured non-ERISA governmental health benefit plans.
Access Phone and Video Doctor Consults via Teladoc — 3/26/20
Through Teladoc®, members and their covered dependents have access to U.S. board-certified doctors via phone, video and mobile app. Doctors are available to treat and write short-term prescriptions (when medically necessary) for the flu, sinus infections and many other conditions.

All Teladoc general medical consults are now being screened for COVID‐19 risk factors according to CDC guidelines. Teladoc has activated a Coronavirus Response Team and is ready to support an increase in visit volume. Prior to requesting a virtual visit, members can complete a COVID-19 self-assessment questionnaire to help them evaluate personal risk of COVID-19 and related complications.
Members can follow these recommendations for using Teladoc:              
  • Visit the Teladoc website for answers to frequently asked questions.
  • For the fastest support, download the mobile app or use the website to request a doctor visit.
    • A wait-time estimator helps members anticipate the expected time for a callback from a doctor.
  • Before the first virtual visit, set up a Teladoc account and provide a brief medical history via the app or web.
Teladoc provides high-quality, virtual care and ranks #1 in Telehealth Satisfaction with Direct to Consumer Providers and Best in Customer Service in the U.S. by J.D. Power.1
 
For more information, visit www.Teladoc.com.
 
1Teladoc Health, Inc. website, Teladoc Ranks First in Inaugural J.D. Power Telehealth Study, https://teladochealth.com/newsroom/press/release/teladoc-health-ranks-first-in-inaugural-j-d-power-telehealth-study/, Oct. 31, 2019
 
Source: Teladoc


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