For Small Groups Only

Q: Regarding the deferral of health insurance payment, is there a specific requirement like the CARES Act with the criteria of the gross profit per quarter is 50% or less than the previous year?

A: None found in the regulations, although the Department of Financial Services is expected to release Emergency Regulations.

Q: To request a deferral, what should we advise our groups? Specifically for UHC, we were informed that we can?t call in for the group and they must call in themselves. Is there any additional information that the groups should be aware of?

A: The regulations maintain that the employer may be granted a deferral of insurance premiums provided it demonstrates a financial hardship as a result of COVID-19.  The Dept. of Financial Services is required to draft Emergency Regulations. It does not appear as if anything has been released.  Refer to DFS link for more information.

Q: For the groups with very few employees on the payroll or only the owner, is there any regulation they can take advantage of? Would Emergency Economic Injury Grant from the SBA be a good suggestion? Would payroll protection under the CARES Act apply for these groups?

A: Paycheck Protection Program: Small businesses with 500 or fewer employees, including non-profits, sole proprietorship, and certain independent contractors can apply. Economic Injury Disaster Loan Program: Same as above.

Both Small and Large Groups

Q: If a member has been laid off and converts their insurance to COBRA and the
group does not apply for a deferral, is there a way for these individuals to protect
their coverage?

A: As long as the plan remains active the COBRA coverage will continue.  If the employer or carrier terminates the plan because they can no longer pay the premiums COBRA will end.

 Q: Also in cases of layoffs due to COVID-19, would the coverage period be extended for
the duration of the pandemic? For example, if the member has started their COBRA coverage in 4/1/2020, would their coverage be extended few more months in addition to the base 18 months?

A: To date the coverage periods for COBRA and state continuation have not been extended.  Some carriers are waiving the active at work requirement and allowing laid off or employees with a reduction in hours to remain on the plan without going onto COBRA or state continuation for a defined period of time.  See COVID-19 resources by carrier here.

Q: If a business shuts down and cancel their benefits, what would be the best approach for the employees to continue their medical benefits?

A: If there is no group policy there are no benefits to be continued.  The individual employees will have an SEP to purchase an Individual policy