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LISI Coronavirus (COVID-19) Resources

The Coronavirus (COVID-19) pandemic has introduced the need to take immediate action to ensure the health and well-being of ourselves, and our families. As insurance industry professionals, this outbreak has also raised a host of questions that continue to evolve daily.


As your dedicated partner, we understand that you need access to information quickly. That’s why we’ve prepared this resource to ensure you have the resources and support you need during this time. We are monitoring this situation vigilantly and we encourage you to bookmark this page and check back often for updates. 

Stay updated with all the COVID-19 news!

COVID-19 News

 

  • Member Access to Care
  • Broker Resources
  • Employer Resources
  • Employer FAQs
Member Access to Care

Vaccine Coverage for COVID-19

Updated 1/8/2020 at 12:02 p.m.

The CARES Act requires coverage of the COVID-19 vaccine under ACA preventive coverage. The vaccine must be covered within 15 days of a recommendation by the United States Preventive Services Task Force (USPSTF) or the Advisory Committee on Immunization Practices (ACIP) and adopted by the Director of the Centers for Disease Control and Prevention (CDC). Note that FDA approval does not trigger the 15 day start.

Typically ACA preventive care must only be covered at no cost-share when performed in-network. The CARES Act requires that during the HHS announced public health emergency, coverage must be available at no cost-share both in-network and out-of-network. Grandfathered group health plans are encouraged, but not required, to provide this coverage as well.

While the cost of the vaccine is covered, members may still need to cover the administrative cost and/or office visit expense if applicable. View the LISI Compliance Alert.

As of December, the Centers for Disease Control and Prevention (CDC) adopted a recommendation that health care workers and long-term care residents should be the first to receive the COVID-19 vaccine once it is authorized or approved.

FDA Fact Sheets:

  • Pfizer-BioNTech COVID-19 Vaccine Fact Sheet
  • Maderna COVID-19 Vaccine Fact Sheet

Helpful Articles:

  • Bloomberg Vaccine Tracker
  • KFF: Estimates of the Initial Priority Population for COVID-19 Vaccination by State
  • KFF: New National and State Estimates for Recommended COVID-19 Vaccination Priority Population
  • Forbes: How Employers Should Prepare for the Covid-19 Vaccine
  • Mercer: Employers can Mandate the COVID-19 Vaccine, but Should They?

CDC Resources:

  • CDC Coronavirus (COVID-19) page
  • How CDC is Making Vaccine Recommendations
  • 8 Things to Know about US Vaccines
CARRIER VACCINE RESOURCES
Aetna
  • COVID Resource Center
  • Vaccine FAQ
Anthem
  • COVID Resource Center
Blue Shield
  • COVID Resource Center
  • Article
Cigna
  • COVID Resource Center
  • Vaccine FAQ
Health Net
  • COVID Resource Center
Kaiser Permanente
  • COVID Resource Center (Northern CA)
  • COVID Resource Center (Southern CA)
  • Broker Letter
  • Vaccine FAQ
  • COVID-19 Hotline with latest info on vaccines 1-855-550-0951
MediExcel Health Plan
  • COVID Resource Center
Oscar
  • COVID Resource Center
  • Member FAQs : See question "Will Oscar Cover COVID-19 vaccines?"
Sharp Health Plan
  • COVID Resource Center
  • Member FAQs : See "Vaccines" topic under COVID-19 FAQ for Members
Sutter Health Plus
  • COVID Resource Center
  • Vaccine FAQ
UnitedHealthcare
  • COVID Resource Center
  • COVID-19 External FAQ
  • Vaccine FAQ
  • Top 3 Things to Know about COVID-19 Vaccines
Western Health Advantage
  • COVID Resource Center

 

COVID-19 Special Enrollment Opportunity

Updated 12/9/2020 at 2:00 pm

In an effort to ensure employees have access to care, carriers have opened limited time special enrollment opportunities (SEO) for small and large employers. The SEO is designed to allow employees, who previously declined coverage during renewal or original enrollment, to enroll on the group plan off-anniversary. Some take it a step further by allowing employees currently enrolled to change their plan - like downgrading to a more affordable option!

If a carrier is not listed below then a window is not being offered at this time. 

CARRIER SEO ALLOWED FOR THOSE WHO WAIVED/DECLINED ENROLLMENT CHANGES ALLOWED FOR EXISTING MEMBERS
Health Net

Deadline closed April 20, 2020.

Group Size
pending.

Eligibility
Employers who offer only a single plan option may make a one-time "mid-plan year" change to downgrade their plan.

Employers with multiple plan offerings are not eligible.

Deadline to Submit
Submit within 90 days. All changes are effective 1st of the month after the application received date.

Western Health Advantage

Group Size
Small and Large group. Applies to medical. Large groups should contact their account manager to discuss possible rate impact.

Eligibility
Available for employees and dependents. Members currently enrolled in another carrier offered by the employer are eligible.

Deadline to Submit
Currently no deadline in place; this will be ongoing until the pandemic is over. Submit request in writing and specify a single effective date for all members to be added.

Group Size
Small and Large group. Applies to medical. Large groups should contact their account manager to discuss possible rate impact.

Eligibility
Employers may make a one-time "mid-plan year" change to their plan offerings. Members may request a change to a lower benefit option during a specified special open enrollment.

Deadline to Submit
Currently no deadline in place; this will be ongoing until the pandemic is over. Submit request in writing and specify a single effective date for all changes.

 

Enhanced Benefits Due to COVID-19

Updated 12/10/2020 at 3:50 pm

Health insurers are responding to the Coronavirus threat by offering members no-cost screening and diagnostic testing. In addition, some are now waiving member cost-share for all COVID-19 treatment.

CARRIER ENHANCED BENEFITS1 RESOURCES
Aetna
  • Screening/diagnostic testing provided at no cost when recommended by a provider.
  • Out-of-pocket costs waived for COVID-19 inpatient admissions through December 31, 2020.
  • Aetna crisis response lines for all members. Just call 1-833-327-AETNA (1-833-327-2386) (TTY: 711).
  • All Aetna members have access to the 24-Hour Nurse Line at 1-800-556-1555 (TTY: 711).
  • Extra Benefits for You
  • Member Resources
  • COVID-19 FAQ
  • Aetna & CVS Health
  • Plan Sponsor Email
  • Plan Sponsor Rx Letter
Anthem Blue Cross
  • Cost-sharing for diagnostic tests and treatment specific to COVID-19 are waived through the end of the public emergency.
  • Relaxed early prescription refill limits for members who wish to refill most maintenance medications, where permissible.
  • Sydney Care Mobile App has a COVID-19 Assessment. Based on results, members can triage to a telehealth doctor for further care guidance.
  • Anthem Coronavirus website includes helpful resources such as a COVID-19 Test Facility Finder to quickly locate a testing facility near you.
  • COVID-19 External FAQ
  • Member Resources
  • Anthem Coronavirus Microsite
  • Member Flyer
  • Coronavirus Facts
Blue Shield of California
  • Screening/diagnostic testing provided at no cost when recommended by a provider. 
  • Out-of-pocket costs waived for COVID-19 medical treatments through January 31, 2021.
  • Early refill limits are waived on maintenance medications.
  • Testing FlowChart
  • Member Resources
  • News Center
  • Broker Connections COVID-19
  • Coronavirus FAQ
Cigna
  • Screening/diagnostic testing provided at no cost for fully-insured and Administrative Services Only (ASO) plans through January 31, 2021
  • No out-of-pocket costs for all COVID-19 treatment received through December 31, 2020.
  • COVID-19 Resource Center
  • Customer FAQ
  • Payment Status for Statutory Disability, Sick and Paid Leave & FMLA
CCSB
  • Members should refer to their enrolled carrier for guidance.
  • Resource Center
Health Net
  • Screening/diagnostic testing provided at no cost when recommended by a provider..
  • Prior authorization for lab work will be waived for screening and testing.
  • Cost-sharing is waived for doctor office, urgent care and outpatient hospital (including emergency dept) visits for medically necessary COVID-19 related services.
  • Waived prescription refill limits for medically necessary COVID-19 related services, and relaxed restrictions on home and mail delivery of prescriptions.
  • Mental Health Resources: MHN maybe contacted 24 hours a day, seven days a week at 1-800-227-1060.
  • Health Net Broker Alerts
  • What you Need to Know
  • What you Need to Know (PDF)
  • Member Resources
  • Employer Alert
  • Member Alert
Kaiser Permanente®
  • Screening/diagnostic testing provided at no cost when recommended by a provider. 
  • Out-of-pocket costs waived for treatment related to a positive COVID-19 diagnosis through December 31, 2020. Self-funded customers are encouraged to do the same.
  • Free mental health app, mY Strength, for all members.
  • Member Resources
  • Member Flyer
  • Article: Coronavirus preparedness
  • News Clip
MediExcel Health Plan
  • Screening/diagnostic testing provided at no cost when recommended by a provider. 
  • COVID-19 website
  • Mediexcel's Response
  • What you Need to Know
Oscar Health
  • Screening/diagnostic testing provided at no cost, through the end of the pandemic, when recommended by a provider. 
  • No out-of-pocket costs for all COVID-19 treatment received through December 31, 2020.
  • Members can visit this site to access mental and behavior health benefits through their partnership with Optum.
  • Emotional support helpline available from Optum 1-866-342-6892. Available to anyone, including family and friends.
  • Oscar teamed up with Calm to offer all members 40% off an annual subscription.
  • Member Resource Center
  • Member FAQ
  • COVID-19 Risk Assessment
Sharp Health Plan
  • Screening/diagnostic testing provided at no cost when recommended by a provider. This includes hospital (including emergency dept), urgent care, provider office visits, and telehealth appointments for the purpose of screening and/or testing for coronavirus.
  • No out-of-pocket costs for all COVID-19 treatment received through December 31, 2020.
  • Member Resources
  • Member FAQ
Sutter Health Plus
  • Screening/diagnostic testing provided at no cost when recommended by a provider. 
  • Member Resources
UnitedHealthcare
  • Screening/diagnostic testing provided at no cost when recommended by a provider through end of the public health emergency. Self-referral not permitted.
  • Cost-sharing for treatment specific to COVID-19 are waived in-network through January 31, 2021.
  • Free Emotional-Support Help Line available for members suffering from fear or stress due to COVID-19, open 24/7.
  • COVID-19 FAQ
  • Broker FAQ Site
  • Member Resources
  • SimplyEngaged Gym/Activity Check In FAQ
Western Health Advantage
  • Screening/diagnostic testing provided at no cost when recommended by a provider. 
  • Coverage for treatment costs associated with COVID-19 care through December 31, 2020.
  • Behavioral health crisis line for members who need help during tumultuous times
  • Member Resources

