Stay informed about Coronavirus (COVID-19)

The following email was sent to employers that offer major medical, certain preventive-only or limited medical self-funded health benefit plans administered by Star Marketing and Administration Inc., except where there are exclusions. The program outlined below is not available to members who live in Georgia, Mississippi, Louisiana, New Mexico, Oklahoma and Texas, or to members of the standard preventive-only plan design administered by us. Employers were encouraged to email the following information to covered employees who are eligible for this program.

Most CVS pharmacists can now prescribe Paxlovid, a COVID-19 antiviral medication, and fill the prescription for higher-risk individuals who are eligible for treatment. Covered employees should contact their local CVS pharmacy within three days of symptoms to see if they’re eligible for Paxlovid at no additional cost to them.
 
This pilot program, which began on Nov. 1, 2022, applies to members of all self-funded health benefit plans administered by Star Marketing and Administration, Inc., except for the standard preventive-only plan design. It does not apply to the Minute Clinic and is not available to covered employees who live in Georgia, Mississippi, Louisiana, New Mexico, Oklahoma and Texas.
 
In July, the FDA revised its emergency use authorization for Paxlovid, expanding the role of state-licensed pharmacists to assess eligibility and prescribe the oral anti-viral medication to higher-risk COVID-19 patients, when appropriate.
 
Most pharmacists can now provide these additional services:

• Determining eligibility for Paxlovid
• Prescribing Paxlovid to eligible patients or providing referrals to healthcare providers, if necessary
• Dispensing Paxlovid for pickup at a retail store or for shipping to a patient’s home (standard shipping rates apply and are billed to members)

Steps covered employees should take
Covered employees and their covered dependents are encouraged to use the digital eligibility screener on CVS.com and via the CVS Pharmacy app to make an appointment for an over-the-phone consultation. COVID-19 positive patients seeking an assessment within a retail pharmacy location will be sent a text message with a link to the digital eligibility form and asked to complete it outside of the building.
 
Eligibility for this service is dependent on several factors, including having certain blood work completed within the last 12 months. Covered employees should contact their local CVS Pharmacy for more information.
 
Covered employees should visit this link to see if they qualify for Paxlovid and to make an appointment.

About Paxlovid
Paxlovid is an investigational medicine used to treat mild-to-moderate COVID-19 in adults, teens and children (12 years of age and older weighing at least 88 pounds) who are at high risk for progressing to severe COVID-19 that could result in hospitalization, according to the FDA. Patients who tested positive for COVID-19 and who took Paxlovid within the first two to five days of having symptoms, fewer than 1 percent needed hospitalization, according to the CDC.
 
Costs for Health Benefit Plans
Employer-sponsored health benefit plans administered by Star Marketing and Administration, Inc., will pay a $60 pharmacist assessment fee and $10 dispensing fee for each member who is prescribed the drug by a pharmacist. Currently, COVID-19 oral antivirals are provided by the U.S. government, so there is no charge for the cost of the medication.
 

The following information was sent to employers that sponsor self-funded, group health benefit plans administered by Star Marketing and Administration, Inc., with the suggestion that they email the information to employees who are covered under these plans.

How to get at-home COVID tests at no charge: 
 
At-home delivery via your employer-sponsored health benefit plan: Effective Aug. 1, 2022, you will have no out-of-pocket costs when purchasing over-the-counter (OTC), at-home COVID tests online from CVS.com. Kits ship free.  
 
Free via the federal government: You may be eligible to order another round of free at-home tests through COVIDtests.gov. Go to the website, click on the “Order Free At-Home Tests” button, and provide your name, email address and home address. Kits ship free.
 
Reimbursement: Effective Aug. 1, 2022, employees covered under a plan administered by Star Marketing and Administration, Inc., will be reimbursed up to $12 for each at-home COVID test purchased: 

• In store from a CVS store, unless you present your ID card at the pharmacy counter and the pharmacy is prepared to provide the tests at no cost.
• In store from an out-of-network pharmacy, and 
• Online from an out-of-network pharmacy or other online retail outlets. (Shipping costs may apply.) 

 A federal mandate requires insurers and plans to provide coverage for up to eight over-the-counter (OTC), at-home COVID tests per 30-day period. The mandate applies to tests purchased through the end of the Public Health Emergency.  
 
How to get reimbursed: 
Employees covered under most plans administered by Star Marketing and Administration, Inc., can pay upfront and submit a receipt for reimbursement. To obtain reimbursement, you should register, login and submit receipts at caremark.com.  
 
If you are covered under a plan without a pharmacy benefit, you can be
reimbursed by submitting receipts to the address on your ID card. Include your name, employee ID number and group number.

The following information was sent to employers that sponsor self-funded, group health benefit plans administered by Star Marketing and Administration, Inc., with the suggestion that they email the information to employees who are covered under these plans.

You now have two ways to save on FDA-approved, at-home COVID-19 tests that do not require a doctor’s order.

• Free via the federal government: Every home in the U.S. is eligible to order four at-home COVID tests through a new website, COVIDTests.gov. Simply provide a name, email and address. Starting at the end of January, tests will ship via the U.S. Post Office usually 7 to 12 days after an order is placed.
• No out-of-pocket costs via your health benefit plan: A federal mandate requires insurers and plans to provide coverage for up to eight over-the-counter (OTC), at-home COVID tests (purchased on or after Jan. 15, 2022) per 30-day period. To get at-home COVID tests, up to the quantity limit, with no out-of-pocket costs, present your plan ID card at a pharmacy counter at a CVS Caremark Participating Retail Pharmacy. A list of participating pharmacies is available by registering and logging in at caremark.com.

Reimbursement
With most employer-sponsored, self-funded plans administered by Star Marketing and Administration, Inc., you can pay upfront and submit a receipt for reimbursement. At this time, most plans will reimburse the cost of tests purchased from CVS.com, out-of-network pharmacies or retail outlets when members register, login and submit receipts at caremark.com.

