FAQ to Help You Respond to Clients’ Questions

Since mid-March, our Nurse Care Managers have conducted outreach to more than 1,000 members who are identified as high risk for severe illness from COVID-19. Our Nurse Care Managers provide support and education, answer members’ questions, and help coordinate any necessary care. Those at high risk include older adults and people of any age who have serious underlying medical conditions, according to the Centers for Disease Control and Prevention. These conditions can include chronic lung disease and moderate-to-severe asthma, serious heart conditions, severe obesity, being immunocompromised including cancer treatment, and others. 

We have a newsletter sign up form on our website that will add you to our distribution list for our newsletters as well as other important communications from us.

Please follow these instructions for submitting payments, enrollment changes, new business and other paperwork.

The Paycheck Protection Program is part of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which President Trump signed into law on March 27, 2020. The Cares Act has two loan programs – one for small businesses and one for larger businesses – which are designed to help those currently struggling because of the Coronavirus.

The Paycheck Protection Program provides $350 billion to support federally guaranteed loans for small employers with 500 or fewer employees, as well as those that meet current Small Business Administration size standards. The size of the loans would equal 250% of the employer’s average monthly payroll. The maximum loan amount would be $10 million. These loans may be forgiven if borrowers maintain their payrolls and employee benefits during the crisis or restore their payrolls afterwards.

For more information on this program please see these helpful resources:

• Small Business Association
• Treasury FAQs
• Paycheck Protection Program Application Form

Tufts Health Plan reads the latest DOI Bulletin as creating a Special Enrollment Period for individuals that are currently uninsured, not the group market.

In the employer group space, a qualifying life event (as defined by the IRS) is required to enroll in coverage off-cycle. There has been no guidance from regulators that this will be changing given COVID-19. We will continue to honor any of the identified qualifying life events, such as loss of current coverage, changes in household, etc.

For non-group, the SEP will now be open through May 25. Also for non-group Connector members who haven't paid their premium, they will not be termed in April.

Until further notice, and because of the COVID-19 pandemic, Tufts Health Plan will permit employers to treat as health plan-eligible those employees as of 3/15/20 whose hours have been reduced or those employees as of 3/15/20 who have been furloughed or temporarily laid off. Tufts Health Plan will rely on employers to identify the persons who are eligible to be offered health coverage and employers must continue to remit payment to Tufts Health Plan of all monthly premiums for such persons. These changes will not apply to newly enrolling employees.

For Massachusetts Business:

• Premiums are due on the first day of coverage period.

• Late payment reminder letters go out 7 days after due date.

• Group term letters go out 45 days after due date.

• Member term letters go out 50 days after term date with offer of 60-day temporary coverage retroactive to the termination date if member pays.

• Group is terminated at day 60, retroactive 60 days to last paid date.

For Rhode Island and New Hampshire Business:

• Premiums are due on first day of coverage period, which is on or before the 1^st of the month.

• Both RI and NH allow a 30-day grace period for premium to be paid.

• Late payment reminder letters go out 5-7 days after due date.

• Group term letters go out 23-25 days after due date.

• Member term letters go out 30-35 days after due date.

• Group is terminated back to end of 30-day grace period.

Tufts Health Plan will, on a case-by-case basis, extend the statutory grace period, one time, for an additional 30-days for fully-insured groups in MA, RI and NH. Requests must be made in writing and signed by the employer. Consideration will be given solely as a result of the Coronavirus (COVID-19) pandemic and its impact on the company’s ability to pay timely premium whether the group has received a PPP loan pursuant to the CARES Act, and the commitment to pay during the extended grace period.

This as an employer decision. The law permits employers to select between 0-90 days. We advise employers to consult your broker, consultant and/or legal counsel on the risk of waiving waiting periods mid-year. Self-insured customers should also consult their stop-loss carriers to ensure that such waiver is permitted.

Employee coverage ends the date we are notified to terminate the employee by the group. For example, if the employer instructs us to terminate as of 1/15, coverage ends that day.  If the employer instructs us to terminate as of 1/31, coverage ends that day. Employees would be eligible for COBRA or state continuation of coverage if they are terminated, or they can seek coverage under a state exchange plan. Depending upon their financial situation, terminated employees may be eligible for a subsidized plan or Medicaid.

For employer groups that close permanently, their employees are not eligible for COBRA. However, depending on the state in which coverage was written, their terminated employees may be eligible for individual coverage on state exchanges or individual coverage on the same plan offered through their former employer in RI and NH at a cost of up to 102% of monthly premium. Depending upon their financial situation, terminated employees may be eligible for a subsidized plan or Medicaid.

Tufts Health Plan continues to support our employers, members, providers and communities through this difficult time. We have given nearly $2 million in grants to community partners, removed barriers to care by eliminating copayments for certain services, amended policies to help physicians deliver essential care, and provided needed flexibility on premium payments.

We understand the difficult nature of the current situation. Tufts Health Plan is continuing to evaluate the impact of both COVID-19 related claims and claims suppression that occurred as a result of the pandemic. We are carefully monitoring claims activity as members have begun to resume normal medical care over the past several weeks. We expect to have a decision on the question of premium credits by late August 2020. This additional time will allow for two full quarters of data to be collected to help inform the decision.

As always, we appreciate your continued support and please contact your account representative for more information.

Consistent with Federal guidance, tests will not be covered if conducted solely for return-to-work or return-to-school purposes, for travel purposes unrelated to seeking medical care, for public health surveillance, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition.  Providers have been directed to use standard procedures to designate that the test was performed at a third-party’s request.

FDA-authorized antibody testing for COVID-19 is covered only when it has been determined by a provider who has performed an individualized clinical assessment to be medically necessary to help make decisions about a patient’s care.

We support these guiding principles around testing:

• Facilitate necessary patient testing
• Ensure resources are targeted
• Distinguish public health surveillance, occupational health and health insurance
• Base our recommendations on medical evidence
• Accommodate evolution of testing
• Protect against fraud and abuse
• Avoid 2021 premium spikes

There is emerging evidence that demonstrates testing for both the virus and the antibody may not be valuable for determining if a person is not contagious, therefore safe to return to work. Tests for the virus reflect point in time data. Antibody testing reliability is unclear and new studies and data show that the antibodies may be short-lived - a few months and maintained at different strengths - and may not be evidence that an employee may safely return to work without risk of getting the illness again.

Keeping sick employees home, social distancing and wearing masks may be safer for return-to-work practices and policies than testing.