 

Ancillary Carriers

CARRIER Enhanced Benefits RESOURCES
Cypress Ancillary Benefits -
  • FAQ
Guardian Enhanced frequency limits on cleanings, exams, and fluoride treatment to a minimum of 2 per calendar year. Applies July 1, 2020 through December 31, 2021.

For plans with Maximum Rollover:
  • For the remainder of 2020, members no longer have a requirement to submit a claim in order to roll over funds
  • Effective January 1, 2021, members will have $100 added to their Maximum rollover account so they have more to spend on care
  • ASO customers should contact their Guardian Service Rep to participate in this enhancement.
  • FAQ
  • Pandemic Support Program Flyer
Humana -
  • Employer Resources
  • FAQs
  • Member Resources
MetLife

Dedicated COVID-19 Hotline through December 2020. Available to groups under 500 lives, provided by LifeWorks (MetLife's EAP vendor). 1-800-366-1192.

Financial Wellness Hub available to groups under 100 lives. To help guide employees as they navigate life choices and manager their finances in this hostile environment. No cost for 90 days and through partnership with Ernst & Young

  • Frequently Asked Questions
  • Best Practices Above 500 Lives
  • Best Practices Below 500 lives
Premier Access / Avesis -
  • COVID-19 FAQ - Brokers
Principal Members and their household are encourages to have a confidential telephonic consultation with a therapist through calling the Employee Assistance Program at (800) 450-1327
  • FAQ page
  • Navigating Business Now
  • COVID-19 and Our Insurance Solutions
  • COVID-19 Market Insights and More
Unum -
  • Member Resources
  • HR Trends Podcast
  • Webinar Recording: FFCRA
  • COVID-19 Outbreak Response
  • Unum COVID-19 FAQ
  • Unum COVID-19 Managing Fear Flyer

 

Enhanced Benefits: Telemedicine

Updated 12/22/2020 at 2:35 pm

Health insurers are responding to the Coronavirus threat by offering members no-cost telemedicine benefits.

CARRIER ENHANCED TELEMEDICINE BENEFITS TELEMEDICINE
Aetna

$0 copay telemedicine through December 31, 2020

  • Teladoc in 3 Easy Steps
  • Teladoc Member FAQ
  • Heal Flyer
Anthem Blue Cross

$0 copay telemedicine through March 31, 2021

  • Sydney Care Info
  • LiveHealth Online
  • LiveHealth Online COVID-19 Flyer
  • LiveHealth Online for Kids
  • Heal Flyer
Blue Shield of California

$0 copay telemedicine with Teladoc through December 31, 2020; includes behavior health.

  • Teladoc Flyer
  • Teladoc Flyer (Trio HMO)
  • Teladoc Member Page
  • Heal Flyer
Cigna

$0 telemedicine for visits related to screening, diagnosis, and testing for COVID-19 through December 31, 2020.

  • Find Virtual Care Options on myCigna
CCSB

Members should refer to their enrolled carrier for guidance.

-

Health Net

$0 telemedicine offered during the state of emergency.

In addition to Teledoc, Health Net has partnered with Babylon Health to offer telehealth services; sign into the Babylon Health app using code HNCOM.

  • Teladoc Flyer
  • Teladoc FAQ
  • Heal Flyer
Kaiser Permanente® -
  • Video Visits Flyer
MediExcel Health Plan -
  • Call The Doctor Line
  • Heal Flyer
Oscar Health Virtual mental health visits now available with Doctor on Demand. No out-of-pocket cost for all COVID-19 care delivered via telemedicine for members through the end of 2020.
  • Doctor on Call
Sharp Health Plan

-

  • Video and Phone Visits
Sutter Health Plus

$0 telemedicine through December 2020 (will not be extended into 2021).

Members can schedule with their own provider or through My Health Online. Telehealth for mental health services is also $0: Members can self-refer and schedule a video visit at liveandworkwell.com or by calling U.S. Behavioral Health Plan, California at 855-202-0984.

  • Video Visits
UnitedHealthcare

Virtual Visits through Teladoc, Doctor on Demand and AmWell
Effective October 1, 2020 through the end of the public health emergency: Members will pay the cost-share for all visits up front. For visits that are due to COVID-19, members will be reimbursed for their cost-share. No action is required on the members part; the reimbursement will be automated.

Telehealth
Expanded telehealth is extended through December 31, 2020. Member cost-share applied for non-COVID-19 visits. Expanded telehealth allows members to connect with their doctor through live, interactive audio-video or audio-only visits. This includes physical therapy, occupational therapy, speech therapy and chiropractic services (audio-visual only).

  • Virtual Visits Flyer
  • Heal Flyer
Western Health Advantage

-

  • Virtual Visits

 

 

 

1 Screening/diagnostic testing when ordered by the physician.
“Kaiser,” “Kaiser Permanente,” “Kaiser Foundation Health Plan” and the Kaiser Permanente Logo are registered trademarks or service marks of Kaiser Foundation Health Plan, Inc., in the United States.

Broker Resources

Are Extended Grace Period Options Available?

Updated 8/27/2020 at 11:10 am

Insurance Commissioner Ricardo Lara issued a Notice requesting that all insurance companies provide their policyholders with at least a 60-day grace period to pay insurance premiums. An additional Notice was issued May 15th to extend the 60-day grace period through July 14, 2020. The Commissioner's request was to ensure policies are not cancelled for nonpayment of premium due to the Coronavirus (COVID-19) public health emergency. It was recommended carriers comply but it was not a requirement. The chart below shows the current standard grace periods as well as any options the carriers have made available.

Group are required to submit payment by the due date shown on their bill. If a group misses their due date, they have up until the standard grace period to make a payment before coverage is cancelled. The standard grace period begins the day after the missed due date. Carriers are reviewing their policies to determine if/how they can assist their employer groups with making payments during this difficult time.

CARRIER STANDARD
GRACE PERIOD
EXTENDED GRACE PERIOD OPTIONS
Aetna 31 days Per the Insurance Commission notice, will support a 60-day grace period for small groups.
Anthem Blue Cross 31 days Grace period extensions are not available. If a group is having trouble paying their bill have them contact the Enrollment & Billing team for assistance at (855) 854-1429.
Blue Shield of California 30 days

A general policy has not been put into place but requests will be reviewed on a case-by-case basis. If a group has determined they will not be able to pay on time they should contact the Billing Team (800-325-5166).

CaliforniaChoice 30 days Requests will be reviewed on a case-by-case basis. Contact the group Account Manager or Customer Service for assistance.
Choice Builder 30 days Requests will be reviewed on a case-by-case basis. Contact the group Account Manager or Customer Service for assistance
CoPower 30 days Grace period extensions are not available.
CCSB 30 days Grace period extensions are not available.
Cypress Ancillary Benefits 30 days Supported a 60-day grace period through May 31, 2020. After this date grace period extensions are no longer available. FAQ
Guardian 30 days Allowing a 60-day grace period.
Health Net 30 days Grace period extensions are not available.
Humana 30 days Grace period extensions are not available.
Kaiser Permanente® 30 days For large and small groups, Kaiser has extended their payment grace period and will not terminate group coverage for unpaid monthly membership premium dues through June 2020.Groups that have missed payments will start receiving delinquency and termination notices in mid-June and will be terminated by August 1, 2020.
MediExcel Health Plan 60 days Grace period extensions are not available.
MetLife 30 days MetLife is extending premium grace periods for Group Products to the lesser of 90 days from premium due date or July 31, 2020, for all premiums due March 1, 2020 and forward.
Oscar Health 30 days Grace period extensions are not available.
Premier Access / Avesis 30 days Supported a 60-day grace period through May 31, 2020. After this date grace period extensions are no longer available
Principal 30 days Supported a 60-day grace period through July 2020 billing statements. In addition, the 60-day extension has now expired for policies whose contractual grace period ended in March. These policies will terminate if premiums due haven’t been paid (certain state exceptions apply).
Sharp Health Plan 30 days Grace period extensions are not available.
Sutter Health Plus 30 days Grace period extensions are not available.
UnitedHealthcare 30 days Grace period extensions are not available.
Unum 30 days If an employer anticipates having any issues with being able to remit premiums due to the circumstances surrounding COVID-19, please contact AskUnum at askunum@unum.com or connect with the groups Billing Coordinator.
Western Health Advantage 30 days A general policy has not been put into place but requests will be reviewed on a case-by-case basis. If a group has determined they will not be able to pay on time they should contact the Premium Billing department.

