Pulse Survey: Mental health benefits
Survey: Since the pandemic began, 66% of employers report increased use of mental health resources offered through their benefits plan, and 62% indicate a significant spike in claim costs
This article reflects guidance issued through July 31, 2020; additional changes are possible in the future as the national emergency continues to unfold.
Recently enacted COVID-19 legislation and related federal guidance require some mandatory group health plan benefit changes and offer other voluntary changes you can elect to provide temporary relief to employees. Be aware that some of the changes require that you notify participants via a summary of material modification (SMM) or an updated summary plan description (SPD).
Now you have some work to do: Deciding which relief options to offer and notifying participants about the changes with an SMM or updated SPD. Communication is crucial, especially during this current crisis. With so many uncertainties these days, notifying participants about relief offered through their benefit plans can bring comfort and appreciation for their benefits.
COVID-19 testing coverage
All group health plans (including high-deductible health plans) must cover COVID-19 testing and the doctor's visit at 100% of the cost (with no cost sharing required of the employee). The plan must pay 100% of the incurred cost of a visit during which a COVID-19 test is administered or ordered, regardless of whether the provider is in- or out-of-network. This includes the cost of items and services related to the administration of a COVID-19 test in a variety of settings: office visits, urgent care, emergency room, drive-through, and telehealth.
When it comes to treatment of COVID-19, however, a recent publication by the U.S. Department of Labor affirms that employers have no mandatory responsibility to waive cost sharing for treatment of COVID-19 symptoms, and the plan's normal deductibles, copays, and coinsurance may apply.
Suspension of deadlines during the "outbreak period"
The outbreak period for the COVID-19 crisis has been defined as beginning March 1, 2020, and ending 60 days after the national emergency period ends. As of mid-August (the publication of this article), the national emergency period has not ended. Certain group health plan compliance deadlines that would fall during this time have been paused until the national emergency ends. These changes apply to ERISA plans (both health and retirement plans).
Keep in mind: Participants don't have to wait until the end of the outbreak period to enroll or submit claims.
In addition to these mandatory updates, recent federal guidance allows other voluntary changes to group health plans. If you choose to implement any voluntary provisions, they should also be included in your communication to participants.
For group health plans, you might be considering:
Employees need to hear from you during these challenging times--especially with some good news. Take a close look at what you can do with your benefits program to ease the pressure on employees and support them in some very practical ways.
COVID-19 benefit changes: Action required for employer health insurance plans
Recently enacted COVID-19 legislation and related federal guidance require some mandatory group health plan benefit changes and offer other voluntary changes you can elect to provide temporary relief to employees.