If you are covered under a plan without a pharmacy benefit, get reimbursed by submitting receipts to the address on your ID card. Include your name, employee ID number and group number.

In the future, reimbursement may be set at a rate of up to $12 for each test. We will provide updates as new information becomes available.

Plan administrators/COBRA administrators are required to notify assistance eligible individuals that COBRA premium assistance made available through the American Rescue Plan Act (ARPA) expires soon, the date of expiration, and that the individual may be eligible for coverage without any premium assistance through COBRA continuation coverage or coverage under a group health plan. Notice to “assistance eligible individuals” is due 15 to 45 days before their premium assistance expires. Federal regulators provided a model notice to use, the Notice of Expiration of Period of Premium Assistance. However, use of the model notice is not mandatory.

We do not currently offer COBRA administration services, but here is a link to the Notice of Expiration of Period of Premium Assistance.

The ARPA requires that from April 1, 2021, through Sept. 30, 2021, generally, certain COBRA qualified beneficiaries who are referred to as assistance eligible individuals who elect or will elect COBRA are not charged any amounts for COBRA coverage (premium assistance or subsidy).

However, there are limited situations where COBRA assistance could run longer. For example, a plan provides that employees and qualified beneficiaries pay premiums for health coverage, including COBRA continuation coverage on a biweekly basis for a corresponding two-week period of coverage. For September 2021, the last two-week period of coverage is from Sept. 19 through Oct. 2. COBRA premium assistance would apply to the entire period of coverage beginning Sept. 19, even though the period of coverage includes coverage for Oct. 1 and Oct. 2.

For more information, read the article, Updates: New Temporary COBRA Subsidy Under the American Rescue Plan Act, which was published on April 27, 2021.

Please see updates regarding links to new COBRA notices, coverage and an FAQ from the federal government.
 
The American Rescue Plan Act (ARPA) requires that from April 1, 2021, through Sept. 30, 2021, certain COBRA qualified beneficiaries who are referred to as “assistance eligible individuals” who elect or will elect COBRA are not charged any amounts for COBRA coverage (premium assistance or subsidy). The employer, plan or insurer, as applicable, will be reimbursed for such amounts through a federal tax credit (against FICA taxes that fund Medicare hospital benefits). The statute also includes various notice requirements regarding the subsidy. President Joe Biden signed the ARPA on March 11, 2021.
 
UPDATE: While we do not currently offer COBRA administration services, here are five COBRA notices recently released by the federal government:
 

• General Notice and Election Notice
• Notice in Connection with Extended Election Period
• Alternative Notice
• Notice of Expiration of Premium Assistance
• Summary of the COBRA Premium Assistance Provisions and Application for Premium Assistance

 
Employers can also access these notices by logging in at TrustmarkSB.com > Administration > Administration Kit > COBRA.
 
What is the duration and applicability of these requirements?
The subsidy starts April 1, 2021, and ends Sept. 30, 2021, unless ending sooner because the individual is no longer eligible.
 
“Assistance eligible individual” means someone, during the period of coverage of April 1, 2021, through Sept. 30, 2021: 
 

• who is a COBRA qualified beneficiary because of loss of employment (other than voluntary termination of employment or gross misconduct) or reduction in hours, and 
• who elects COBRA coverage.

 
Which employers are required to offer COBRA coverage?
COBRA generally applies to all private-sector group health plans maintained by employers that had at least 20 employees on more than 50 percent of its typical business days in the previous calendar year. COBRA also applies to plans sponsored by state and local governments, but not to plans sponsored by the federal government or by churches and certain church-related organizations.
 
UPDATE: Assistance Eligible Individuals can switch to other coverage offered to similarly situated active employees if the plan allows it, provided that the new coverage is no more expensive than the prior coverage.
 
UPDATE: Read this FAQ, which was released by the U.S. Department of Labor on April 7, 2021.
 
Learn more.

The deadline to apply for a Paycheck Protection Program (PPP) loan has been extended to May 31, 2021.  However, prospective applicants may want to move quickly as there is a concern the program may run out of funding prior to the deadline.¹ The PPP was designed to help small businesses keep workers on the payroll during the COVID-19 pandemic. 

For information about the PPP, follow this link. 

Late last month, President Joe Biden signed the PPP Extension Act of 2021, into law, extending the application deadline to May 31, 2021, from March 31, 2021. In addition, the new law allows the Small Business Administration through June 30, 2021, to process applications received by the new deadline. 

¹CNBC, The Paycheck Protection Program has a problem. It will likely run out of money before May 31 deadline; April 7, 2021; www.cnbc.com/2021/04/07/paycheck-protection-program-may-run-out-of-money-before-may-deadline.html
 

The American Rescue Plan Act (ARPA) requires that from April 1, 2021, through Sept. 30, 2021, certain COBRA qualified beneficiaries who are referred to as “assistance eligible individuals” who elect or will elect COBRA are not charged any amounts for COBRA coverage (premium assistance or subsidy). The employer, plan or insurer, as applicable, will be reimbursed for such amounts through a federal tax credit (against FICA taxes that fund Medicare hospital benefits). The statute also includes various notice requirements regarding the subsidy. President Joe Biden signed the ARPA on March 11, 2021.
 
While we do not currently offer COBRA administration services, we will publish two model notices from the federal government when they become available.
 
What is the duration and applicability of these requirements?
The subsidy starts April 1, 2021, and ends Sept. 30, 2021, unless ending sooner because the individual is no longer eligible.
 
“Assistance eligible individual” means someone, during the period of coverage of April 1, 2021, through Sept. 30, 2021: 

• who is a COBRA qualified beneficiary because of loss of employment (other than voluntary termination of employment or gross misconduct) or reduction in hours, and 
• who elects COBRA coverage.

Which employers are required to offer COBRA coverage?
COBRA generally applies to all private-sector group health plans maintained by employers that had at least 20 employees on more than 50 percent of its typical business days in the previous calendar year. Both full- and part-time employees are counted to determine whether a plan is subject to COBRA. COBRA also applies to plans sponsored by state and local governments, but not to plans sponsored by the federal government or by churches and certain church-related organizations.
 