 

Are Payment Deferrals or Refunds Available?

Updated 7/9/2020 at 8:25 am

Some carriers are offering payment deferral programs to those in need, while others may be refunding a portion of premiums. For groups that receive a refund, broker compensation may be affected.

CARRIER PAYMENT DEFERRAL PREMIUM REFUNDS
Aetna Not available. Not available.
Anthem Blue Cross Not available. If a group has trouble paying their bill have them contact the Enrollment & Billing team for assistance at (855) 854-1429.

Premium credits will be issued to fully-insured employer groups based on their April 2020 invoices. This is a one-time credit. The credit will appear on the employers August 2020 invoices (issued in July):

  • 15% of the April premium for small group medical plans
  • 50% of the April premium for dental plans

Broker compensation will not be impacted.

Blue Shield of California

For April - July 2020 premium payment, Blue Shield offers a Premium Payment Plan Program. Available to those whose premium is delinquent, but current as of the prior month, and who are from the following segments:

  • IFP on-exchange and off-exchange members
  • Medicare Supplement members
  • Small Group employers

Read the FAQ for eligibility and requirements.

Broker compensation will be paid based on the premium paid by the group.

Not available.

CaliforniaChoice

Deferral requests will be reviewed on a case-by-case basis. Broker compensation will be reduced by the deferred amount.

The following premium credits will be applied to August 2020 invoices:

  • For members enrolled in UnitedHealthcare, a one-time 10% credit
  • For members enrolled in MetLife, a one-time 50% credit

Note for all: Does not apply to new business effective 8/1/20 and later. Broker compensation will be reduced by the credited amount.

Choice Builder If an employer is having trouble making payments they should reach out to their account manager or customer service. Payment extension requests will be evaluated on a case-by-case basis.

Not available.

CoPower Not available. Not available.
CCSB For April and May 2020 premium payment, CCSB offers a Premium Deferral Program. Employer pays a minimum 25% of the premium due for April and/or May. The deferred amounts will be spread across the remaining months of 2020. Not available.
Cypress Ancillary Benefits Not available. Not available.
Guardian Not available. 1-month premium credit will be applied for fully-insured dental and vision plans. Pandemic Support Program Flyer
  • For existing groups: The premium credit will be applied to the 2nd bill after the group renewal, beginning with September 2020 renewals through August 2021.
  • For new business: the premium credit will be applied to the 1st bill for dental and vision cases with July 2020 effective dates through March 2021.
Employers may elect a rate guarantee instead of the premium credit.
  • For existing groups: employer may choose a 2 year rate guarantee on both products.
  • For new business: employer may choose a 2 year rate guarantee for dental and a 2 or 3 year rate guarantee for vision.
Health Net Not available. Not available.
Humana Premium payment flexibility option may be available to employers facing financial hardship. Contact Humana at 1-800-592-3005.

Not available.

Kaiser Permanente® Not available. Not available.
MediExcel Health Plan Not available. Not available.
MetLife Not available. Fully-insured Dental PPO customers will receive a 25% premium credit on a future bill for the months of April and May 2020. Flyer
Oscar Health Not available. Not available.
Premier Access / Avesis Not available. Not available.
Principal Not available. 10% premium credit will be applied for May-September bills, these will show on the June-October invoices.
Sharp Health Plan Not available. Not available.
Sutter Health Plus Not available. Not available.
UnitedHealthcare Premium extension options available on a case-by-case basis. Broker compensation will be paid based on the premium paid by the group.

UnitedHealthcare will give premium credits on medical coverage, estimated to range 5%-20% based on enrolled plans, to be applied to June billing statements. Applies to all California small and large employers.

For all dental plans, UHC will give a one-time 50% premium credit in the month of July, which will be reflected on June invoices.

Broker compensation will be reduced by the credited amount.

Unum If an employer anticipates having any issues with being able to remit premiums due to the circumstances surrounding COVID-19, please contact AskUnum at askunum@unum.com or connect with the groups Billing Coordinator. Not available.
Western Health Advantage If a group has determined they will not be able to pay on time they should contact the Premium Billing department. Not available.

 

Can Employers Cover Furloughed Employees or Those With Reduced Hours?

Updated 12/14/2020 at 8:52 am

Carriers are easing guidelines so employers can keep their employees covered, even if the employees no longer meet eligibility due to reduced hours. For carriers who have made this option available, review the chart to find out how long these employees may be covered. Unless otherwise indicated, these rules apply to small and large group fully-insured plans.

Keep in mind that employees who are permanently terminated are no longer eligible and should be offered COBRA/Cal-COBRA as usual.

CARRIER COVID-19 GUIDELINE REFERENCE
Aetna Members can remain on the plan, through December 31, 2020, as long as premiums are paid.
  • COVID-19 FAQ
Anthem Blue Cross Members can remain on the plan, through March 31, 2021, as long as premiums are paid. -
Blue Shield of California Members can remain on the plan as long as premiums are paid.
  • Blue Shield Notification Article
CaliforniaChoice Members can remain on the plan, at the employers discretion, as long as premiums are paid. -
CCSB Members can remain on the plan, at the employers discretion, as long as premiums are paid. -
Cypress Ancillary Benefits Members were allowed to remain on the plan, through April 30, 2020, as long as premiums were paid. There is no extension to this guideline.
  • FAQ
Delta Dental Members can remain on the plan, at the employers discretion, as long as premiums are paid. -
Guardian Not available, ended June 2020. -
Health Net Not available, ended July 2020. -
Humana Members can remain on the plan, through March 31, 2021, as long as premiums are paid. -
Kaiser Permanente® Members can remain on the plan as long as premiums are paid. -
MediExcel Health Plan

Members can remain on the plan, at the employers discretion, as long as premiums are paid.

Approved groups will be allowed to remain active for a 6 month period, even if their last member terminates, keep their contract honored. Groups renewing during this period will be required to accept their renewal with new rates.

  • Temporary Billing Options
MetLife

Group Life, Dental, AD&D, Vision, Accident & Health and Legal
Will allow employees who are furloughed, temporarily laid-off or have reduced hours/salary to continue their coverage for 12 months from the date of the furlough, temporary lay-off or reduced hours/salary.

Group Life
Will allow employees who are furloughed, temporarily laid-off or have reduced hours/salary to continue their coverage for 12 months from the date of the furlough, temporary lay-off or reduced hours/salary. Coverage amounts will not be reduced as a result of temporary salary reductions and will remain in effect just as they were prior to the furlough, temporary lay-off or reduced hours/salary. Accordingly, premium needs to be remitted based on the volume for the regular (non-reduced) coverage amounts.

Group Disability
Will allow employees who experience a furlough, temporary lay-off or have reduced hours/salary between March 1, 2020 and May 31, 2020, to continue their coverage for 60 days from the date of the furlough, temporary lay-off, or reduced hours/salary. Coverage amounts will not be reduced as a result of temporary salary reductions and will remain in effect just as they were prior to the furlough, temporary lay-off or reduced hours/salary. Accordingly, premium needs to be remitted based on the volume for the regular (non-reduced) coverage amounts.

-
Premier Access / Avesis Members can remain on the plan, through April 1, 2021, as long as premiums are paid.
  • COVID-19 FAQ - Brokers
Principal Not available, ended June 2020.
  • Insurance Coverage and COVID-19
Oscar Health Members can remain on the plan as long as premiums are paid. -
Sharp Health Plan Members can remain on the plan, through December 31, 2020, as long as premiums are paid. -
Sutter Health Plus pending -
UnitedHealthcare Members can remain on the plan as long as premiums are paid. Coverage will remain in force the later of the public health emergency, or no longer than 20 consecutive weeks after the public health emergency for non-medical leaves (i.e., temporarily laid off) or no longer than 26 consecutive weeks for a medical leave. Applies to medical, dental and vision.
  • COVID-19 FAQ
VSP Members can remain on the plan as long as premiums are paid. -
Western Health Advantage Members can remain on the plan as long as premiums are paid. Employers also have the option of paying premium for terminated employees who elect to enroll in COBRA/Cal-COBRA; with this option employers can set a specific amount of time they are committing to pay the premium (e.g. 1, 2, or 3 months). -

 

Can an Employer Self-Adjust their Bill and Pay Only True Premiums?

Updated 5/5/2020 at 10:00 am

Employers may want to adjust their own billing statement to pay only for employees still covered, taking into account any recent terminations. This is referred to as paying true premium. Avoid cancellation by understanding each carriers position on true premium.

