March 17th, 2020
Guidance for Small Employers insured by Anthem considering COVID-19:
As of this morning our phones started ringing off the hook with calls from consumers and employers concerned about maintaining health insurance coverage in this new COVID-19 environment. We have spoken with Anthem and while we await further guidance and direction on what relief options exist:
Today Anthem is announcing the following updates for members of its affiliated health plans:
- Access to Virtual Care and Development of a Coronavirus Assessment via Anthem’s Sydney Care Mobile App: Anthem is working to accelerate the availability of a Coronavirus Assessment on the Sydney Care mobile app, which members can download at no cost. The Coronavirus Assessment is designed based on guidelines from the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) to help individuals quickly and safely evaluate their symptoms and assess their risk of having COVID-19. Inputs provided by individual users include symptoms, recent travel and potential contact with anyone with the disease. Based on the results, Anthem members will be able to connect directly to a board-certified doctor via text or secure two-way video via the Sydney Care app who can then recommend care options.
Sydney Care is available for Anthem members to download now on Android or iOS. This app should accompany their Sydney Health or Engage benefits app. Coronavirus Assessment functionality is in development and expected to be available within the next week.
Additionally, effective immediately, Anthem’s affiliated health plans will implement the following changes:
- Access to Testing and Medical Care: Anthem’s affiliated health plans will continue to waive copays, coinsurance and deductibles for the diagnostic test related to COVID-19. In addition, this will be extended to include waiver of copays, coinsurance, and deductibles for visits associated with in-network COVID-19 testing, whether the care is received in a physician’s office, an urgent care center or an emergency department.
- Access to Medication: Anthem is relaxing early prescription refill limits for members who wish to receive a 30-day supply of most maintenance medications, where permissible.
Additionally, Anthem continues to encourage health plan members who have a pharmacy plan that includes a 90-day benefit, to talk to their doctor about whether changing from a 30-day supply to a 90-day supply, of any prescription medicines they take on a regular basis, is appropriate. Members filling 90-day prescriptions can obtain their medications through our home delivery pharmacy and in some circumstances, select retail pharmacies. Members can call the pharmacy services number on the back of their health plan ID card to learn more.
- Access to Virtual Care: For 90 days, Anthem’s affiliated health plans will waive any member cost share for telehealth visits, including visits for mental health, for our fully insured employer plans, Individual plans, Medicare plans and Medicaid plans, where permissible. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other telehealth providers delivering virtual care. Access to LiveHealth Online as well as virtual care via text is available to members through the Sydney Care app. Self-insured plan sponsors will have the choice to participate in this program.
Anthem continues to recommend members use virtual care options when possible, as it can help prevent spread of coronavirus and improve access to care. Virtual care is a safe and effective way for members to see a doctor to receive health guidance related to COVID-19 from their homes via smart phone, tablet or computer.
For employers who have been impacted by the COVID-19 Virus and are no longer able to operate their businesses in a normal capacity, there are many questions about employee status and what employers can and cannot do regarding benefits eligibility.
Options to allow employees to stay on the group plan:
An active employee as defined by the Anthem Small Group Underwriting Guidelines 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.
Ineligible employees as defined by the Anthem Small Group Underwriting Guidelines include 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.
What this means is that any Small Group Employer (under 50) insured by Anthem may keep all employees enrolled on the employer sponsored health plan even if they are on furlough or have been temporarily laid off for up to 12 weeks and for up to six months if the employee becomes ill. However, in this case the employer will need to continue to contribute to the employee’s premium in the same amount as prior to the Leave of Absence (LOA).
What happens to my employee’s health coverage if I have to terminate their employment?
If an employer is forced to terminate their employees employment their employees can still stay on the group plan;
- Employers with less than 20 employees are able to allow their former employees to stay on the plan for up to 12 months through Statewide Continuation of benefits (Employee pays 100% of the cost to be on the plan plus a 2% administration fee).
- Employers with 20 or more employees must be offered COBRA benefits for up to 18 months (Employee pays 100% of the cost to be on the plan plus a 2% administration fee).
Options for covered employees who have been furloughed or temporarily laid off:
For employees unable to afford their portion towards the employer sponsored group coverage because of an illness, injury, temporary layoff (up to 12 weeks) or Leave of Absence it is important to understand options available through the Marketplace.
If you leave your job for any reason and lose your job-based insurance, you can buy a Marketplace plan. Losing job-based coverage, even if you quit or get fired, qualifies you for a Special Enrollment Period (SEP). This means you can buy insurance outside of the yearly Open Enrollment Period and if eligible because of income qualify for up front financial assistance with Subsidy (Premium Tax Credits) and in some cases reductions in your out of pocket expenses through Cost Share Reductions (for individuals with Modified Adjusted Gross Incomes below 250% of the Federal Poverty Level).