Learn more.
 

A new federal law increases the lending authority of the Paycheck Protection Program (PPP) by $7.25 billion. The PPP was designed to help small businesses keep workers on the payroll during the COVID-19 pandemic. The provision increasing its lending authority was included in the $1.9 trillion American Rescue Plan Act, which President Joe Biden signed into law on March 11, 2021.

The PPP’s eligibility rules have been expanded to include certain nonprofit organizations and digital news services. PPP loans are forgivable if at least 60% of the money is used for payroll expenses, including health coverage, and the remainder goes to mortgage interest, rent, utilities, personal protective equipment or certain other business expenses. The program is scheduled to expire on March 31, 2021.

For information about the PPP, follow this link.

For two weeks beginning today, Feb. 24, 2021, only businesses and non-profit organizations with fewer than 20 employees will be able to apply for assistance from the Paycheck Protection Program (PPP), which was designed to help small businesses keep workers on the payroll during the COVID-19 pandemic.

Follow this link to learn more about the PPP and how to apply for relief.

The 14-day application period will allow lenders to focus on serving the needs of the smallest businesses and those that need the most support, and federal officials will work to ensure small businesses take maximum advantage of this two-week window.

In addition to the two-week application period set exclusively for businesses with fewer than 20 employees, President Joe Biden announced reforms that will:

• Revise the PPP’s funding formula to allow sole proprietors, independent contractors and self-employed individuals to receive more financial support through the relief program;
• Allow small business owners with prior non-fraud felony convictions to apply for PPP assistance; 
• Allow small business owners with student loan debt delinquency to participate in the PPP; and
• Ensure access for non-citizen small business owners who are lawful U.S. residents by clarifying that they may use Individual Taxpayer Identification Number (ITIN) to apply for the PPP.

The application deadline for PPP funding is March 31, 2021.

An end-of-year funding and Covid-19 relief bill was signed into law on Sunday, December 27, 2020.  It revives the Paycheck Protection Program (PPP) which expired over the summer, and authorizes more than $284 billion to the U.S. Small Business Association (SBA) for first and second PPP small business loans.
 
Employer expenses for insurance premiums/group health benefits paid or incurred during the Covered Period, qualify as payroll costs, and would be eligible for loan forgiveness. 

The new COVID-19 relief bill expands eligibility under the program allowing businesses facing severe revenue reductions the opportunity to apply for a second loan and creates a simplified forgiveness application process for loans of $150,000 or less.
 
Businesses can apply for loans through the SBA.

Please consult with your tax advisor and/or legal counsel for further program details.

When the COVID-19 vaccine becomes available to the general public, members of health benefit plans administered by Star Marketing and Administration, Inc., and their covered dependents are encouraged go to a pharmacy that participates in their CVS Caremark Network to get the vaccine.

These self-funded, employer-sponsored plans will cover provider administration of the vaccine.

Remember:

• The federal government is paying for the COVID-19 vaccine during the Public Health Emergency.
• Providers who receive free supplies of the COVID-19 vaccine from the federal government are prohibited from charging for any upfront costs, so members should not be billed afterward, according to federal guidance.
• If a provider mistakenly charges a copay or fee for the administration of the vaccine, those who pay at the point of service, or who are billed later, should submit the claim to Star Marketing and Administration, Inc. In these situations, an employer-sponsored plan will reimburse a member for the administration of the vaccine at a predetermined amount.

At this time, a COVID vaccine has not been authorized in the United States. We will keep you updated as new information becomes available.
 

The COVID-19 vaccine will be paid for by the federal government through funding authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, but administration of the vaccine by a provider will be paid for by the applicable plan or insurance policy.

The U.S. Departments of the Treasury, Labor and Health and Human Services, released an interim final rule (IFR), effective Nov. 2, 2020, on the COVID-19 vaccine and testing for COVID-19 with a request for comments.

Interim Final Rule with Request for Comments
The IFR includes provisions for implementing that section of the CARES Act requiring non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance to provide coverage during the public health emergency, without cost sharing, for qualifying coronavirus preventive services, which includes administration of the COVID-19 vaccine.

This coverage is required to be provided within 15 business days after the date on which the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) makes an applicable recommendation relating to a qualifying coronavirus preventive service.

Specifically, plans and issuers must cover COVID-19 immunizations that have in effect a recommendation of ACIP, even if not listed for routine use on the Immunization Schedules of the CDC.

This IFC also provides that:

• During the public health emergency for COVID-19, plans and issuers must cover – without cost-sharing – qualifying coronavirus preventive services (this would include the immunization if it was not provided free of charge by the federal government, and its administration), regardless of whether an in-network or out-of-network provider delivers such services.
• Non-grandfathered plans and issuers offering non-grandfathered group and individual plans/policies must cover – without cost-sharing – items and services that are integral to the furnishing of recommended preventive services, including the administration of COVID-19 immunizations.
• For a provider with whom the plan or issuer does not have a negotiated rate for such service (such as an out-of-network provider), the plan or issuer must reimburse the provider for such service in an amount that is reasonable, as determined in comparison to prevailing market rates for such service. 
• The departments consider the amount of payment to be reasonable, for example, if the plan or issuer pays the provider the amount that would be paid under Medicare for the item or service.

The Centers for Medicare & Medicaid Services (CMS) has stated that it issued guidelines to help states, localities and territories to develop vaccine programs and establish populations for prioritized vaccination. CMS has also indicated that VaccineFinder will be updated once COVID-19 vaccinations are widely available to the public to help direct people to find a vaccine provider near them.

We will provide updates as they become available.

Applicable to self-funded plans administered by Star Marketing and Administration, Inc., which use the Cigna Payer Solutions and utilization management services.

Utilization Management Changes and Billing Guidance for Providers
Cigna is committed to supporting providers and facilities, and has extended some adjustments to authorization requirements, medical necessity reviews, precertification, discharge planning and claim payment to Dec. 31, 2020. In response to the COVID-19 pandemic, in some cases Cigna is waiving or modifying prior authorizations, and in other cases there will be no change.

