COVID-19 Questions About Group Insurance Benefits and Leaves

The Standard is aware of the new regulations and guidance issued jointly by the United States Department of Labor and the Internal Revenue Service that extend certain time frames under ERISA and the Internal Revenue Code due to the COVID-19 pandemic. At present, The Standard does not plan to issue amendments to plans to address these guidelines. However, we are taking steps to ensure that each of our impacted group insurance policies are administered in compliance with the extended time frames. Such steps may include, but are not limited to, updating practices and procedures, staff training and modifications to some claims administration letters.

The Standard will provide continuity of coverage for all Life, Short Term Disability, Long Term Disability, Dental, Hospital Indemnity, Critical Illness, and Accident insurance policies for all effective dates through December 31, 2020.

The Standard will allow an individual who experienced a furlough, temporary layoff, reduction in hours or salary to become insured under The Standard’s group insurance policy with the following conditions:

• The employee was insured on the date before the effective date of The Standard’s group policy.
• Coverage was continued with premium payment under the prior carrier’s accommodation.

The Standard will extend coverage until the earlier of the date on which the prior carrier’s accommodation would have expired or December 31, 2020.

Group Life, Disability, Supplemental (including Accident, Critical Illness and Hospital Indemnity), Dental and Vision coverage normally ends when an employee loses eligibility because the employee is no longer working the required minimum number of hours or they are on an unpaid leave of absence.

However, as an accommodation to our policyholders during this time of uncertainty, subject to continued payment of premium, these coverages can be continued through June 30, 2020, while employees are not working due to a partial or full furlough or temporary layoff occurring on or after March 1, 2020. The Standard is continually monitoring the situation and we will update the potential extensions beyond June 30, 2020 date as needs evolve.

Coverage for dependents in effect when employees’ work hours are reduced during a furlough or a temporary layoff may also be continued through June 30, 2020, subject to continued payment of premiums through that date.

The amount of Life insurance, dependent Life insurance and spousal Life insurance during a furlough, temporary layoff or reduction in hours shall be the amount in force on the employee’s last day of active work prior to the furlough, temporary layoff or reduction in hours or salary. Premium remitted to The Standard should be based on the amount of coverage prior to the furlough, temporary layoffs, reduction in hours or salary. If premium remitted is less, the amount of insurance coverage will be adjusted proportionally.

Yes. The Standard’s Hospital Indemnity product provides daily benefits for hospitalization due to an illness. Members are eligible for a benefit if they spend at least 20 consecutive hours for examination by a physician for diagnosis or treatment of an illness in a hospital setting. In addition, The Standard’s Hospital Indemnity product includes a waiver of premium provision which waives the premium after a member has been hospitalized for 30 days or more.

No. These benefits do not include pandemic exclusions.

No. If the employer has approved work-from-home arrangements due to COVID-19 public health concerns, we will consider the covered employee actively at work under the group STD policy.

Employees who experience a furlough, temporary layoff, reduction in hours or salary and had continued coverage with premium paid through June 30, 2020, may regain coverage if they return to work before March 1, 2021 and otherwise satisfy all eligibility requirements under the applicable group policy.

If an employee cancels their contributory coverage and then returns to work and enrolls for coverage again within 30 days of returning, any coverage that was in effect when the employee ceased to be insured can be reinstated subject to the group policy’s reinstatement provisions. Any coverage requirements (e.g., preexisting condition for Long Term Disability, two-year suicide exclusion for Life, etc.) that were not fully met when the employee’s work hours were reduced will continue to apply until the balance of the requirement period is served.

Employees who return to work after March 1, 2021, and employees who were not insured prior to the reduction in the employee’s work hours, may become insured as a new employee. All coverage requirements apply. Evidence of Insurability requirements for late enrollments will also apply.

When coverage terminates, the continuation, conversion and portability provisions contained in the applicable Group Insurance policy will be available according to the terms of the policy.

When Dental or Vision coverage stops, members may have the option to elect COBRA. Upon notification within 30 days of their return to work, coverage will resume as normal.

Yes. Travel Assistance for employers with that benefit will remain available to your covered employees. If an individual has tested positive for COVID-19, their request would be treated like a standard medical case. If the individual is eligible for transport benefits, those benefits would be arranged in accordance with the departing and receiving country’s government clearance on flying.

All individuals should ensure they have the latest travel advisories regarding the coronavirus and their intended destination. This information can be accessed here: travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html.