CARRIER GUIDELINE
Aetna Employers may pay true premium. Employers should indicate terminated employees on the billing statement and review the next months bill to ensure members are removed.
Anthem Blue Cross Employers should pay billed premium to avoid cancellation.
Blue Shield of California Employers may be able to pay true premium. Employers should contact the Billing Team (800-325-5166) to request support.
CaliforniaChoice Employers should pay billed premium to avoid cancellation.
CCSB Employers should pay billed premium to avoid cancellation.
Health Net Employers may pay true premium. Employers must not terminate employees retroactively and must clearly identify on the remittance who will remain active on the plan.
Kaiser Permanente® Employers should pay billed premium to avoid cancellation.
MediExcel Health Plan Employers may be able to pay true premium. Employers should contact their account manager first to discuss.
Oscar Health Employers should pay billed premium to avoid cancellation. If given advance notification, Oscar can cancel members and regenerate the bill to reflect new employee counts.
Sharp Health Plan Employers should pay billed premium to avoid cancellation.
Sutter Health Plus Employers should pay billed premium to avoid cancellation.
UnitedHealthcare Employers should pay billed premium to avoid cancellation.
Western Health Advantage Employers should pay billed premium to avoid cancellation.

 

 

Do Carriers Have Special Rules for Renewals and Re-certifications?

Updated 7/1/2020 at 9:35 am

Some carriers will not be re-certifying groups during this difficult time. Carrier systems may still auto generate letters to employer groups so it's important to know what you can expect.

CARRIER GUIDELINE
Aetna Will continue to re-certify 1 and 2 life groups at renewal.
Anthem Blue Cross

Groups will NOT be re-certified, they will auto renew. Groups that have temporarily shut down due to COVID-19, that are in the middle of or have an upcoming open enrollment period, will be allowed 60 days after the renewal date to make policy changes.

For specialty lines, groups with July-December renewals will auto-renew with no rate action.

Blue Shield of California Groups will NOT be re-certified, they will auto renew. If a group receives a decline notice, this should be disregarded.
CaliforniaChoice Business as usual.
CCSB Business as usual, groups are not re-certified under normal procedures.
Cypress Ancillary Benefits All renewals for May through August will auto renew with no increase.
Guardian
  • Groups with 2-499 lives: All renewals for May 1, 2020 through August 31, 2020 will receive a rate pass. The next renewal rate review will be set to the plan anniversary in 2021.
  • Groups with 500+ lives: All renewals for May 1, 2020 through August 31, 2020 will be deferred for 3 months from the original renewal date. After this, the original renewal date will apply for 2021 and future renewals.
Health Net Business as usual.
Humana Business as usual for renewal distribution. Employers will be allowed an additional 30 days from their effective date to complete open enrollment activities.
Kaiser Permanente®

Groups will NOT be re-certified, they will auto renew. If a group receives a re-certification letter, this should be disregarded (it is auto generated).

In addition, Kaiser will allow a delayed open enrollment window when it was not offered prior to the contract effective date, so long as it's offered to all eligible employees and all carriers offered.

MediExcel Health Plan Groups will NOT be re-certified, they will auto renew.
MetLife All renewals for May through September, with under 500 lives, will auto renew with no increase. (excludes business written through a trust, association, or PEO)
Premier Access

Under 500 Lives: All renewals for May through August will auto renew with no increase.

500 or More Lives: All renewals for May through August will be deferred 3 months from the original renewal date. After this, the original renewal date will apply for 2021 and any future renewals.

Principal

Dental and Vision renewals for May 2020 through April 2021, with under 500 lives, will auto renew with no increase.

Life and Disability renewal for May through October 2020, with under 500 lives, will auto renew with no increase. These policies will resume normal renewal practices as of November 2020.

Oscar Health Business as usual.
Sharp Health Plan Business as usual.
Sutter Health Plus Groups will NOT be re-certified, they will auto renew.
UnitedHealthcare

Will continue to re-certify at renewal, however UHC is allowing employers more time to submit their information.

Specialty lines renewal guidelines (Dental, Vision, Life, Disability & Supplemental Health):

  • Specialty lines with 2-499 employees, renewing May-December 2020, will auto-renew with no rate action. Includes UnitedHealthcare and All Savers business.
  • Specialty lines with 500-3,000 employees, renewing May-September 2020, will have their renewal deferred until October 1, 2020. The original renewal rate will be applied October 1 for the remaining contract period. Includes UnitedHealthcare and fully-insured products tied to UMR medical self-funded (ASO) products.
Western Health Advantage Business as usual.

 

 

Can Employers Make Off-Anniversary Eligibility Changes?

Updated 12/7/2020 at 4:25 pm

With the unique circumstances facing employer today, some may be looking to change their contract. This could mean changes like adjusting eligibility to include part-time employees as eligible or shortening the waiting periods so new hires can join the plan sooner. Most carriers require these changes be made only at the anniversary date. Read below to see which carriers may be loosening their guidelines.

Related: To see what carriers have opened a special enrollment opportunity allowing employers to make a plan downgrade, view the Member Access to Care tab above.

CARRIER GUIDELINE
Aetna Not allowed, changes may only be requested at open enrollment.
Anthem Blue Cross

Small Group ACA: Window to make changes closed May 31, 2020. 

Large Group: Employer may be able to make off-cycle changes. It is subject to underwriting approval. Please review page 29 of Anthem's FAQ for further details.

Blue Shield of California Underwriting will review as an exception request. Employer must submit a completed Request for Contract Change Form along with the groups most recent reconciled DE-9C. If part-time employee must submit an application. All items can be send to SGUW@blueshieldca.com.
CaliforniaChoice Employers may make a one-time "mid-plan year" change to adjust contribution.
CCSB Not allowed, changes may only be requested at open enrollment. However, when it comes to FT/PT eligibility, CCSB does not monitor this and relies on the employer to determine when employees are added to the plan.
Guardian Not allowed, changes may only be requested at open enrollment.
Health Net Not allowed, changes may only be requested at open enrollment.
Humana Requests will be reviewed by underwriting on a case-by-case basis.
Kaiser Permanente® Members can remain on the plan as long as premiums are paid.
MediExcel Health Plan Not allowed, changes may only be requested at open enrollment. However, when it comes to FT/PT eligibility, MediExcel does not monitor this and relies on the employer to determine when employees are added to the plan.
Oscar Health Not allowed, changes may only be requested at open enrollment.
Sharp Health Plan Through Dec. 31, 2020, groups can downgrade their medical benefits to a single benefit plan (one time only). The group’s effective date will not change.
Sutter Health Plus pending
UnitedHealthcare Not allowed, changes may only be requested at open enrollment.
Western Health Advantage Employers may make a one-time "mid-plan year" change to add part-time eligibility. Employers should submit a request in writing and specify a single effective date for the change and all members to be added.

 

 

Can Employers Waive the Waiting Period for Re-Hires?

Updated 1/11/2021 at 11:36 am

Many employees who have been laid off will be re-hired once the pandemic is over. Read below to learn how each carrier handles this and whether your employer group will be able to waive the group waiting period for these individuals.

CARRIER GUIDELINE
Aetna The waiting period is waived for employees rehired within 1 year.
Anthem Blue Cross

If employee is rehired within 60 days*
Coverage will resume with no lapse and back-premium must be paid. If an employer’s eligibility rules prohibit the employee from being reinstated as of the original effective date, the employer must notify Anthem of the requested effective date (no back premium will be owed). .

If employee is rehired more than 60 days* but not more than 91 days after the termination date
Coverage shall restart effective on the rehire date. The rehired employee will not be subject to any applicable group-imposed waiting period and must complete a new Employee Enrollment Application.

If employee is rehired more than 91 days (13 weeks) after the termination date
The employee is considered a new employee, subject to any applicable group-imposed waiting period and must complete a new Employee Enrollment Application.

* deadline is normally 30 days; it is extended to 60 days for enrollment received through 12/31/20.

Blue Shield of California The waiting period is waived for employees rehired within 6 months.
CaliforniaChoice Will allow the employer to define the waiting period when the employee returns to work.
CCSB Does not monitor and will allow the employer to make the determination.
Cypress Ancillary Benefits Standard guidelines apply.
Guardian Employees who lost eligibility between March 1, 2020 and June 30, 2020 due to COVID-19, and are re-hired within 6 months of their termination date, will not be subject to a waiting period.
Health Net Standard re-rules apply.
Humana Waiting period is waived for re-hired employees who were terminated due to COVID-19. If a different provision is requested by the employer, Humana grants first of the month following. 
Kaiser Permanente® Large Group: will allow the group to define the waiting period, as long as the waiting period and employer contribution are consistent for all employees.
Small Group: will allow the group to define the waiting period when the employee returns to work, with no minimum, but no greater than 90 days.

 

MediExcel Health Plan Does not monitor and will allow the employer to make the determination.
Oscar Health Employees rehired by May 31, 2020 will not be subject to a waiting period. Must specify employee is a "rehire who was previously covered by Oscar."
Premier Access Will waive the waiting period of rehires through April 1, 2021.
Principal Will waive the waiting period if rehired within 6 months of termination date.
Sharp Health Plan Does not monitor and will allow the employer to make the determination.
Sutter Health Plus Does not monitor and will allow the employer to make the determination.
UnitedHealthcare Waiting period is waived for re-hired employees who were terminated due to COVID-19.
Western Health Advantage WHA will rely on employer instruction to notify them of employee eligibility, even if the time differs from their waiting period, so long as it does not exceed first of the month following 60 days.