Claims for services with no authorization requirements or with adjusted authorizations should be paid.

Below is a list of important information Cigna has shared with providers:
 
UTILIZATION MANAGEMENT (applicable to admissions between 3/15/20 to 12/31/20)

• Cigna will suspend retrospective reviews for medical necessity of inpatient hospital admissions and emergency services for the first 72 hours.
• Cigna has waived precertification for home healthcare services.
• Cigna has extended the response time frame an additional 90 days for requests for additional information.

New end date communicated 10/31/20: UTILIZATION MANAGEMENT (applicable to admissions between 3/15/20 to 10/31/20)

• Cigna will waive providers’ requirement to submit a new precertification request when the member already has an approved request for the same service and is referred to another similar participating provider (e.g., getting CT scan at another facility).

INPATIENT LEVEL OF CARE (applicable 3/23/20 to 12/31/20)

• Concurrent review for continued stay at these facilities will begin on the first business day after transfer.
• Communicated 4/3/20: Cigna has waived the precertification requirement for urgent transfer of patients from acute inpatient site of care to SNF, AR and LTACH facilities.

PRIOR AUTHORIZATIONS EXTENSIONS (applicable 1/1/20 to 12/31/20)

• Elective outpatient prior authorization decisions have been extended from 90 days to 180 days for all services. Claims will remain payable as long as the service is performed within 6 months of the original authorizations. This applies to decisions made from Jan. 1, 2020, through Dec. 31, 2020, related to high-tech radiology service preauthorizations performed by eviCore for members with the Cigna network.

We are here to assist you. Please contact your Account Manager at AccountManagementSB@trustmarkbenefits.com or call 800.522.1246 with questions.

To view previous time frames, read our article, “Extended Time Frames: Cigna^® Utilization Review for all Plans with Cigna Payer Solutions 6/24/20.”

Cigna^® is a trademark of Cigna Intellectual Property, Inc., which is not an affiliate of Star Marketing and Administration, Inc., and Trustmark Life Insurance Company.

The loan forgiveness application portal is open for the Paycheck Protection Program (PPP), which was designed to provide a direct incentive to help small businesses keep workers on the payroll during the COVID-19 pandemic.

More than 5 million PPP loans totaling of $525 billion were approved from April 2020 through Aug. 8, 2020, the last day that businesses could apply for relief, according to the U.S. Small Business Administration (SBA).¹

Businesses seeking loan forgiveness have 24 weeks to spend PPP funds. The portion of the loan proceeds that must be spent on payroll costs is 60%. Partial forgiveness may be an option for businesses that fall short of the threshold.

To learn more about the PPP, follow this link.

For more on loan forgiveness, including applications, follow this link.

This information should not be construed as financial, tax, legal or compliance advice. Please consult your tax adviser, professional benefits adviser or legal counsel about these matters.

¹Paycheck Protection Program (PPP) Report: Approvals through 8/8/2020

 
 

Due to the pandemic, President Donald Trump signed a presidential memorandum in August that called for the deferral of the employee portion of the Social Security payroll tax.
 
The memorandum indicated the deferral:

• would be effective Sept. 1, 2020, through Dec. 31, 2020, and
• would impact employees whose bi-weekly wages subject to the Social Security tax are less than $4,000. 

 According to IRS guidance, employers who decide to defer the payroll tax are responsible for ensuring that it is repaid through withholdings from employee paychecks Jan. 1, 2021, through April 30, 2021.
 
Learn more:

• IRS Notice 2020-65

 This article should not be construed as tax, legal or compliance advice. Please consult your tax adviser, professional benefits advisor or legal counsel about these matters.

An incredible 42 percent of American employees are now working from home full-time.¹ Check out the links below from our sister company, HealthFitness^®, for recommendations on how to set up a home work station that helps promote health and productivity.

• View: Recommendations for ergonomic home workstations
• Read: How to create a healthy ergonomic workstation at home
• Flyer: Try these ergonomic stretches at home

 
¹Stanford news: “Stanford research provides a snapshot of a new working-from-home economy,” June 29, 2020

HealthFitness, a Trustmark company, delivers a complete and personalized wellbeing solution that is designed to make people healthier and includes the best of fitness and recreation management, wellness, and injury prevention and treatment.
 

Applicable to self-funded plans administered by Star Marketing and Administration, Inc., which use the Cigna Payer Solutions and utilization management services.

Utilization Management Changes and Billing Guidance for Providers
Cigna is committed to supporting providers and facilities, and has extended some adjustments to authorization requirements, medical necessity reviews, precertification, discharge planning and claim payment to Dec. 31, 2020. In response to the COVID-19 pandemic, in some cases Cigna is waiving or modifying prior authorizations, and in other cases there will be no change.

Claims for services with no authorization requirements or with adjusted authorizations should be paid.

Below is a list of important information Cigna has shared with providers:

UTILIZATION MANAGEMENT (applicable to admissions between 3/15/20 to 12/31/20)

• Cigna will suspend retrospective reviews for medical necessity of inpatient hospital admissions and emergency services for the first 72 hours.
• Cigna will waive providers’ requirement to submit a new precertification request when the member already has an approved request for the same service and is referred to another similar participating provider (e.g., getting CT scan at another facility).
• Cigna has waived precertification for home healthcare services.
• Cigna has extended the response time frame an additional 90 days for requests for additional information.

INPATIENT LEVEL OF CARE (applicable 3/23/20 to 12/31/20)

• Concurrent review for continued stay at these facilities will begin on the first business day after transfer.
• Communicated 4/3/20: Cigna has waived the precertification requirement for urgent transfer of patients from acute inpatient site of care to SNF, AR and LTACH facilities.

PRIOR AUTHORIZATIONS EXTENSIONS (applicable 1/1/20 to 12/31/20)

• Elective outpatient prior authorization decisions have been extended from 90 days to 180 days for all services. Claims will remain payable as long as the service is performed within 6 months of the original authorizations. This applies to decisions made from Jan. 1, 2020, through Dec. 31, 2020, related to high-tech radiology service preauthorizations performed by eviCore for members with the Cigna network.

