Coronavirus (COVID-19) Broker Frequently Asked Questions

Broker Guidance

Yes. Laid off or furloughed employees that were covered by the plan may remain on the plan until June 30, 2020 without electing COBRA or continuation under state law. The group must continue to pay the monthly premium payments, and employee premium contributions must be the same or less than they were prior to the layoffs or furlough. Coverage must be maintained on a uniform, non-discriminatory basis to all eligible laid off or furloughed employees.

No. But if one person remains actively employed and covered under the EmblemHealth benefit plan, the plan will remain in force as long as the monthly premium payment is received. If no one remains actively employed and covered under the EmblemHealth benefit plan, the plan will be considered terminated.

Yes. If one person remains actively employed and covered under the EmblemHealth plan, members losing coverage may elect to continue coverage under COBRA and/or New York state law by following the normal notice, election, and payment procedures.

If there are no active employees, the plan is considered terminated and COBRA will not be an option.

 

In the event of an employee’s termination, a member losing coverage will have the right to convert to an EmblemHealth individual direct payment policy. They may also be able to enroll in individual coverage on the open market, on and off the New York State of Health, and under a special enrollment period. Some may qualify through the New York State of Health for Medicaid or Essential Plans.

If small groups are suffering financial hardship as a result of the COVID-19 pandemic, they can request that we extend the time to pay their premium until June 1, 2020.  This extension of time applies to premiums that were due on April 1, 2020 and those that will come due on May 1, 2020. Once the extension expires, the full amount of past-due premium is owed. To request an extension or explore other options, please contact our Broker Services team at 866-614-6040.

No. EmblemHealth will not make any changes to large group rates or premiums through June 30, 2020 if the drop in enrollment is the result of the COVID-19 crisis. We reserve the right to reevaluate both enrollment and rates beginning July 1, 2020.

No. EmblemHealth expects to continue to meet renewal rate actions as required by the state and/or our contracts. We do not anticipate delays or other changes.

EmblemHealth recommends employers work with their employees to assess coverage options and eligibility by calling our dedicated customer sales at 800-447-9169. Employees and members terminated from group coverage have the right to convert to an EmblemHealth individual direct payment, ACA-compliant “metal” policy. Such employees and members may also qualify to purchase individual coverage on or off the New York State of Health exchange pursuant to a special enrollment period and/or qualifying event. Some individuals may qualify for Medicaid, Medicare, or the Essential Plan through the New York State of Health. EmblemHealth offers plans in these markets.

For members who promptly elect conversion to an EmblemHealth individual direct payment plan and pay the applicable premium, coverage will be retroactive to the date of termination from the group plan. For members that seek coverage outside of the conversion option, the member’s loss of coverage or other qualifying event will determine their special enrollment period and effective date of coverage. Call our dedicated sales phone number at 800-447-9169 or visit healthcare.gov. Note that premium subsidies are not available for plans purchased outside of the New York State of Health exchange.

Yes. EmblemHealth does not require a waiting period for medical/hospital coverage. If an employer normally applies a waiting period for its EmblemHealth plan, EmblemHealth will not expect the employer to enforce the waiting period for employees rehired by June 30, 2020.

ACH/wire payments are strongly encouraged. Be sure to include the group name on the reference line. Below are links to detailed instructions for sending ACH/wire payments for HIP/HIPIC and GHI.

 

If you are an existing active group, please also consider registering on our employer group portal to make your premium payments. You can be assisted with this process by contacting 877-444-7417.

Cost-sharing for COVID-19 testing and diagnosis is waived for in-network providers only. Normal out-of-network cost-sharing and benefit limitations apply.

No changes are expected. Commissions and other compensation will continue to be paid in the normal course.

Please visit our website for the latest answers to FAQs and more. In addition, we have set up a dedicated microsite so that we can keep all of our members and partners updated as news and information becomes available.

Congress passed the Families First Coronavirus Response Act (H.R. 6201) on March 18, 2020. The act requires certain employers with fewer than 500 employees to provide coronavirus-related paid sick leave. To assist employers subject to this requirement for related qualified health plan expenses during sick leave, the federal government is providing refundable tax credits for those qualified health plan expenses. The details of this program are complex and should be discussed with a tax professional. Click here for more information.

