Last week saw new legislation passed in response to COVID-19. Below is an overview of Families First Coronavirus Response Act as it pertains to group medical plans and FMLA. Additionally, we understand many of you will be impacted by the newly issued stay at home orders by states such as Ohio and would like to let you know that we are here to help you determine the impact on the medical plan.
Families First Coronavirus Response Act
- COVID-19 Testing (effective March 19th)
- Group health plans, including grandfathered plans, shall provide coverage for the following without cost sharing requirements or prior authorizations:
- Diagnostic testing for COVID-19
- Items and services provided during a medical visit that result in COVD-10 testing or screening. Specifically mentions in person, telehealth, urgent care and emergency room visits.
- Expanded FMLA (effective April 2nd):
- Applicable to:
- Employers with 50*-499 employees.
- Eligible employees are full or part time employees that have been on the employer’s payroll for a minimum of 30 calendar days. Employers can exclude health care providers or emergency responders from eligibility).
- Benefit to employee:
- Employee can take up to twelve weeks FMLA leave for a “qualifying need related to a public health emergency”.
- When an employee is unable to work due to need to care for a minor child if the child’s school or place of childcare is closed or unavailable due to public health emergency.
- First ten days unpaid, but employee can use accrued paid leave, including the emergency paid sick leave found in this legislation.
- Next ten weeks paid at 2/3 of the employee’s regular rate, for the number of hours the employee would otherwise be scheduled (max $200 per day, $10,000 total).
- Job-protected leave, with exception for employers with fewer than 25 employees if the employee’s position no longer exists due to public health.
*May be exempt if they can show that it would jeopardize the viability of the business.
- Paid sick leave (effective April 2nd):
- Applicable to:
- Private employers with fewer than 500 employees and public agencies.
- Employees eligible immediately, full-time employees get 80 hours, part time employees get the number of hours equal to what they typically average over two weeks.
- Sick leave to be used for the following:
- the employee is subject to a federal, state, or local quarantine or isolation order related to COVID-19;
- the employee has been advised by a health care provider to self-quarantine because of COVID-19;
- the employee is experiencing symptoms of COVID-19 and is seeking a medical diagnosis;
- the employee is caring for an individual subject or advised to quarantine or isolation;
- the employee is caring for a son or daughter whose school or place of care is closed, or childcare provider is unavailable, due to COVID-19 precautions; or
- the employee is experiencing substantially similar conditions as specified by the Secretary of Health and Human Services, in consultation with the Secretaries of Labor and Treasury.
- Payable benefit:
- For full time employees caring for a family member (last three bullets above), sick leave is paid at 2/3 the employee’s regular rate.
- These hours are in addition to those already offered by employers, however the hours cannot be carrier over beyond 12/31/2020.
- What isn’t addressed:
- COVID-19 treatment
- COBRA coverage
- Companies with 500 or more employees
As you consider the impact of the Families First Coronavirus Response Act and state mandated stay-puts, your account manager will be working with you and your broker to determine how this impacts your specific plan. We will review your current continuation of coverage and benefits for testing and treatment language contained in your summary plan description. For stop loss that is placed by Custom Design Benefits, we are also helping to determine if any plan amendments will be required along with any concessions the stop loss carrier is able to make in regards to eligibility language and stop loss premium payments. For clients that place your stop loss contract, we will work with your broker to answer any questions you may have.
Should a member need to seek testing for COVID-19, please refer them to their primary care physician. The provider will need to assess their symptoms and direct them to a testing facility if needed.
We understand this is a difficult time that we must all navigate together. Please know we are here to help during this very fluid time. We will continue to support your members with the service you have to come to expect from Custom Design Benefits.