We are here to assist you. Please contact your Account Manager at AccountManagementSB@trustmarkbenefits.com or call 800.522.1246 with questions.

To view previous time frames, read our article, “Extended Time Frames: Cigna^® Utilization Review for all Plans with Cigna Payer Solutions 6/24/20.”

Cigna^® is a trademark of Cigna Intellectual Property, Inc., which is not an affiliate of Star Marketing and Administration, Inc., and Trustmark Life Insurance Company.

Paycheck Protection Program: Loan Application Deadline Extended
 
Small businesses now have until Aug. 8, 2020, to apply for a loan designed to provide a direct incentive to keep workers on the payroll during the COVID-19 pandemic.
 
On July 4, 2020, President Donald Trump extended the deadline for applying for the Paycheck Protection Program (PPP) from June 30, 2020, to August 8, 2020. As of June 30, 2020, approximately $130 billion remained available for loans through the PPP.
 
Businesses that are seeking loan forgiveness will have 24 weeks, instead of 8 weeks, to spend PPP funds. The portion of the loan proceeds that must be spent on payroll costs has been reduced to 60% from 75%.
 
Small businesses can also check with their state and local governments to see if other relief is available. 
 
To learn more about the PPP, follow this link.
 

Applicable to self-funded plans administered by Star Marketing and Administration, Inc., which use the Cigna Payer Solutions and utilization management services.

Utilization Management Changes and Billing Guidance for Providers
Cigna is committed to supporting providers and facilities, and has extended to July 31, 2020, some adjustments to authorization requirements, medical necessity reviews, precertification, discharge planning and claim payment. In response to the COVID-19 pandemic, in some cases Cigna is waiving or modifying prior authorizations, and in other cases there will be no change.

Claims for services with no authorization requirements or with adjusted authorizations should be paid.

Below is a list of important information Cigna has shared with providers:

UTILIZATION MANAGEMENT (applicable to admissions between 3/15/20 to 7/31/20)

• Cigna will suspend retrospective reviews for medical necessity of inpatient hospital admissions and emergency services for the first 72 hours.
• Cigna will waive providers’ requirement to submit a new precertification request when the member already has an approved request for the same service and is referred to another similar participating provider (e.g., getting CT scan at another facility).
• Cigna has waived precertification for home healthcare services.
• Cigna has extended the response time frame an additional 90 days for requests for additional information.

INPATIENT LEVEL OF CARE (applicable 3/23/20 to 7/31/20)

• Concurrent review for continued stay at these facilities will begin on the first business day after transfer.
• Communicated 4/3/20: Cigna has waived the precertification requirement for urgent transfer of patients from acute inpatient site of care to SNF, AR and LTACH facilities.

PRIOR AUTHORIZATIONS EXTENSIONS

• (Applicable 1/1/20 to 7/31/20) - Elective outpatient prior authorization decisions have been extended from 90 days to 180 days for all services. Claims will remain payable as long as the service is performed within 6 months of the original authorizations. This applies to decisions made from Jan. 1, 2020, through July 31, 2020, related to high-tech radiology service preauthorizations performed by eviCore for members with the Cigna network.

We are here to assist you. Please contact your Account Manager at AccountManagementSB@trustmarkbenefits.com or call 800.522.1246 with questions.

To view previous time frames, read our article, “UPDATE: States Suspend Certain Utilization Management Reviews due to COVID-19 5/5/20.”

Cigna^® is a trademark of Cigna Intellectual Property, Inc., which is not an affiliate of Star Marketing and Administration, Inc., and Trustmark Life Insurance Company.

We have updated our communication about health benefit plan design changes and answers to common questions related to plan administration and the pandemic.

For details click here.

A small business economic relief program offers more time to use loans and more flexibility with the funding as a result of the Paycheck Protection Program Flexibility Act, which was signed into law on June 5, 2020.
Here are several important changes made to the Paycheck Protection Program (PPP):

• Small business owners now have 24 weeks, rather than 8 weeks, to spend PPP funding.
• The minimum portion of a PPP loan that must be spent on payroll costs to qualify for forgiveness is now 60% (rather than 75%).
• Small businesses can use their loan through Dec. 31, 2020, six months longer than the previous deadline of June 30, 2020.
• Businesses will not be penalized in their eligibility for loan forgiveness if they can show that they are unable to operate at their prepandemic number of full-time equivalent employees, as a result of guidance or regulations involving social distancing or other safety requirements related to COVID-19.

The application deadline for PPP funding remains June 30, 2020.

To learn more about PPP, follow this link.

Trustmark and Star Marketing and Administration, Inc., do not provide investment, tax or legal advice. Consult a licensed professional. Federal and state regulations are subject to change.
 

As small businesses reopen across the country, these resources can help.

• Supporting Small Businesses: Offers help for small businesses to bridge this economic emergency with funds to help keep their employees on their payroll and stay in business. Funding from the Small Business Administration (SBA); information from the White House, the Centers for Disease Control and Prevention (CDC), the Federal Emergency Management Agency (FEMA), and the SBA
• Guidelines: Opening Up America Again: Provides guidelines for a three-phased approach for reopening based on the advice of public health experts. These steps will help state and local officials when reopening their economies and getting people back to work while continuing to protect American lives. Includes guidelines to aid employers. From the White House and CDC
• Coronavirus (COVID-19): Small Business Guidance and Loan Resources: Offers guidance for businesses and employers for reopening, loans and resources, and local assistance. From the U.S. Small Business Administration 
• Coronavirus Small Business Survival Guide: Review a list of coronavirus resources specifically for business owners. From the U.S. Chamber of Commerce 
• Save Small Business Initiative: Offers resources, webinars, financial aid information, tax guidance and state-by-state opening guidelines. From the U.S. Chamber of Commerce 
• Resources for Small Businesses During COVID-19: Review tips, resources, financial news, and health and safety information. From ShopKeep, a tablet-to-cloud payments and point-of-sale platform 
• Helping Your Business Through COVID-19: Provides resources, recommended steps to take, and digital training. From Google for Small Business

Small business owners can also check with their state and local governments to see if other relief is available.