Member Guidance

If you are seeing an in-network doctor for flu-like symptoms and the doctor recommends that you get tested for the coronavirus, your in-network doctor’s visit is covered by your plan at no cost to you.

If your plan includes out-of-network benefits, you also have benefits for covered out-of-network services at the normal plan cost-sharing and terms for the out-of-network service.

If you want an early refill for your prescription due to the COVID-19 outbreak, please tell your pharmacist to enter the following Submission Clarification Code (SCC): SCC 13. Some pharmacies are not familiar with this new code, so be sure to let yours know about it. If your early refill is rejected even after using this code, please ask your pharmacist to contact the Express Scripts Pharmacy Help Desk at 800-922-1557.

Our Nurse Hotline is staffed with experienced, licensed nurses who are continually briefed on the latest information and are available for confidential, one-on-one health counseling and to answer health questions 24 hours a day, 7 days a week. You can reach the Nurse Hotline at 877-444-7988.

If you have flu-like symptoms or symptoms of COVID-19, call your doctor. Based on the details of your symptoms and any recent travel, your doctor will follow guidance from the state department of health to determine whether it’s recommended that you get tested.

Some providers may offer virtual office visits (known as telehealth). Due to the COVID-19 pandemic, covered services received via telehealth from in-network providers will temporarily be covered without cost-sharing. This applies even if the services are not related to COVID-19. During the pandemic, these visits may be offered through a wider variety of technologies and means than are usually permitted.

 

AdvantageCare Physicians (ACPNY) will have virtual visits available for all ACPNY patients starting the week of May 30, 2020. ACPNY patients will receive an email about how to use this service.

 

Check with your in-network provider to see if they offer care through telehealth. For EmblemHealth members with Teladoc® included as part of their benefit plan, Teladoc offers virtual doctor visits 24 hours a day, 7 days a week. Visit Teladoc® online or by calling 800-835-2362 to talk with a doctor. For a temporary period of time during the pandemic, no cost-sharing will apply to Teladoc visits, even if they are not related to COVID-19.

 

If your plan includes benefits for out-of-network services (PPO or POS plans), out-of-network providers may also offer visits via telehealth. Covered services that you receive from out-of-network providers via telehealth are covered subject to the normal cost-sharing terms for out-of-network services.

Telehealth: Telehealth means the use of electronic information and communication technologies, including the telephone, by a health care provider to deliver health care services to an insured while such insured is located at a site that is different from the site where the health care provider is located.

 

Check with your provider to see if they offer covered services via telehealth. For a temporary period of time during the pandemic, no cost-sharing will apply to covered services that members receive from in-network providers via telehealth.

 

Telemedicine: This refers to our Teladoc program. Many, but not all, EmblemHealth benefit plans include this feature. Teladoc offers virtual doctor visits 24 hours a day, 7 days a week, for non-emergency services. For a temporary period of time during the pandemic, no cost-sharing will apply to Teladoc visits, even if they are not related to COVID-19.

 

If any employer group wishes to add the Teladoc benefit, please contact your EmblemHealth representative. EmblemHealth is temporarily allowing groups to add this feature at any time during the plan year at the group’s option.

No. Preauthorization requirements are temporarily suspended, so that hospitals can more quickly deliver care to patients during the COVID-19 outbreak.

COVID-19 Special Open Enrollment

No. The special open enrollment period waives restrictions on adding new enrollees outside of open enrollment or the normal special enrollment period. The special open enrollment period is not intended to allow members to change plans. This opportunity is limited to employees and their dependents who waived coverage at the time when they were first eligible for coverage in this plan.

Electronic submissions will be accepted through April 15, 2020.

No. The “Notice of Special COVID-19 Enrollment Opportunity” will serve as the plan amendment.

No. To simplify the process and eliminate unnecessary paperwork, we are asking employers to verify this information – it does not need to be submitted to us.

No. For example, if an employee has yet to elect coverage, or previously declined coverage but is still within the standard waiting period before coverage would begin as of April 1, 2020, that employee is eligible for coverage effective April 1, 2020 without having to wait any additional time beyond April 1, 2020.

Adds will be reflected on the first invoice that generates after the request is processed.