There are a wide variety of scenarios under which an individual may be quarantined, ranging from a voluntary self-quarantine without a COVID-19 diagnosis to a mandated quarantine with a diagnosis.

If an individual is quarantined as directed by a licensed health care professional or government agency, we will assess a claim for benefits as follows:

• If the individual has been diagnosed with COVID-19 and is unable to work from home, they will remain insured and eligible under the group STD policy.
• If the individual has not been diagnosed and is unable to work from home, they will retain coverage and eligibility under the STD policy should they eventually become disabled.

It is important to remember that under most STD policies a covered individual must be unable to work, either at their place of employment or from home, and must experience a loss of income to be eligible for STD benefits in all cases.

Such individuals will retain coverage under the STD policy for the duration of the quarantine, and we will evaluate any claim for disability benefits individually.

Pre-Disability Earnings will be based on the employee’s last day of active work prior to the furlough, temporary layoff, reduction in hours or salary. Premium remitted to The Standard should be based on the amount of coverage prior to the furlough, temporary layoffs, reduction in hours or salary. If premium remitted is less, the amount of insurance coverage will be adjusted proportionally.

Our group insurance policies require the employee to be Actively At Work at least a specified number of hours each week. Our language specifies Actively At Work includes regularly scheduled days off, holidays, or vacation days, so long as the employee is capable of Active Work on those days. However, an employee who is on furlough does not meet the Active Work requirement of the group policy.

The Standard will be flexible and seek alternate methods to obtain the medical details needed to substantiate disability claims. We have adapted our processes to collect information verbally and electronically wherever possible. Alternate sources of medical information, such as telehealth summaries, patient portal records and telephonic confirmation from treatment providers are some of the potential solutions that may be acceptable. Our clinical resources will also gather medical documentation over the phone to assist with the disability claims management process. To comply with any new state or federal regulations, we will adjust the timeframes or requirements as needed.

The Standard will administer tracking the FMLA leave under the FFCRA. However, we do not have the capabilities to administer the paid sick leave or the pay aspects of the FMLA.

See the Families First Coronavirus Response Act Summary and FAQ for details about FFCRA.

If employees receive paid sick leave due to their own medical condition, The Standard will determine if that benefit is offset, or in any way reduced, by the facts of their claim and the applicable policy provisions. If sick leave or family leave is paid to employees under FFCRA that is unrelated to their own medical condition, that benefit would not be offset under our group STD and LTD policies.

See the Families First Coronavirus Response Act Summary and FAQ for details about FFCRA.

It is our practice to adjudicate Teledentistry claims the same as we do for claims from a traditional practice setting. Providers have been advised through ADA guidance on how to submit claims accordingly. Please see the Guide to Teledentistry.

The Standard is prepared to provide detailed information on 12 months of bills for small groups who request it to apply for Small Business Administration loans. The Coronavirus Aid, Relief and Economic Security (CARES) Act states that funds can be used for “payments required for group health care benefits (including insurance premiums).” There are no parameters listed that are specific to Dental and/or Vision benefits. If you have questions about how to use the funds, please contact your lawyer.

The Standard has extended the premium payment grace period to 90 days for all customers in order to help those who may need additional time to collect and remit premiums during the COVID-19 crisis. Additionally, we will honor existing policy grace periods that are longer than 90 days. For all policyholders, we will align the grace period for a longer duration in accordance with any applicable State insurance directive. The extended grace periods will be effective through June, 2020 payments and reviewed at that time.

We have a nationwide network of trained and licensed benefits counselors to help with virtual group meetings for our entire product portfolio, including our suite of Supplemental products.

Given the circumstances we understand that enrollments in process will require additional time, and we will re-engage on this activity as business conditions normalize. Since enrollment completion is a dependency to onboard customers, our priority in this period is to work with our customers to get their policies in force on their effective date so that claims can be paid. We will work with in-force customers currently in annual or open enrollment on a case-by-case basis.

We will temporarily suspend application of the minimum participation requirements for groups through July 1, 2020 effective dates with the understanding that those groups will complete an additional open enrollment as business conditions normalize. Once business conditions are deemed to have normalized, all group policy provisions will be applied as written.

Yes, we accept electronic signatures. For beneficiary designations, The Standard has policy language available that will support employers' use of electronic signatures. Please refer to your contract for more information.

For those employers wishing to move to The Standard, but prefer to move later in the year, we can accommodate those requests. The Standard will honor any quoted rates out to December 31, 2020. Quoted rate guarantees will be honored unless there is a material change in covered lives. Our Underwriting teams have been working remotely and we have not experienced delays in RFP responses.