 

Is Deductible Credit Available for Re-Hires?

Updated 5/7/2020 at 11:05 am

For the many employees that have been terminated and offered COBRA/Cal-COBRA, understand what will happen when they are re-hired and brought back onto the group plan. Some carriers will allow the members deductible credit to roll over, while others will reset the member at re-enrollment under the group plan.

CARRIER GUIDELINE
Aetna Deductible credit available. Will be applied as long as the member's ID number has not changed, and in most cases the ID number does not change for re-hires.
Anthem Blue Cross Deductible credit not available. The deductible will reset to $0 at re-hire enrollment.
Blue Shield of California Deductible credit is available for employees re-hired by the same employer in the same calendar year.
CaliforniaChoice Refer to enrolled carrier for guideline.
CCSB Refer to enrolled carrier for guideline.
Health Net Deductible credit available. Will be applied as long as the member remains on the same plan with the same member ID, in the same calendar year.
Kaiser Permanente® Deductible credit is available for employees re-hired by the same employer in the same calendar year.
MediExcel Health Plan Deductible credit not available. The deductible will reset to $0 at re-hire enrollment.
Oscar Health Deductible credit is available for employees re-hired in the same state and on the same metal tier.
Sharp Health Plan Deductible credit available. Member should keep track of their deductible and maintain EOB records to provide proof.
Sutter Health Plus Deductible credit not available. The deductible will reset to $0 at re-hire enrollment.
UnitedHealthcare Deductible credit not available. The deductible will reset to $0 at re-hire enrollment.
Western Health Advantage Deductible credit is available for employees re-hired by the same employer in the same calendar year.

 

How Do We Submit Employee Applications If We Can't Obtain Signatures?

Updated 8/17/2020 at 3:43 pm

For new business submissions, some employees may not have access to printers/scanners/smart phones or may not have internet at home. This poses a concern for carriers that require employees sign applications. Read below to identify which carriers are more flexible on this requirement, and those that require a signature due to legal requirements.

CARRIER SIGNATURE GUIDELINE ELECTRONIC SIGNATURES ACCEPTED
Aetna

Signatures will not be required when submitting enrollment via the eTool spreadsheet.

During the pandemic: will accept font signatures when accompanied by the email trail as documentation of the signature date.

Yes, must link to a reputable eSignature company. May also use signature with digital certificate.
Anthem Blue Cross Signatures will not be required when submitting enrollment via the census spreadsheet. Yes, must link to a reputable eSignature company.
Blue Shield of California Signatures are required. Electronic signatures are accepted so long as they are time and date stamped by the service being used. Yes, must link to a reputable eSignature company and have date/time stamp.
CaliforniaChoice Signatures are required. Online enrollment available through the CalChoice system. Yes, must link to a reputable eSignature company.
CCSB Signatures are required. Electronic signatures are accepted. Yes, must link to a reputable eSignature company and have date/time stamp.
Health Net Signatures are required. Electronic signatures are accepted. Yes, may sign with digital ID or link to a reputable eSignature company.
Kaiser Permanente® Any type of signature will be accepted, including font/brush scripts. Yes, must link to a reputable eSignature company.
MediExcel Health Plan Signatures required if submitting applications. If signatures can't be obtained, submit census enrollment instead. Not allowed.
Oscar Health All enrollment is done online. Yes.
Sharp Health Plan Signatures are required. Yes, must link to a reputable eSignature company.
Sutter Health Plus Until further notice, will process the enrollment application with/without Subscriber/Employee signature as long as form is being submitted directly to SHP Enrollment/Sales by an authorized representative of the employer group such as an HR, Benefits Admin, COBRA TPA or Broker contact. Yes, fillable forms allow for electronic signature.
UnitedHealthcare Signatures not required, all enrollment processed through SAM. Yes, must link to a reputable eSignature company.
Western Health Advantage Signatures are required. Electronic signatures are accepted. Yes, must link to a reputable eSignature company.

 

Brokers: How Does Partial Group Payment Affect Commissions?

Updated 5/6/2020 at 3:05 pm

Some employers may be unable to make their full monthly premium payment. Learn which carriers will pay you commission based only on premium paid (even if partial) versus those that require full payment in order to release commission.

CARRIER GUIDELINE
Aetna Commission will be paid based on the premium paid by the group.
Anthem Blue Cross Group must be paid to date for the month in which commission will be paid.
Blue Shield of California Commission will be paid based on the premium paid by the group.
CaliforniaChoice Group must be paid to date for the month in which commission will be paid.
CCSB Commission will be paid based on the premium paid by the group.
Health Net Commission will be paid based on the premium paid by the group.
Kaiser Permanente® Commission will be paid based on the premium paid by the group.
MediExcel Health Plan Commission will be paid based on the premium paid by the group.
Oscar Health Commission will be paid based on the premium paid by the group.
Sharp Health Plan Commission will be paid based on the premium paid by the group.
Sutter Health Plus Commission will be paid based on the premium paid by the group.
UnitedHealthcare Commission will be paid based on the premium paid by the group.
Western Health Advantage Commission will be paid based on the premium paid by the group.

 

 

Are Dental Personal Protective Equipment (PPE) Charges Covered?

Updated 6/9/2020 at 2:50 pm

Some dental offices are charging a new fee to cover protective equipment, such as gloves and masks. There is no legislation that requires coverage for these materials and therefore they may be excluded under the plan. This list will be updated as confirmation becomes available from each dental carrier.  

CARRIER PPE CHARGE GUIDELINE
Ameritas This is not a covered benefit; the member will be responsible for the full cost of the PPE fee when receiving services.
Ameritas is reviewing this practice due to recent changes in the industry.
Choice Builder This is not a covered benefit; the member will be responsible for the full cost of the PPE fee when receiving services.
Cypress Ancillary Benefits This is not a covered benefit; the member will be responsible for the full cost of the PPE fee when receiving services.
MetLife This is not a covered benefit; the member will be responsible for the full cost of the PPE fee when receiving services.
MetLife is reviewing this practice due to recent changes in the industry.
Premier Access This is not a covered benefit; the member will be responsible for the full cost of the PPE fee when receiving services.
Premier Access is reviewing this practice due to recent changes in the industry.
Principal When a member sees an in-network provider, from June-December 2020, Principal will automatically pay $7 toward the cost of PPE. This is paid regardless of whether the provider is charging a PPE fee. Any PPE fee charge beyond this amount will be the members responsibility.

 

Get Answers

Check out LISI Compliance Alerts on current popular topics:

  • Benefits Questions
  • Benefit Eligibility during Sick Leave, Furloughs and Terminations (updated April 7)
  • HDHPs Will Not Lose HSA Qualified Status for Covering COVID-19 Expenses
  • Families First Coronavirus Response Act Impact on Employee Benefits
  • Families First Coronavirus Response Act - Compliance Alert

Review materials provided by our partner, Benefit Comply:

  • Return to Work Checklist

Review materials provided by our partner, ThinkHR :

  • ThinkHR COVID-19 Employer FAQ
  • ThinkHR COVID-19 Employer Survey

Review materials provided by our partner, Guardian HR:

  • State-by-State COVID-19 Issues to Consider for the Private Sector
  • CA Side by Side Comparison of Leaves for COVID-19

 

Contact your LISI Regional Sales Manager for help navigating this challenging time for you and your clients.

Employer Resources

Webinars

Guardian HR hosted a webinar on April 20, 2020 on COVID-19 related employment law and benefit issues:

  • View the Slides
  • Watch the Recording

ThinkHR hosted a webinar on March 31, 2020, to address employer questions around current guidelines from the CDC, illness & quarantine questions, the Families First Coronavirus Response Act, and reducing hours or closing:

  • View the Slides
  • Watch the Recording
  • Read the Employer FAQ (updated April 8)

ThinkHR hosted a webinar on March 19, 2020, to address employer questions around employment, work from home policies, and to explain the Families First Coronavirus Response Act:

  • View the Slides
  • Watch the Recording

 

Immediate Steps to Take

The Economic Development Collaborative (EDC) has provided some helpful information through their COVID-19 Business Resource Guide:

As the spread and impact of COVID-19 is still an unknown, the EDC recommends employers and self- employed individuals to take the following action steps:

  1. Contact your insurance provider - Do you have business interruption insurance? If so, you may have coverage that supplements any income or sales loss during this time.
  2. Track Losses - During moments of disruption it is important to track any loss your business may have incurred as programs designed to assist cash flow needs and access to capital depend on accurate counts of economic injury or production loss.
  3. Do you have performance-based contracts with your suppliers or customers? - reviewing your current contracts and obligations will clarify limitations of liability and force majure.
  4. Has your business experienced disruption or concern in the following areas?
    • Supply chain disruption and liability
    • Questions or concerns about the implications of tariffs
    • Technology plans for setting up remote work stations for employees
    • Concerns about cash flow during disruption
    • Concerns about credit and finance issues
    • Concerns about force majure

Assistance for Employers

The EDC had gathered recommendations for programs that can assist employers and employees affected by the Coronavirus:

PROGRAM WHAT IS IT MORE INFO
Work Sharing Program

Employers experiencing a slowdown in their businesses or services as a result of the Coronavirus impact on the economy may apply for the UI Work Sharing Program through the EDD.

