Last updated: November 13, 2020   

FAQ to Help You Respond to Employee Questions

Updated on a regular basis

This FAQ will be updated on a regular basis and we encourage you to check back often. Look for a date after the individual question to see when it was posted or updated.

How is Tufts Health Plan supporting members who are at high risk for severe illness from COVID-19? (3/31/20)

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.

Since businesses are now working remotely, how are you handling physical paper during this time? (3/31/20)

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

Will you offer a grace period for premium payments during the COVID-19 outbreak? (3/20/2020, updated 4/2/2020)

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 and the commitment to pay during the extended grace period.

What is the Paycheck Protection Program and what does it mean for small employers? (3/31/20)

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:

Can I use PPP loan dollars to pre-pay my health insurance premiums? (4/30/20)

Tufts Health Plan is able to accept pre-payment of health insurance premiums. However, Tufts Health Plan cannot advise if Paycheck Protection Program ("PPP") loans may be used to pre-pay health insurance premiums.  Please consult with your PPP lender, legal counsel, financial advisor and/or accountant. The U.S. Small Business Administration, which administers PPP, is also regularly updating guidance. 

For more information, see these helpful resources:

How are employers expected to address the liability issues of people coming back to work, then getting sick and blaming the employer? (6/12/20)

Liability for COVID-19 infections is an issue of great concern to employers. To date, there has been no Federal legislation to shield employers from such liability, although many trade groups have advocated for it.

A host of law firms have published articles about employer liability for COVID-19. For example:

At a minimum, Employers should carefully follow workplace safety and return-to-work guidance from the CDC, OSHA, and state and local governments. Employers should also consult with their own legal counsel to develop risk mitigation strategies for their particular business.

Can COVID-19 claims be subject to worker's compensation? If so, what would be required to "prove" a worker's comp claim? (6/12/20)

Whether an illness is subject to workers’ compensation is matter of state law. Under ordinary circumstances, workers’ compensation typically does not cover routine community-spread illnesses like a cold or the flu because they usually cannot be directly tied to the workplace. However, if the hazard of contracting a disease is inherent in the employment, then workers’ compensation may be available. Employers whose employees routinely come into contact with persons infected with COVID-19 — medical workers, for example — are likely at greater risk for a workers’ compensation claim. Legislation and/or decisions by government regulators could also expand the availability of workers’ compensation for employees infected with COVID-19.

Employers should consult with their own counsel concerning potential workers’ compensation claims associated with COVID-19.

Below are a number of resources concerning COVID-19 and workers’ compensation:

Will Tufts Health Plan offer premium credits to their clients as a result of the suppression of claims earlier this year? (6/24/20)

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.

Will Tufts Health Plan cover testing for return to work or school or travel? (11/13/20)

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.

The Commonwealth of Massachusetts offers free COVID-19 testing at specific locations around the state.  You can direct employees to these locations for free, a-symptomatic testing. They may be subject to costs for services rendered other than COVID-19 testing. For more details and information regarding this state-run program, please visit Stop the Spread.