The Standard plans to continue renewing our policies as scheduled and we do not currently foresee any delays.

As we face the challenges surrounding coronavirus/COVID-19 together, The Standard recognizes that this may be taking a particular toll on our small business customers. To help with that, we are holding rates on all groups up to 500 employees with renewal dates of May, June and July 2020.

All Dental new customers up to 500 employees will receive a 2-year rate guarantee. This applies to new customers with effective dates of May, June and July 2020. These customers will also have the ability to defer their effective date to any time within 2020 if they choose with quoted rates being honored.

The Standard will take into consideration the reasons for enrollment changes. Plans that are being reviewed for renewal pricing during COVID-19 and experience layoffs will be addressed on a case-by-case basis. Our contracts have a 25% enrollment change clause.

Generally, New York employees of private employers with fewer than 100 employees are eligible for a job-protected combined PFL and DBL paid quarantine benefit (“New York COVID-19 Paid Quarantine Leave”) to replace one hundred percent of their salary up to $2884.62 per week following exhaustion of five days paid sick leave if they are unable to work while they are the subject of a mandatory or precautionary order of COVID-19 quarantine or isolation order issued by the State, department of health, local board of health, or government entity.

It is our understanding that a Shelter In Place order or other broad closure of schools do not generally constitute a mandatory or precautionary order of quarantine or isolation needed to qualify for benefits under the new law.

Guidance regarding how to obtain a quarantine or isolation order can be found here: paidfamilyleave.ny.gov/system/files/documents/2020/03/obtaining-order-of-quarantine.pdf.

If an employee’s minor child is the subject of COVID-19 quarantine or isolation order issued by the State, department of health, local board of health, or government entity, the employee is not eligible for the combined PFL/DBL benefit that constitutes New York COVID-19 Paid Quarantine Leave.

However, an otherwise eligible employee can file for PFL which in 2020 will replace 60% of their weekly salary up to $840.70/week for the duration of the minor child’s COVID-19 quarantine.

Employees are not eligible for PFL to care for family members other than minor children who are COVID-19 quarantined or isolated. They may, however, be eligible for paid time off with their employer, and possibly for PFL if the family member suffers from a serious health condition.

A mandatory or precautionary order of quarantine or isolation due to COVID-19 directed to an employee or their minor child by name which is issued by the state of New York, the department of health, local board of health, or any government entity duly authorized to issue such order due to COVID-19 is necessary for consideration of these claims.

Samples of such orders are shown here:

• Mandatory Isolation Order
• Mandatory Quarantine Order
• Precautionary Quarantine Order

Guidance regarding how to obtain a quarantine or isolation order can be found here: paidfamilyleave.ny.gov/system/files/documents/2020/03/obtaining-order-of-quarantine.pdf.

Yes, employees may take New York COVID-19 Paid Quarantine Leave if they are currently under an order of mandatory or precautionary quarantine or order of isolation issued by the State, department of health, local board of health, or government entity even if that order was issued prior to the enactment of the new law (March 18, 2020).

Employees are not eligible for New York COVID-19 Paid Quarantine Leave if they are subject to a quarantine because they have voluntarily traveled to a country with level two or three health notice from the CDC if the travel was not at the direction of their employer and they were provided notice of the travel health notice and knew about this restriction in the new law.

No, employees must be unable to work due to their receipt of a qualifying COVID-19 quarantine or isolation order to be considered for these new benefits.

New York COVID-19 Paid Quarantine Leave during an employee’s own quarantine are reduced by FFCRA benefits received for the same leave reasons.

PFL benefits are not available for care of a minor child under COVID-19 quarantine or isolation order if the employee is eligible for FFCRA benefits from their employer for the same reason.

We expect that the paid leave entitlements of the FFCRA and New York paid sick law will run concurrently.

Yes, job protection is guaranteed while employees are on these types of leave.

It is our understanding that an employee may theoretically receive a second mandatory or precautionary order of quarantine or isolation for themselves or for a minor child.

Note, New York COVID-19 Paid Quarantine Leave counts towards the maximum 26-week DBL duration, and PFL benefits for care of a minor child under quarantine or isolation order count towards the maximum 10-week PFL duration in a 52-week period. In no event can an employee receive more than a total of 26 weeks of DBL and PFL combined in a 52-week period.