This program allows employers to seek an alternative to layoffs. Retaining their trained employees by reducing their hours and wages that can be partially offset with UI benefits. Workers of employers who are approved to participate in the Work Sharing Program receive the percentage of their weekly Unemployment Insurance benefit amount based on the percentage of hours and wages reduced, not to exceed 60 percent.

Work Sharing Program
Extension Filing Payroll Tax

Employers statewide directly affected by the new coronavirus (COVID-19) may request up to a 60-day extension of time from the EDD to file their state payroll reports and/or deposit payroll taxes without penalty or interest.

This extension may be granted under Section 1111.5 of the California Unemployment Insurance Code (CUIC). A written request for extension must be received within 60 days from the original delinquent date of the payment or return.

EDD website
Extension Filing Personal and Business Taxes

The Franchise Tax Board announced special tax relief for all California taxpayers affected by the COVID-19 pandemic. FTB is postponing until July 15, 2020 the filing and payment deadlines for all individual and business entities for 2019 tax returns, 2019 tax return payments, 2020 1st and 2nd quarter estimate payments, 2020 LLC taxes and fees, and 2020 Non-wage withholding payments.

Franchise Tax Board
Economic Injury Disaster Loan Program (EIDL)

The SBA will work directly with state Governors to provide targeted, low-interest loans to small businesses and non-profits that have been severely impacted by the Coronavirus (COVID-19). The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. Find more information on the SBA’s Economic Injury Disaster Loans at SBA.gov/Disaster.

  • SBA: Apply Online
  • SBA Small Business Guidance & Loan Resources
  • SBA EIDL Program Fact Sheet and Q&A
  • SBA EIDL Presentation

Assistance for Employees

The Labor & Workforce Development Agency has created the below chart to help employers understand what benefits their employees may be entitled to. This information does not yet reflect options now available as a result of the new Family First Coronavirus Response Act.

PROGRAM WHY WHAT BENEFITS MORE INFO HOW TO FILE
Disability Insurance If you're unable to work due to medical quarantine or illness related to COVID-19 (certified by a medical professional) Short-term benefit payments to eligible workers who have a full or partial loss of wages due to a non-work-related illness, injury, or pregnancy. Approximately 60-70 percent of wages (depending on income); ranges from $50-$1,300 a week for up to 52 weeks. Learn more about your eligibility for Disability Insurance File a Disability Insurance claim
Paid Family Leave If you're unable to work because you are caring for an ill or quarantined family member with COVID-19 (certified by a medical professional) Up to six weeks of benefit payments to eligible workers who have a full or partial loss of wages because they need time off work to care for a seriously ill family member. Approximately 60-70 percent of wages (depending on income); ranges from $50-$1,300 a week for up to 6 weeks. Learn more about your eligibility for Paid Family Leave File a Paid Family Leave claim
Unemployment Insurance If you have lost your job or have had your hours reduced for reasons related to COVID-19 Partial wage replacement benefit payments to workers who lose their job or have their hours reduced, through no fault of their own.

Range from $40-$450 per week for up to 26 weeks.

Governor’s Emergency Proclamations waive the non-payable one-week waiting period for regular UI benefit payments to eligible individuals affected by current disasters. This means individuals can be paid benefits for the first week they are unemployed due to the disaster.

Learn more about your eligibility for Unemployment Insurance

Unemployment Benefits Finder By State

File an Unemployment Insurance claim

Unemployment Insurance Checklist

Paid Sick Leave If you or a family member are sick or for preventative care when civil authorities recommend quarantine The leave you have accumulated or your employer has provided to you under the Paid Sick Leave law. Paid to you at your regular rate of pay or an average based on the past 90 days. Learn more about your eligibility for Paid Sick Leave If accrued sick leave is denied, file a Wage claim
Workers' Compensation If you are unable to do your usual job because you were exposed to and contracted COVID-19 during the regular course of your work, you may be eligible for workers’ compensation benefits. Benefits include temporary disability (TD) payments, which begin when your doctor says you can't do your usual work for more than three days or you are hospitalized overnight. You may be entitled to TD for up to 104 weeks. TD stops when either you return to work, your doctor releases you for work, or your doctor says your illness has improved as much as it's going to. TD generally pays two-thirds of the gross wages you lose while you are recovering from a work-related illness or injury, up to a maximum weekly amount set by law. In addition, eligible employees are entitled to medical treatment and additional payments if a doctor determines you suffered a permanent disability because of the illness. Learn more about your eligibility for Workers' Compensation benefits File a Workers' Compensation claim

Stay Informed

  • California Governor’s Office of Business and Economic Development
  • California Department of Public Health
  • Franchise Tax Board FAQs

Center for Disease Control and Prevention

  • Centers for Disease Control and Prevention (CDC)
  • What you need to know about the coronavirus disease [Chinese] [Spanish]
  • What to do if you are sick with the coronavirus disease [Chinese] [Spanish]
  • Stop the spread of germs [Chinese] [Spanish]
  • CDC Frequently Asked Questions and Answers [Chinese] [Spanish]
  • CDC Symptoms of coronavirus disease [Chinese] [Spanish]
  • CDC Coronavirus Website

Employment Development Department (EDD)

  • EDD COVID-19 Webpage
  • Benefit Programs for California Workers
  • COVID-19 FAQs [Spanish COVID-19 FAQs]

Small Business Administration (SBA)

  • SBA Coronavirus Relief Options
  • Guidance for Businesses and Employers

What you can do

  • Know symptoms and risks
  • Avoid gatherings and events
  • Get testing and treatment
  • Apply for unemployment
  • Apply for disability benefits
  • Apply for paid family leave
  • Get help for small businesses
Employer FAQs

California Rebuilding Fund

Updated 8/27/2020 at 11:11 am

Taken from the Governor’s Office of Business and Economic Development (GO-Biz): 

The Governor’s Office of Business and Economic Development (GO-Biz) today announced the California Rebuilding Fund, a new public-private partnership that will leverage government backed capital to support California’s small businesses – especially the smallest under-served firms and entrepreneurs from communities that have been historically disenfranchised.

The initiative was approved yesterday during the California Infrastructure and Economic Development Bank’s (IBank) August board meeting. Prior to the approval, the State of California allocated $25 million and new statutory authority to IBank to enable a collaboration with the state’s private sector. This public-private partnership will in turn drive capital to Community Development Financial Institutions (CDFIs) and other mission-based lenders that provide much-needed loans to California’s underbanked small businesses. With the support of this new IBank funding, California’s CDFIs increase their capacity to help small businesses recover and reposition themselves to survive the realities of the COVID-19 marketplace

 

National Emergency Extensions for COBRA, HIPAA and ERISA Deadlines

Updated 5/1/2020 at 3:30 pm

The Department of Labor and the Department of the Treasury have issued EBSA Disaster Relief Notice 2020-01.

Beginning March 1, 2020, and ending 60 days after the National emergency is over, all group health plans, disability plans, other employee welfare benefit plans, and employee pension plans must disregard this time period (the “Outbreak Period”) when administering plans and deadlines. Standard election time frames will begin again once the Outbreak Period ends. This includes things like COBRA election/notice deadlines and submitting claims for coverage, including the run-out period for FSA and HRA plans.

Read the LISI Compliance Update for details.

 

Families First Coronavirus Response ACT (FFCRA)

Updated 4/7/2020 at 3:50 pm

The Department of Labor has provided additional guidance on the new law, which we strongly encourage employers to read. We also encourage you to review the additional materials available:

  • ThinkHR COVID-19 FAQ
  • LISI Compliance Alert: FFCRA Updated DOL Q&A
  • LISI Compliance Alert: IRS Releases Guidance on FFCRA Tax Credit

Summary
For certain circumstances related to COVID-19, employees will be eligible for:

  • Up to 2 weeks of paid sick leave (EPSL) for illness, quarantine, or school closures (full pay for self, 2/3 pay for family care)
  • Up to 12 weeks of Family and Medical Leave Act (FMLA) leave for school closures (10 days unpaid and then up to 10 weeks at 2/3 pay)

Effective Date of Law
The FMLA and Paid Sick Leave sections discussed below went into effect on April 1, 2020 and expire December 31, 2020. Leave benefits and payroll credits will not be retroactive.

 

Emergency Family and Medical Leave Act (EFMLA)

Covered Employers
Employers with fewer than 500 employees are covered.

Covered Employees
Any employee who has been employed for at least 30 calendar days, though employers may be able to exclude employees who are health care providers or emergency responders. See the ThinkHR COVID-19 FAQ for details on how the FFCRA defines health care providers and emergency responders.

Covered Leave Purpose
To care for a child under 18 of an employee if the child’s school or place of care has been closed, or the childcare provider is unavailable, due to a public health emergency, defined as an emergency with respect to the coronavirus declared by a federal, state, or local authority.

Duration
Up to 12 weeks of job-protected leave.

Compensation

  • No pay for first 10 days of leave (other paid time off, and emergency sick leave under the FFCRA, may be applied).
  • After 10 days, employers must pay two thirds of the employee’s regular rate of pay for the number of hours they would normally be scheduled to work, capped at $200/day and $10,000 total.