Due to the coronavirus (COVID-19) pandemic, federal agencies have temporarily extended certain deadlines under group health benefit plans, including dental plans, disability and other plans subject to ERISA and the Internal Revenue Code, including HRAs and FSAs. The U.S. Department of Labor (DOL) and the IRS have issued a notification of relief that affects a number of  deadlines, including those related to special enrollee elections, COBRA coverage, filing claims and appeals. 

The COVID-19 outbreak in the United States was declared a national emergency, beginning March 1, 2020. The relief notification extends certain time frames by mandating the period starting March 1 through 60 days after the national emergency is over (known as the “outbreak period”) to not be considered in applying certain deadlines. The date for the end of the national emergency has not yet been announced. ¹However, the extension cannot exceed one year.  

We will administer plans consistent with these temporarily extended deadlines mandated by the federal government.  

The chart below identifies the deadlines that affect employer-sponsored, self-funded health benefit plans administered by Star Marketing and Administration, Inc.  

View chart

¹The date of the end of the national emergency could vary for different parts of the country, if public emergencies end at different times in different states or regions. 

Prescriptions for over-the-counter medicine are no longer needed to obtain reimbursement from flexible spending accounts (FSAs), health reimbursement arrangements (HRAs) and health savings accounts (HSAs). In addition, feminine hygiene products were added to the list of eligible expenses.

These changes, which became effective for eligible purchases made on or after Jan. 1, 2020, were included in The Coronavirus Aid, Relief, and Economic Security Act, which became law on March 27, 2020.

The information below previously was published on April 24, 2020, after more than $300 billion was added to the Paycheck Protection Program (PPP), a federal program designed to provide a direct incentive for small businesses to keep workers on the payroll. To learn more about the PPP, visit this page on the U.S. Small Business Administration’s website.
 
More than $300 Billion Added to Small Business Relief Program - 4/24/20
An additional $321.3 billion has been infused into the Paycheck Protection Program, $310 billion of which is available for loans available through the U.S. Small Business Administration (SBA) designed to provide a direct incentive for small businesses to keep workers on the payroll.

The Paycheck Protection Program and Health Care Enhancement Act, which was signed into law on April 24, 2020, made the additional funding available.

As part of the program, the SBA will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for eligible expenses, such as payroll costs (including health benefits), rent under leases in effect before Feb. 15, 2020, interest on mortgages incurred before Feb. 15, 2020, or utilities for service that began before Feb. 15, 2020.

Employers can also check with their state and local governments to see if there is other relief available for small businesses. 

For more information about the Paycheck Protection Program, click on this link.
 

See information below for 4/17/2020 updates from Cigna.

States Suspend Certain Utilization Management Reviews due to COVID-19 - 4/15/20
Because of COVID-19’s impact on the nation’s healthcare system, some states have directed insurers and their utilization review agents and encouraged third party administrators for their self-funded clients to temporarily suspend utilization management reviews to allow providers to focus on treating patients. Claims must be processed during this time, even if pre-certification has not been requested.

As a result of these decisions, your plan may be impacted. Since many members are choosing to defer elective procedures at this time, we expect that the temporary suspension of utilization management services will have little impact on claims during this period.

Impacted Services

The following services could be impacted:

• Preauthorization, and concurrent reviews for surgeries and inpatient hospital services, and retrospective review for inpatient hospital services and emergency services provided at in-network hospitals.
• Preauthorization for home healthcare services following an inpatient hospital admission;
• Preauthorization for inpatient rehabilitation services following a hospital admission.

 The situation is changing rapidly as states, networks and utilization review vendors continue to announce decisions.

Aetna Signature Administrators^® (ASA) PPO Network

Applicable to self-funded health benefit plan designs administered by Star Marketing and Administration, Inc., which use the ASA PPO Network.

Trustmark Health Benefits provides Utilization Review services for all of our clients with the ASA PPO Network. Trustmark Health Benefits Utilization Review is complying with the federal mandate, which states that the network cannot subject any testing to pre-certification requirements if it is related to COVID-19.

Cigna Utilization Review for all Plans with Cigna Payer Solutions

Applicable to self-funded plans administered by Star Marketing and Administration, Inc., which use the Cigna Payer Solutions and utilization management services.
 
Cigna Payer Solutions Update 4/17/20
 
Utilization Management Changes and Billing Guidance for Providers
Cigna is committed to supporting providers and facilities and has made some adjustments to authorization requirements, medical necessity reviews, precertification, discharge planning, and claim payment.

In response to the COVID-19 pandemic, in some cases Cigna is waiving or modifying Prior Authorizations, and in other cases there will be no change.

Claims for services with no authorization requirements or with adjusted authorizations should be paid.

Below is a list of important information Cigna has shared with providers:

UTILIZATION MANAGEMENT (applicable to admissions between 3/15/20 to 5/31/20)

• Cigna will suspend retrospective reviews for medical necessity of inpatient hospital admissions and emergency services for the first 72 hours.
• Cigna will waive providers’ requirement to submit a new precertification request when the member already has an approved request for the same service and is referred to another similar participating provider (e.g., getting CT scan at another facility).
• Cigna has waived precertification for home healthcare services.
• Cigna has extended the response timeframe for an additional 90 days for requests for additional information.

INPATIENT LEVEL OF CARE (applicable 3/23/20 to 5/31/20)

• Concurrent review for continued stay at these facilities will begin on the first business day after transfer.
• Communicated 4/3/20: Cigna has waived the precertification requirement for urgent transfer of patients from acute inpatient site of care to SNF, AR, and LTACH facilities.