Claimants must submit their application to The Standard within 30 days from the first day they take leave to avoid losing any benefits.

Together with their quarantine or isolation order, the employee will need to complete the employee portions of The Standard’s Request for COVID-19 Quarantine Leave for Yourself package.

Guidance regarding how to obtain a quarantine or isolation order can be found here: paidfamilyleave.ny.gov/system/files/documents/2020/03/obtaining-order-of-quarantine.pdf.

Examples of quarantine or isolation orders are shown here:

• Mandatory Isolation Order
• Mandatory Quarantine Order
• Precautionary Quarantine Order

The employee should then send the completed package to the employer to complete the employer sections of the package. The employer has three business days to complete these sections and return the package to the employee. If the employee does not receive the package within three business days, they can proceed to the next step and submit the application.

Next, the employee will submit the completed package to The Standard together with the quarantine or isolation order.

The Standard must pay or deny a New York COVID-19 Paid Quarantine Leave claim within 18 calendar days of receiving the completed request.

Together with their child's quarantine or isolation order, the employee should complete the Request for COVID-19 Quarantine Leave for Minor Child package.

Guidance regarding how to obtain a quarantine or isolation order can be found here: paidfamilyleave.ny.gov/system/files/documents/2020/03/obtaining-order-of-quarantine.pdf.

Examples of quarantine or isolation orders are shown here:

• Mandatory Isolation Order
• Mandatory Quarantine Order
• Precautionary Quarantine Order

The employee should then send the completed package to their employer to complete the employer sections of the package. The employer has three business days to complete these sections and return the package to the employee. If the employee does not receive the package within three business days, they can proceed to the next step and submit the application.

Next, the employee will submit the completed package to The Standard together with the quarantine or isolation order.

The Standard must pay or deny the claim within 18 calendar days of receiving the completed request.

Employees should submit their completed request package to The Standard within 30 days from the first day of leave. If you’d like to send a Request for COVID-19 Quarantine Leave package to us by email, please start by submitting this request form.

If The Standard has denied a New York COVID-19 Paid Quarantine Leave claim or PFL, the employee may file a request for arbitration. Arbitration is handled by NAM (National Arbitration and Mediation). More information can be found on NAM’s website.

Carriers must pay or deny benefits within 18 calendar days of receiving the completed request for benefits. To ensure timely payment, employees should make sure to completely fill out the appropriate Request for COVID-19 Quarantine Leave package for themselves or for their minor children and attach the order of mandatory or precautionary quarantine.

The leave packages are found here:

• Request for COVID-19 Quarantine Leave for Yourself
• Request for COVID-19 Quarantine Leave for Minor Child

Guidance regarding how to obtain a quarantine or isolation order can be found here: paidfamilyleave.ny.gov/system/files/documents/2020/03/obtaining-order-of-quarantine.pdf.

Examples of quarantine or isolation orders are shown here:

• Mandatory Isolation Order
• Mandatory Quarantine Order
• Precautionary Quarantine Order

New York COVID-19 Paid Leave is comprised of both PFL and DBL.

DBL and PFL portions of this new benefit may be treated differently for tax purposes.

DBL is third-party sick pay, and taxation depends on employee contributions. It is reported on Form W-2.

PFL when paid to care for a family member is ordinarily considered is non-wage income and is taxable regardless of employee contributions and is reported on Form 1099. However, tax advice should be consulted to determine if the PFL component of New York COVID-19 Paid Leave, which is payable for an employee’s own quarantine or isolation is considered third-party sick pay.

It is our understanding that the number of additional COVID-19 related paid sick days a subject employer must provide equals the number of work days an employee would have been scheduled to work during a 5 or 14 calendar day period (number depends on employer size). Employers should confirm this understanding with their legal counsel.

It is our understanding that subject employers must provide additional paid sick leave during a 5- or 14-day period an eligible employee is unable to work while the subject of a mandatory or precautionary order of COVID-19 quarantine or isolation. The employee is eligible for the pay they would have otherwise received had they continued to work for that 5- or 14-day period (duration of the period depends on employer size).

For hourly, part-time, commissions salespeople, and other employees who are not paid a fixed wage, employers should determine the employee’s pay by looking at a representative period of time to set the employee’s average daily pay rate. This understanding should be confirmed with an employer’s own legal counsel.

It is our understanding that part-time employees should be paid for the number of days/amount of time during a 5- or 14-day period that they would have otherwise worked. This understanding should be confirmed with an employer’s own legal counsel.