Reinstatement to Position after Leave
The same reinstatement provisions apply as under traditional FMLA. However, restoration to position does not apply to employers with fewer than 25 employees if certain conditions are met:

  • The job no longer exists because of changes affecting employment caused by an economic downturn or other operating conditions that affect employment caused by a public health emergency;
  • The employer makes reasonable efforts to return the employee to an equivalent position; and
  • The employer makes efforts to contact a displaced employee if anything comes up within a year of when they would have returned to work.

 

 

Emergency Paid Sick Leave (EPSL)

Covered Employers
Employers with fewer than 500 employees.

Covered Employees
All employees (no matter how long they have been employed), though employers may be able to exclude employees who are health care providers or emergency responders. See the ThinkHR COVID-19 FAQ for details on how the FFCRA defines health care providers and emergency responders.

Covered Leave Purposes

  1. When quarantined or isolated subject to federal, state, or local quarantine/isolation order;
  2. When advised by a health care provider to self-quarantine (due to concerns related to COVID-19);
  3. When experiencing symptoms of COVID-19 and seeking a medical diagnosis;
  4. When caring for an individual doing #1 or #2 (2/3 pay);
  5. When caring for a child whose school or place of care is closed due to COVID-19 (2/3 pay); or
  6. When the employee is experiencing any other substantially similar condition (2/3 pay).

Duration of Leave

  • Full time employees are entitled to 80 hours of paid sick leave.
  • Part time employees are entitled to sick leave equal to the number of hours worked on average over a typical two-week period.

Rate of Pay

  • Sick leave must be paid at the employee’s regular rate of pay for leave used for the employee’s own illness, quarantine, or care.
  • Sick leave must be paid at two-thirds of the employee’s regular rate if taken to care for a family member or to care for a child whose school has closed, or if the employee’s childcare provider is unavailable due to the coronavirus.
  • Pay is capped at $511/day and $5,110 total for reasons 1, 2, and 3 described above.
  • Pay is capped at $200/day and $2,000 total for reasons 4, 5, and 6 described above.

Small Business Exemption
Employers with fewer than 50 employees may be eligible for an exemption from the childcare leave provisions if at least one of the three statements below are true:

  • Providing leave would result in the small business’s expenses and financial obligations exceeding available business revenues and cause it to cease operating at a minimal capacity;
  • The absence of the employee or employees requesting leave would entail a substantial risk to the financial health or operational capabilities of the small business because of their specialized skills, knowledge of the business, or responsibilities; or
  • There are not sufficient workers who are able, willing, and qualified, and who will be available at the time and place needed, and these labor or services are needed for the small business to operate at a minimal capacity.

 

 

Payroll Tax Credit

The IRS has released Guidance on the FFCRA Tax Credit. Employers should regularly check back for additional instructions.

LISI Compliance Alert: IRS Releases Guidance on FFCRA Tax Credit

Background
The FFCRA requires certain employers (generally private employers with fewer than 500 employees, and all public employers) to provide Paid Sick Leave and Expanded FMLA leave for certain events related to the COVID-19 pandemic. Private employers can recoup their costs of providing this leave through an advanced payroll tax credit. The credit is designed to reimburse private employers who are subject to the law for the extra cost of compensation and benefits provided to employees entitled to take leave due to one of the reasons defined in the FFCRA.

The IRS provided detailed guidance on the process employers need to follow in order to take advantage of the tax credit. The process permits affected employers to withhold an amount equal to qualified wages and health expenses from payroll taxes that are to be deposited with the federal government. The employer’s qualified costs can be withheld from the employer’s portion of payroll taxes, payroll taxes deducted from the employees’ pay, and federal income tax withheld from employees’ pay. The amounts withheld will then be reported on the employer’s quarterly payroll tax filing. If there are insufficient payroll tax funds available to offset the employer’s qualified wage and health expenses related to providing FFCRA protected leave, the employer can file a Form 7200 to claim an advance credit.

Determining the Amount of Qualified Health Plan Expenses
Employer tax credits to cover the cost of employees taking FFCRA qualified leave include what are referred to as “qualified health plan expenses.” Qualified health plan expenses include plans defined as group health plans in Code section 5000(b)(1). This is a broad definition that includes employer-sponsored medical plans, HRAs, dental plans, vision plans, Rx plans, health FSAs, and others, but does not include employer contributions to a QSEHRA, Archer MSA or HSA.

The amount of qualified health plan expenses generally includes both the portion of the cost paid by the employer and the portion of the cost paid by the employee with pre-tax salary reduction contributions. If an employee participates in more than one eligible plan, the qualified expenses of each plan in which the employee participates are aggregated for that employee.

Documentation
The IRS also provided guidance on documentation employers must obtain from employees who take FFCRA leave. This documentation does not need to be submitted to the IRS but must be maintained to justify tax credits claimed by the employer in the event of an audit. See more in the LISI Compliance Alert

 

 

Get Answers to the Top FFCRA Questions

Our partner ThinkHR has provided a great resource with questions they've received during recent webinars. Below are highlights taken from the ThinkHR COVID-19 FAQ.

Do we need to provide the required sick leave under the FFCRA in addition to the sick leave we already offer?
Yes. The Department of Labor makes it clear in an FAQ regarding the FFCRA that leaves under the FFCRA are intended to be in addition to any pre-existing leave entitlements that an employee may have.

Do we still have to provide EPSL or EFMLA if we lay off or furlough employees?
No. Employers who are closed — either due to lack of business or a state or local order — do not have to provide these leaves. Employees who are furloughed (temporarily not working but still on the payroll) are also not entitled to these benefits. In either of these cases, employees would be eligible for unemployment insurance instead. However, employers should ensure that they are not making furlough or layoff decisions based on an employee’s request or potential need for leave, as this would likely be considered interference or retaliation (and grounds for a lawsuit).

How are we supposed to pay for the sick leave and FMLA leave mandated by the Families First Coronavirus Response Act?
To take immediate advantage of the paid leave credits, businesses can retain and access funds that they would otherwise pay to the IRS in payroll taxes. If those amounts are not sufficient to cover the cost of paid leave, employers can seek an expedited advance from the IRS by submitting a streamlined claim form that will be released soon.

For many, business slowdowns related to the spread of COVID-19 have made it hard to imagine how employers could bear any additional expenses. We encourage anyone with these concerns to read the linked announcement carefully.

The full announcement can be found here: Treasury, IRS, and Labor Announcement on FFCRA Implementation. Including the information in the link, this is all we currently know about the payroll tax credit under the FFCRA and how to access or administer it.

If I am a nonprofit or a public employer, do tax credits and reimbursement apply to me?
Most public employers (e.g., cities, municipalities, public school districts) will not be eligible for the tax credits or reimbursements provided in the act. Private nonprofit entities, however, are eligible

What are our EPSL and EFMLA obligations to different employee situations, such as remote employees?
All employees are entitled to emergency paid sick leave (EPSL) and emergency expansion of the FMLA (EFMLA) benefits unless a specific exemption applies to your business or the individual.

Is the FFCRA retroactive or applicable before its effective date?
No. The Families First Coronavirus Response Act (FFCRA) goes into effect on April 1, 2020 and is not applicable before that time.

How do EFMLA and EPSL relate to each other, especially in regard to caring for children?
The emergency FMLA (EFMLA) and emergency paid sick leave (EPSL) both cover caring for children whose school or place of care is closed due to COVID-19 precautions, though EFMLA has the broader restriction that the child be under 18 years old. The leaves can run concurrently with the first 10 days of EFMLA being unpaid, which will, in many cases, coincide with the 80 hours of pay (at 2/3 the regular rate) under EPSL for full-time employees.

 

 

Documentation and Additional Guidance

Required FFCRA Poster
The Department of Labor (DOL) has released a mandatory employee rights poster for the FFCRA. It should be posted or distributed to employees electronically (via email or online portal) by April 1. Read more on the requirements.

Enforcement of FFCRA
The DOL will not bring enforcement actions against employers for violations of the FFCRA prior to April 17, 2020, provided that the employer has made reasonable, good faith efforts to comply with the Act. Read more about the brief non-enforcement period.

Documentation Required to Substantiate Leave Payments
(From the IRS) An Eligible Employer will substantiate eligibility for the sick leave or family leave credits if the employer receives a written request for such leave from the employee in which the employee provides:

  1. The employee’s name;
  2. The date or dates for which leave is requested;
  3. A statement of the COVID-19 related reason the employee is requesting leave and written support for such reason; and
  4. A statement that the employee is unable to work, including by means of telework, for such reason.

In the case of a leave request based on a quarantine order or self-quarantine advice, the statement from the employee should include the name of the governmental entity ordering quarantine or the name of the health care professional advising self-quarantine, and, if the person subject to quarantine or advised to self-quarantine is not the employee, that person’s name and relation to the employee.

In the case of a leave request based on a school closing or child care provider unavailability, the statement from the employee should include the name and age of the child (or children) to be cared for, the name of the school that has closed or place of care that is unavailable, and a representation that no other person will be providing care for the child during the period for which the employee is receiving family medical leave and, with respect to the employee’s inability to work or telework because of a need to provide care for a child older than fourteen during daylight hours, a statement that special circumstances exist requiring the employee to provide care.