PRIOR AUTHORIZATIONS EXTENSIONS

• (Applicable 1/1/20-5/31/20) - Elective outpatient Prior Authorization decisions have been extended from 90 days to 180 days for all services. Claims will remain payable as long as the service is performed within 6 months of the original authorizations. This applies to decisions made from Jan. 1, 2020, through May 31, 2020, related to high-tech radiology service preauthorizations performed by eviCore for members with the Cigna network.

 
Trustmark Health Benefits Utilization Review

Applicable for self-funded plans administered by Star Marketing and Administration, Inc., which use the Trustmark Health Benefits Utilization Review Services.

Trustmark is complying with the federal mandate, which states that we cannot subject any testing to pre-certification requirements if it is related to COVID-19. This federal mandate is in place until the earlier of the end of the federal emergency or Dec. 31, 2020.

Communication to Providers
States have already communicated these changes to providers, so providers likely will not request authorization for services.

We are here to assist you. Please contact your Account Manager at AccountManagementSB@trustmarkbenefits.com or call 800.522.1246 with questions.

An additional $321.3 billion has been infused into the Paycheck Protection Program, $310 billion of which is available for loans available through the U.S. Small Business Administration (SBA) designed to provide a direct incentive for small businesses to keep workers on the payroll.

The Paycheck Protection Program and Health Care Enhancement Act, which was signed into law on April 24, 2020, made the additional funding available.

As part of the program, the SBA will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for eligible expenses, such as payroll costs (including health benefits), rent under leases in effect before Feb. 15, 2020, interest on mortgages incurred before Feb. 15, 2020, or utilities for service that began before Feb. 15, 2020.

Employers can also check with their state and local governments to see if there is other relief available for small businesses. 

For more information about the Paycheck Protection Program, click on this link.

Because of COVID-19’s impact on the nation’s healthcare system, some states have directed insurers and their utilization review agents and encouraged third party administrators for their self-funded clients to temporarily suspend utilization management reviews to allow providers to focus on treating patients. Claims must be processed during this time, even if pre-certification has not been requested.

As a result of these decisions, your plan may be impacted. Since many members are choosing to defer elective procedures at this time, we expect that the temporary suspension of utilization management services will have little impact on claims during this period.

Impacted Services

The following services could be impacted:

• Preauthorization, and concurrent reviews for surgeries and inpatient hospital services, and retrospective review for inpatient hospital services and emergency services provided at in-network hospitals.
• Preauthorization for home healthcare services following an inpatient hospital admission;
• Preauthorization for inpatient rehabilitation services following a hospital admission.

 
The situation is changing rapidly as states, networks and utilization review vendors continue to announce decisions.

Aetna Signature Administrators^® (ASA) PPO Network

Applicable to self-funded health benefit plan designs administered by Star Marketing and Administration, Inc., which use the ASA PPO Network.

Trustmark Health Benefits provides Utilization Review services for all of our clients with the ASA PPO Network. Trustmark Health Benefits Utilization Review is complying with the federal mandate, which states that the network cannot subject any testing to pre-certification requirements if it is related to COVID-19.

Cigna Utilization Review for all Plans with Cigna Payer Solutions

Applicable to self-funded plans administered by Star Marketing and Administration, Inc., which use the Cigna Payer Solutions and utilization management services.

Cigna has announced that for both fully-insured and self-funded plans where Cigna would normally be providing utilization management services will not undergo utilization review, effective through June 18, 2020. This includes: 

• No authorization required for emergency department visits
• No post-service review of emergency room care for medical necessity
• No precertification for home health care services
• No authorization required for emergency ground or rotary transportation
• Emergent transport to nearby facilities capable of treating customers is covered without authorization
• No authorization required for transport between facilities such as hospitals and skilled nursing facilities and hospitals and acute rehab centers

Please note that claims for services with no authorizations for the services listed above are to be paid by each plan’s third-party administrator. For these services, third-party administrators should not expect to see authorization information in Cigna systems or on the authorization file.

Trustmark Health Benefits Utilization Review

Applicable for self-funded plans administered by Star Marketing and Administration, Inc., which use the Trustmark Health Benefits Utilization Review Services.

Trustmark is complying with the federal mandate, which states that we cannot subject any testing to pre-certification requirements if it is related to COVID-19. This federal mandate is in place until the earlier of the end of the federal emergency or Dec. 31, 2020.

Communication to Providers
States have already communicated these changes to providers, so providers likely will not request authorization for services.

We are here to assist you. Please contact your Account Manager at AccountManagementSB@trustmarkbenefits.com or call 800.522.1246 with questions.
 

The federal government is offering loans to help small businesses keep workers on their payroll and tax advantages to support businesses during the COVID-19 outbreak. Review these five provisions contained in the economic stimulus packages to see if they are right for your business:

1. Paycheck Protection Program from the U.S. Small Business Administration (SBA)
This loan program is designed to provide a direct incentive for small businesses to keep their workers on the payroll. The SBA will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for eligible expenses, such as payroll costs, rent under leases in effect before Feb. 15, 2020, interest on mortgages incurred before Feb. 15, 2020, or utilities for service that began before Feb. 15, 2020. The program is available through June 30, 2020. Learn more.

2. Employee Retention Credit for Eligible Employers
This provision provides a refundable payroll tax credit for 50 percent of certain wages paid by qualifying employers to employees during the COVID-19 crisis. The payroll tax credit is available to employers whose:

• operations were fully or partially suspended due to a COVID-19 related stay-at-home order; or
• gross receipts declined by more than 50 percent when compared to the same quarter in the prior year.

An employer that accepts a PPP loan is not eligible for the credit under this provision. Learn more.

3. Delay of Payment of Employer Payroll Taxes
Employers will be allowed to defer payment of the 6.2 percent employer share of Social Security taxes on employee wages that employers are otherwise responsible for paying to the federal government with respect to their employees. The provision requires that the deferred employment tax be paid over the following two years, with half due by Dec. 31, 2021, and the remainder due by Dec. 31, 2022. An employer whose SBA loan has been forgiven under the PPP loan forgiveness program is not eligible to defer payment under this provision.

