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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. |
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):
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:
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:
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
|
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. |
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 June 30, 2021, as long as premiums are paid. | |
Anthem Blue Cross | Members can remain on the plan, through June 30, 2021, as long as premiums are paid. | - |
Blue Shield of California | Members can remain on the plan as long as premiums are paid. | |
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. | |
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. |
|
MetLife |
Group Life, Dental, AD&D, Vision, Accident & Health and Legal Group Life Group Disability |
- |
Premier Access / Avesis | Members can remain on the plan, through April 1, 2021, as long as premiums are paid. | |
Principal | Not available, ended June 2020. | |
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. | |
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). | - |
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. |
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 |
|
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):
|
Western Health Advantage | Business as usual. |
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. |
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* If employee is rehired more than 60 days* but not more than 91 days after the termination date If employee is rehired more than 91 days (13 weeks) after the termination date * 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. |
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. |
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. |
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. |
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. |
Check out our Compliance Alerts on current popular topics:
Review materials provided by our partner, Benefit Comply:
Review materials provided by our partner, ThinkHR :
Review materials provided by our partner, Guardian HR:
Contact your Regional Sales Manager for help navigating this challenging time for you and your clients.
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