USHL Continues to Help Clients During This Difficult Time
As an essential business, US Health and Life (USHL) is committed to serving our clients during this challenging time, even with Michigan’s governor issuing a Stay Home, Stay Safe directive on Monday, March 23. We have moved our associates to remote operations for their safety and well-being while maintaining our full operations as part of our business continuity plans. We continue to pay claims and perform call center operations and work on billing and enrollment changes.
More details on our continuing operations during the COVID-19 are available to read here.
Enhancements to Member Coverage
Effective March 15, 2020, through December 31, 2021 (subject to review), USHL is waiving all deductibles, copays, member cost-sharing and prior authorization requirements for COVID-19 diagnostic testing related to the worldwide outbreak of the novel coronavirus disease.
Also, USHL is waiving all out-of-pocket costs for members who receive inpatient treatment for COVID-19 at in-network and out-of-network locations.
Visits related to COVID-19 provided at a physician office, clinic, urgent care or emergency department will be covered at 100%, without member cost-sharing.
Laboratory charges directly related to COVID-19 testing will be covered at 100% with no member cost-sharing, regardless of whether the testing occurs at a physician’s office, clinic, urgent care or emergency department.
For out-of-pocket costs related to inpatient treatment, all locations will be regarded as being in-network locations.
Inpatient treatment of COVID-19 will be covered at 100% without member cost sharing.
Charges not related to COVID-19 treatment, hospitalization or other care will continue to be covered according to the plan documents. Members with questions about their coverage and benefits should refer to plan documents for details and contact customer service with any questions.
No prior authorization for COVID-19 testing or inpatient admissions
There are no prior authorization requirements for members to receive COVID-19 testing or for COVID-19 or suspected COVID-19 inpatient admissions. For more information about prior authorization, please visit the prior authorization page.
In an effort to help our members avoid exposure to germs, USHL is also allowing 90-day refills on any necessary medications.
USHL is covering telehealth services, which can also help our members avoid germs.
With telehealth benefits, members can call and receive medical consultations via telephone with their doctors, clinics and other health care providers the same as if members made a visit to a doctor’s office in person.
Telehealth benefits allow members to receive a wider range of medical services remotely, without having to travel to a doctor’s office, clinic, hospital or other medical facilities.
A telehealth “visit” would be covered under the current schedule of benefits – including the benefit changes for COVID-19 – and a member should consult their current benefits information to learn about what cost-sharing would apply to the visit.
If a member needs care due to COVID-19, they should contact their Primary Care Provider (PCP), a clinic or urgent care facility. Members should be encouraged to contact their PCP for care, direction and guidance as not to place an unnecessary burden on emergency department resources.
We are also providing information about steps we as a company are taking to protect members and clients during this pandemic, including what we are doing for avoidance measures, communication and continuation of services to you, our clients, as this document details.
Changes for Employers Relating to COVID-19
US Health and Life (USHL) is sensitive and aware of the needs of our groups during this difficult time. We have made some additional accommodations to address these concerns by extending our grace period for premium payment and extending coverage to laid-off or furloughed employees. These changes are in effect immediately and will be re-evaluated in 90 days.
Extending grace period to 60 days for premium payments
USHL is extending the Grace Period for premium payment from 30 to 60 days.
Employers will continue to receive monthly invoices
USHL will continue to perform ACH pulls at the same time of the month as the current invoicing process
If an ACH pull rejects as NSF, USHL will contact the employer to verify the banking information as well as determine their intent to pay the invoice or take advantage of the extended grace period
USHL will not term a group for non-payment of premium sooner than 60 days from the due date
Groups and agents will continue to receive late notices for past due premium as the account approaches 60 days delinquent
Covering laid off or furloughed employees
USHL will continue to provide coverage for employees that are laid-off or furloughed during this crisis
Employers who have laid-off or furloughed employees may continue to cover them under their group policy
USHL will only remove an employee or dependent if the employer requests USHL to terminate them from the plan
If the employee is laid-off or furloughed during this crisis, the employer does not need to change their enrollment status other than to terminate the employee, add dependents or terminate dependents
The employer must continue to pay all premiums associated with members covered under the plan
Changes based on IRS guidance
These plan changes have been based upon the IRS allowing employers to cover all diagnostic and treatment costs associated with COVID-19 without meeting an HDHP deductible and without denying plan members’ and employees’ contributions to Health Savings Accounts (HSA). This information was published by the IRS as Notice 2020-15, at https://www.irs.gov/pub/irs-drop/n-20-15.pdf.
IRS and Department of Labor changes to timely filing and various notice time limits
Recognizing the difficulties faced by plan sponsors, administrators, and participants during the COVID-19 emergency, the Department of Labor and IRS issued a joint notice extending timelines for group health plans covered by ERISA. Health and Human Services (HHS) has announced it will extend similar relief to non-federal governmental health plans. The guidance broadly extends numerous plan deadlines applicable to participants and administrators. Deadlines mentioned below cannot be enforced and will not be able to be enforced until 60 days after the end of the National Emergency declared by President Trump.
COBRA: Multiple COBRA deadlines have been extended until after the outbreak period ends, including:
30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event;
60-day deadline for individuals to notify the plan of a determination of disability;
14-day deadline for plan administrators to furnish COBRA election notices;
60-day deadline for participants to elect COBRA; and
45-day deadline in which to make a first premium payment and 30-day deadline for subsequent premium payments.
HIPAA Special Enrollment: The 30- and 60-day HIPAA special enrollment periods are extended. 30-day special enrollment periods may be triggered when eligible employees or dependents lose eligibility for other health plan coverage in which they were previously enrolled, and when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption. 60-day special enrollment periods may be triggered by changes in eligibility for state premium assistance under the Children’s Health Insurance Program (CHIP).
Claims Procedures: The deadlines are extended for individuals to file claims for benefits, for initial disposition of claims, and for providing claimants a reasonable opportunity to appeal adverse benefit determinations under ERISA plans and non-grandfathered group health plans. Group health plans and disability plans generally must allow at least 180 days* in which to appeal.
External Review Process: Non-grandfathered group health plan deadlines have been extended for providing a state or federal external review process following exhaustion of the plan’s internal appeals procedures. State deadlines may vary; plans using a federal external review process must allow at least four months after the receipt of a notice of adverse benefit determination in which to request an external review. Other deadlines* that apply for perfecting an incomplete request for review are also extended.
Furnishing Notices: Plans and responsible plan fiduciaries will not be treated as having violated ERISA if they act in good faith and furnish any notices, disclosures, or documents that would otherwise have to be furnished during the outbreak period (including those requested in writing by a participant or beneficiary) “as soon as administratively practicable under the circumstances.”
Form 5500: The notice confirms that Form 5500 filing relief is provided in accordance with IRS guidance, which provides that filings otherwise due on or after April 1, 2020, and before July 15, 2020, are now due July 15, 2020. In addition, the notice provides relief for Form M-1 filings for the same period.