4. Modifications for Net Operating Losses
Limitations on a company’s use of losses from prior years will be relaxed. A net operating loss from 2018, 2019 or 2020 can be carried back five years. The provision temporarily removes the taxable income limitation to allow a net operating loss to fully offset income.

5. Emergency Sick and Family Leave*
This provision provides businesses with fewer than 500 employees refundable tax credits to reimburse them for the cost of providing paid sick and family leave wages related to COVID-19. An employer that uses refundable tax credits outlined in this provision is not eligible for the employee retention credit for the same wages. .
 
For more information, visit Coronavirus and Economic Impact Payments: Resources and Guidance on the IRS website.

 *This provision is contained in The Families First Coronavirus Response Act, which was signed by President Donald Trump on March 18, 2020. All other provisions highlighted in this article were introduced in The Coronavirus Aid, Relief, and Economic Security Act, which became law on March 27, 2020.

We do not provide tax or legal advice. Please consult with your tax advisor and/or legal counsel about these federal programs.
 

The health and wellbeing of our associates and customers are our top priorities. We understand that the toll of COVID-19 goes well beyond the impact of the illness itself.
 
We want to share what we’re doing to help employers through this unprecedented situation and offer answers to commonly asked questions.
 
For more information please read this article.

The Paycheck Protection Program from the U.S. Small Business Administration (SBA) is a loan program designed to provide a direct incentive for small businesses to keep their workers on the payroll.
 
The SBA will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for payroll, rent, mortgage interest, or utilities.
 
The Paycheck Protection Program will be available through June 30, 2020. Lenders may begin processing loan applications as soon as April 3, 2020.
 
To learn more, follow this link.
 
Source: U.S. Small Business Administration website; Paycheck Protection Program; reviewed April 1, 2020.
 
We do not provide tax or legal advice. Please consult with your tax advisor and/or legal counsel about such federal programs.
 

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.
 

On Wednesday, March 18, 2020, a new federal law was enacted, requiring coverage of testing for the coronavirus without any cost sharing, prior authorization or other medical management requirements.
President Donald Trump signed the Families First Coronavirus Response Act, effective March 18, 2020, through Dec. 31, 2020, which requires¹ the following:

• Self-funded ERISA and church group major medical benefit plans must cover testing for the coronavirus without cost sharing, i.e., deductible, copay or coinsurance.
• Prior authorization or other medical management requirements, such as medical necessity determinations and out-of-network penalties, must not be imposed.
• The mandates apply to items and services furnished during a visit at healthcare providers offices, urgent care centers, emergency rooms , or via telehealth consultations (whether by Teladoc^® or another provider) that result in an order for or administration of a test for the diagnosis of COVID-19.

¹This section of the law does not apply to federal or other governmental benefit plans.

In addition to mandated benefit changes from the new federal law, members of major medical benefit plans administered by Star Marketing and Administration, Inc., may speak with their employer about other benefit changes made for telemedicine services due to COVID-19, if applicable.

Under self-funded, group major medical benefit plans administered by Star Marketing and Administration, Inc., claims for covered employees and their dependents for diagnostic testing and medically necessary treatment for COVID-19 will be processed in accordance with their employer group’s plan provisions.
We have reached out to employers with major medical benefit plans and suggested benefit changes due to the coronavirus spread. We will provide an update here when those benefit changes are final.
 
Employers can view a summary of their covered employees’ benefits by logging in > Administration > Manage My Group > Member Summary of Benefits. For a snapshot view of benefits, members can log in > Benefits, Claims and EOBs. For a full explanation of benefits both employers and members can view their health benefit plan document in the Document Center, after logging in.

The situation with the novel coronavirus (COVID-19) continues to evolve. For the latest information on COVID-19, please visit the Centers for Disease Control website.

Know the facts about coronavirus disease 2019 (COVID-19). The CDC website has detailed information, including a situation summary, prevention information and travel guidance.  The CDC also offers handouts and posters.

The following healthy habits can help you protect yourself and others from flu and other viruses, such as COVID-19:

• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.¹
• If soap and water are not readily available, use a hand sanitizer that contains at least 60-percent alcohol.¹

Other important habits include²:

• Avoid close contact with people who are sick.
• Stay home when you are sick, except to get medical care.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Cover your coughs and sneezes with a tissue.
• Clean and disinfect frequently touched surfaces and objects daily (for example, phones, keyboards, tables, countertops, light switches, doorknobs, and cabinet handles).
• If surfaces are dirty, they should be cleaned using a detergent and water prior to disinfection. For disinfection, a list of products with Environmental Protection Agency-approved emerging viral pathogens claims, maintained by the American Chemistry Council Center for Biocide Chemistries, is available here. Always follow the manufacturer’s instructions for all cleaning and disinfection products.*

If you or your family have recently traveled overseas or plan to do so, follow guidance found on the CDC website regarding self-monitoring for infection and self-quarantine.

If you feel sick, contact your doctor. Also remember, Teladoc^®3 provides members of employer-sponsored, self-funded health benefit plans administered by Star Marketing and Administration, Inc., with access to a U.S. board-certified doctor through the convenience of phone and video consults for nonurgent emergency care. Your employer can post these flyers in highly visible areas: Protect yourself and your family from COVID-19 and Coronavirus Frequently Asked Questions.

This information is intended for educational purposes only, and should not be interpreted as medical advice.

¹ CDC website, Clean Hands Save Lives, https://www.cdc.gov/handwashing/when-how-handwashing.html, Oct. 3, 2019

² CDC website, Coronavirus Disease 2019 (CVID-19), Get Your Household Ready for Coronavirus Disease 2019, https://www.cdc.gov/coronavirus/2019-ncov/community/home/get-your-household-ready-for-COVID-19.html

³ A consult fee may apply and is subject to change during the plan year. Refer to your Plan Document for details. Trustmark^® and Trustmark Small Business Benefits^® are trademarks of Trustmark Insurance Company. Teladoc Health, Inc. is not an affiliate of Star Marketing and Administration, Inc., and Trustmark Life Insurance Company.