Guidance from the DOL on Administering FFCRA Leaves
We strongly suggest that employers read through the entire Questions and Answers document, so they have an understanding of how the leaves work. The following are some highlights from the updated guidance:

  • These leaves are not available to employees with reduced hours, furloughed employees, or employees whose workplaces are closed. See questions 23-28.
  • These leaves are not available to employees whose workplaces are closed due to a federal, state, or local shelter-in-place or stay-at-home orders, or due to business slowdowns. See question 23.
  • These leaves (and payroll tax credit) are not retroactive. Employees are not entitled to pay under these leaves if they were absent or out of work (for any reasons) prior to April 1. See question 13.
  • Both emergency paid sick leave (EPSL) and emergency Family and Medical Leave (EFMLA) can be taken on an intermittent basis in certain situations. See Questions 20-22 for explanations about when intermittent leave is allowed.
  • Employees may not be required to use other forms of paid leave prior to or concurrently with EPSL or EFMLA. See questions 32 and 33.
  • Employers should keep documentation to show that employees who received leave were actually in need of leave. The documentation requirements are outlined in IRS guidance as discussed above. See Questions 15 and 16.

 

 

 

Coronavirus Aid, Relief, and Economic Security Act (CARES Act)

Updated 4/8/2020 at 4:20 pm

On Friday, March 27, the President signed the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The new law is a $2 trillion economic stimulus package designed to repair the economic damage caused by COVID-19 and provide additional protection to individuals and businesses who may lose income due to the pandemic. While most of the act pertains to direct payments and loans, there are some sections that affect employers.

LISI Compliance Alert
CARES ACT: Small Business Loans
Small Business Administration (SBA) Relief for Small Business

Providing Alternatives to Closure and Layoffs
The CARES Act gives employers the following options and benefits, which may allow them stay open and keep more people employed:

  • Small businesses may be eligible for emergency grants of up to $10,000 to cover immediate operating costs.
  • The Small Business Administration (SBA) may provide loans of up to $10 million per business; any portion of that spent to pay employees, keep workers on payroll, or pay for rent, mortgages, or existing debt could be forgiven, provided workers remain employed through the end of June.
  • Small businesses with existing SBA loans may have up to six months of payments waived.
  • Businesses that have experienced a decline in gross receipts of 50% as compared to the same quarter of 2019 or that have been fully or partially shutdown by order may be eligible to receive a refundable tax credit for 50% of qualified employee wages up to $10,000 per employee. This is unrelated to the dollar-for-dollar payroll tax credit that can be taken for FFCRA leaves.
  • Businesses may defer payment of employer payroll taxes imposed between the enactment of this law and December 31, 2020 with half of the deferred taxes due by December 31, 2021 and the rest due by December 31, 2022. This is unrelated to the dollar-for-dollar payroll tax credit that can be taken for FFCRA leaves.

We are unable to advise on these topics as they are outside the scope of our expertise. We encourage you to follow the IRS Coronavirus Tax Relief page and the SBA Coronavirus Loan Resources page, as well as consult with your tax professional or financial advisor. Detailed guidance on how to access these financial resources should be coming soon from those sources.

Impact on Unemployment Insurance
The act increases the length of time someone can be on unemployment benefits to a maximum of 39 weeks. In many states, this will be an increase of 13 weeks of benefits. The act also adds $600 to the weekly amount an individual would usually receive. Independent contractors may be eligible for benefits under this expansion. While these unemployment benefits are generous, employers should still consider their options and incentives under the CARES Act mentioned above before making decisions about reduced hours, furloughs, or layoffs.

Employees who experience reduced hours, furloughs, or layoffs should be encouraged to file for unemployment insurance as soon as possible. We recommend that both employers and employees visit their state’s unemployment insurance department website and track local and state news, as departments across the country are updating their rules to facilitate displaced workers during this time.

 

 

Paycheck Protection Program (PPP)

The Paycheck Protection Program (“PPP”) authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. All loan terms will be the same for everyone. The loan amounts will be forgiven as long as:

  • The loan proceeds are used to cover payroll costs, and most mortgage interest, rent, and utility costs over the 8 week period after the loan is made; and
  • Employee and compensation levels are maintained.

Payroll costs are capped at $100,000 on an annualized basis for each employee. Due to likely high subscription, it is anticipated that not more than 25% of the forgiven amount may be for non-payroll costs. Loan payments will be deferred for 6 months.

Visit the Paycheck Protection Program (“PPP”) page for more details.

Eligible Employers
Small businesses with 500 or fewer employees—including nonprofits, veterans organizations, tribal concerns, self-employed individuals, sole proprietorships, and independent contractors— are eligible. Businesses with more than 500 employees are eligible in certain industries.

When to Apply
Starting April 3, 2020, small businesses and sole proprietorships can apply. Starting April 10, 2020, independent contractors and self-employed individuals can apply. We encourage you to apply as quickly as you can because there is a funding cap.

How to Apply
You can apply through any existing SBA 7(a) lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating. Other regulated lenders will be available to make these loans once they are approved and enrolled in the program. You should consult with your local lender as to whether it is participating. All loans will have the same terms regardless of lender or borrower. A list of participating lenders as well as additional information and full terms can be found at www.sba.gov.

 

 

Economic Injury Disaster Loan Program (EIDL)

The SBA will work directly with state Governors to provide targeted, low-interest loans to small businesses and non-profits that have been severely impacted by the Coronavirus (COVID-19). The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. Find more information on the SBA’s Economic Injury Disaster Loans at SBA.gov/Disaster.

Benefits.gov offers an online questionnaire to assist employers in determining eligibility. Employers can apply online through the SBA website.

  • SBA Small Business Guidance & Loan Resources
  • SBA EIDL Program Fact Sheet and Q&A
  • SBA EIDL Presentation

Details shown below are from the Benefits.gov website.

Program Description
The Small Business Administration's (SBA) disaster loans are the primary form of Federal assistance for the repair and rebuilding of non-farm, private sector disaster losses. The disaster loan program is the only form of SBA assistance not limited to small businesses.

The Economic Injury Disaster Loan Program (EIDL) can provide up to $2 million of financial assistance (actual loan amounts are based on amount of economic injury) to small businesses or private, non-profit organizations that suffer substantial economic injury as a result of the declared disaster, regardless of whether the applicant sustained physical damage.

An EIDL can help you meet necessary financial obligations that your business or private, non-profit organization could have met had the disaster not occurred. It provides relief from economic injury caused directly by the disaster and permits you to maintain a reasonable working capital position during the period affected by the disaster. EIDLs do not replace lost sales or revenue.

Program Requirements
To be eligible for EIDL assistance, small businesses or private non-profit organizations must have sustained economic injury and be located in a disaster declared county or contiguous county.

Check if you may be eligible for this benefit

Loan Terms
The SBA can provide up to $2 million in disaster assistance to a business. The $2 million loan cap includes both physical disaster loans and EIDLs. There are no upfront fees or early payment penalties charged by SBA. The repayment term will be determined by your ability to repay the loan.

Application Process
Apply online for disaster loan assistance at your own convenience through SBA's secure Disaster Loan Assistance website. For application information, please call 1-800-659-2955 or email DisasterCustomerService@sba.gov.

Contact Information
For more information about this program, please visit the Economic Injury Disaster Loan page.

 

Additional Resources

FAQs from the California Employment Development Department can help answer questions on Disability or Paid Family Leave Benefits, Unemployment Insurance Benefits, and other employer information.

In addition, the Governor’s Office of Business and Economic Development (GO-Biz) has compiled helpful information for employers, employees, and all Californians as it relates to the Coronavirus (COVID-19) pandemic. For a complete list of resources, please visit the California Coronavirus (COVID-19) Response website.

Small Business Technical Assistance

  • California’s network of small business support centers help businesses figure out which loans are best for them, develop resiliency strategies, and find other resources. Learn more.
  • The Office of the Small Business Advocate has also provided answers to a list of frequently asked questions to help support California’s small businesses. Learn more.
  • If you need to talk to a specialist in GO-Biz’s Office of the Small Business Advocate directly, please contact the team.

U.S. Small Business Administration Economic Injury Disaster Loan Program

  • SBA loans are available to the entire state of California.
  • For more Information about SBA disaster assistance programs, and to apply directly online, go to the SBA Website.
  • To contact SBA’s Customer Service Center:
    • Email SBA: disastercustomerservice@sba.gov
    • Call: 1-800-659-2955/1-800-877-8339 (TTY)

CA Infrastructure and Economic Development Bank (IBank) Finance Programs (1-750 employees)

  • Disaster Relief Loan Guarantee Program: This disaster program provides loan guarantees of up to $1 million for small business borrowers in declared disaster areas.
  • Jump Start Loan Program: This program offers loans from $500 to $10,000 to low-wealth entrepreneurs in declared disaster and emergency areas.
  • To contact IBank:
    • Email IBank: IBank@IBank.ca.gov
    • Call: 1-916-341-6600

California Capital Access Program (CalCAP) (1-500 employees)

  • CalCAP is a loan loss reserve program which may provide up to 100% coverage on losses as a result of certain loan defaults. Individual borrowers are limited to a maximum of $2.5 million enrolled over a 3-year period.
  • To contact the California State Treasurer’s Office:
    • Email CalCAP: calcap@treasurer.gov
    • Call: Call: 1-916-653-2995

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