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Continuity of Coverage

We know that things are changing quickly right now, including your workplace. Many employers have had to place employees on furlough or part-time status due to social distancing guidelines, and we want to ensure that your employees continue to have access to the care and help they need.

That's why, in addition to waiving cost sharing for in-network physician recommendation/prescription Coronavirus testing, we're providing additional flexibility regarding employer group coverage.

Fully insured plans

We will waive "actively at work" eligibility requirements for coverage through September 30, 2021. This enables coverage for existing employees/members transitioned to part-time or furlough status. The only requirements are that: 

a. the affected employees/members be currently enrolled on the plan, 

b. coverage be offered on a uniform, non-discriminatory basis, 

c. the premium is paid for the coverage with the same level of employer subsidies previously offered, and 

d. at least one employee/member remain in a full-time, actively at work employment.

No. The length of the extension of coverage is at the employer's option. The employer may elect to extend coverage to an earlier end date but may not continue coverage beyond the September 30, 2021 date. If an employee fails to pay their contributions to coverage during their extension of coverage, the employer may terminate their coverage under the plan.

Any employees/members who were enrolled and eligible for coverage because they were actively working at the first of the month will be covered through the end of the month. We won't be offering partial refunds of premiums for employees/members whose coverage would have ended by their employer partway through the month. This applies through September 2021. 

In that case, employees/members have the right to elect COBRA under federal law (except for church-sponsored plans which may offer contractual COBRA) or mini-COBRA under Pennsylvania, West Virginia, or Delaware law if the employer is eligible. This coverage would be available at a cost of up to 102% of the fully insured rate. The decision to offer access to subsidized coverage versus COBRA coverage must be made on a uniform, non-discriminatory basis. Please share your group’s COBRA information with your employees/members, and please make note of recent updates to COBRA election rules that the federal government adopted in light of the COVID-19 pandemic. 

a. If your group is not eligible for COBRA, Highmark has options available through the individual exchange market for continuous access to coverage. Your employees/members can reach out to a dedicated Highmark phone line for information on securing an approved ACA insurance plan at 1-855-329-7791. Plans and coverage vary by county and are available in WV, PA and DE. 

b. If you have furloughed employees/members that are 65 years old and older, they can sign up for Medicare Advantage and/or Medicare Supplemental plans from Highmark at 1-833-490-1668. Plans are available in all Highmark regional markets. (Individual MA, Medigap, and PDP are available in our PA footprint and much of our WV footprint. Only Medigap and PDP are available in DE.) 

If there is at least one actively-at-work employee, the policy continues. If not, individual market plans are available to ensure continuous coverage. See information above. 

If an employee/member is laid off or furloughed prior to September 30, 2021, due to COVID-19 business disruption and rehired prior to October 1, 2021, Highmark will waive the waiting period for coverage. 

If you restore contributions by September 30, 2021, to the former level in effect prior to March 22, 2020, Highmark will permit affected dependents to re-enroll if that special enrollment is timely requested. Affected dependents will be given the appropriate effective date of coverage based on the special enrollment period rules. 

Highmark will not enforce participation requirements through September 30, 2021.

If your Highmark coverage began prior to September 1, 2021, we’ll honor the quoted rates for 90 days. Employees/members who have had reductions in hours or been furloughed will have access to coverage regardless of their “actively at work” status for 90 days following the job status change. (This access to coverage is subject to the requirements mentioned in question one on page one.) After 90 days, we’ll reevaluate your employee/member population and make a rate adjustment if necessary. 

If your Highmark coverage began prior to September 1, 2021, we’ll honor the quotes rated until renewal. We’ll also permit furloughed or laid-off employees to be added back to the plan and we’ll waive the waiting period for coverage. 

Highmark will not re-rate policies for reductions in enrollment through September 30, 2021. 

Please contact your Highmark Client Manager to discuss your situation. 

Unfortunately, no. Due to Affordable Care Act requirements, we’re not able to permit changes sooner than 60 days. 

Yes, we can permit that change. The same contributions must apply to similarly situated employees, and the increase to lower-paid employees must correspond with bona fide distinctions made under other employer policies and practices. They cannot decrease employer contribution for lower-paid employees or increase for higher-paid employees.

Self-insured plans

If you need to terminate coverage due to a reduction in hours, then employees/members and their beneficiaries will have the right to elect COBRA under federal law (except for church-sponsored plans, which may offer contractual COBRA.) Talk to your COBRA administrator for more details, especially with respect to recent changes in COBRA rules by the federal government.

a. If your group is not eligible for COBRA, Highmark has options available through the individual exchange market for continuous access to coverage. Your employees/members can reach out to a dedicated Highmark phone line for information on securing an approved ACA insurance plan at 1-855-329-7791. Plans and coverage vary by county and are available in WV, PA and DE. 

b. If you have furloughed employees/members that are 65 years old and older, they can sign up for Medicare Advantage and/or Medicare Supplemental plans from Highmark at 1-833-490-1668. Plans are available in all Highmark regional markets. (Individual MA, Medigap, and PDP are available in our PA footprint and much of our WV footprint. Only Medigap and PDP are available in DE.)

Please contact your Highmark Client Manager to discuss your situation. 

We’ll honor the quoted rates for 90 days. We’ll then reevaluate your employee/member population and fees. 

Yes. Self-insured customers may use the same extension-of-coverage guidelines for our administrative services as the fully-insured policy guidelines, subject to the same limitations. We recommend that they check with their stop-loss administrator to confirm the flexibility available through them.