Frequently Asked Questions
July 10, 2020
Symetra is closely following the Coronavirus Disease 2019 (COVID-19) pandemic. We want to assure you that our operations are functioning and we are available to assist with the current and future needs of you and your employees.
Below are answers to some of the most common questions being asked about how COVID-19 affects basic and supplemental life, short- and long-term disability, absence management, critical illness/specified disease, accident, GapAssist, hospital indemnity and fixed-payment plans.
[New] Does Symetra fixed-payment insurance cover COVID-19 testing at 100%?
Our fixed-payment insurance policies are not considered “group health plans” or “group health insurance coverage” under the FFCRA. Therefore, these plans will not cover the costs associated with COVID-19 testing at 100%, but will continue to pay according to your plan's schedule of benefits.
[New] Does fixed-payment insurance cover quarantine in a military base or temporary state housing as an `inpatient hospital stay?'
To be covered, the quarantine must take place in a “health care facility” (hospital, hospital ICU or licensed nursing facility) and there must be a charge for room and board.
[Updated] What measures are in place to continue benefits for employees who lose their group coverage as a result of COVID-19?
We are willing to maintain coverage on employees who become ineligible solely for one or more of the following reasons as a result of the COVID-19 crisis:
- Not working enough hours to meet "minimum number of hours" requirements
- Being temporarily laid off
- Taking a leave of absence
- Changing from full-time to part-time status
Symetra can maintain this coverage until the earlier of:
- 120 days from the date employee would have otherwise become ineligible, or
- September 30, 2020
For example, if an employee was temporarily laid off on April 1, 2020 due to COVID-19, coverage can be continued until July 30, 2020. If an employee was temporarily laid off on July 1, 2020, coverage may be continued until September 30, 2020. Please note that we will follow the continuation provisions of the group policy if they are more generous than what's listed above.
Premium will still be due for these employees for all periods during which coverage is in-force, although the due date for such premium may be extended, as discussed in these FAQs. We also require that employers treat all eligible employees consistently with regard to continuing coverage that would otherwise lapse.
Please note that employees who are terminated will lose coverage unless the coverage is continued in accordance with the policy. As a reminder, you should offer conversion rights, portability (if applicable) or other extension of coverage benefits to all employees once they lose their coverage. Standard policy conversion and portability timeframes and rules will apply.
To request COVID-related continuation of coverage as noted above, please contact your Symetra Account Manager.
How will Symetra handle employees whose coverage has not yet become effective due to the impacts of COVID-19? For example: 1. If the group policy became effective on April 1, will employees who were temporarily laid off on that date still have coverage? 2. If an employee elected coverage that would have become effective on April 1, but they were temporarily laid off prior to that date, is that employee still covered?
If an employee's coverage did not become effective due to:
- Not working enough hours to meet "minimum number of hours" requirements,
- Being temporarily laid off,
- Taking a leave of absence or
- Changing from full-time to part-time status,
as a result of COVID-19, then we are willing to consider the employee covered as of the date coverage would have otherwise become effective. Symetra will treat this coverage as effective through June 1, 2020, or in accordance with the continuation provisions in the group policy if those provisions are more generous. After this time, coverage will terminate for any employee who does not return to work in an eligible class.
Premium will still be due for these employees for all periods during which coverage is in-force, although the due date for such premium may be extended, as discussed in these FAQs. We also require that employers treat all eligible employees consistently with regard to considering such coverage as effective. To request coverage for your employees as described above, please contact your Symetra Account Manager.
A covered individual is diagnosed with exposure to COVID-19, and/or is showing flu-like symptoms, and has been quarantined by a medical professional. Are they considered disabled according to the group disability policy, and/or does the medical condition meet the definition of a serious health condition per federal and state leave regulations?
Each claim related to COVID-19 will be evaluated on its own merits. This review will include, at minimum, the severity of the symptoms and the ability of the person to continue working while quarantined. For federal and/or most state medical leaves, the individual’s doctor must first certify this as a serious health condition for Symetra to make a determination.
Employees in New York who are under a mandatory or precautionary order of quarantine or isolation issued by the state of New York, the Department of Health, a local board of health, or any government entity authorized to issue such an order as a result of COVID-19, or providing care for a minor dependent child who is subject to a quarantine order, may be eligible for paid sick leave and/or COVID-19-related benefits under New York’s Disability Benefits Law and Paid Family Leave Law.
A covered individual is showing flu-like symptoms and has self-quarantined without consulting a physician. Are they considered disabled according to the group disability policy, and/or does the medical condition meet the definition of a serious health condition per federal and state leave regulations?
As with any claim, Symetra requires supporting documentation from a health care provider in order to pay disability benefits. For federal and/or state medical leaves, the individual’s doctor must certify that the individual has a serious health condition before Symetra can approve leave.
A covered individual is quarantined, but still working. Are they considered disabled according to the group disability policy, and/or does the medical condition meet the definition of a serious health condition per federal and state leave regulations?
This would not be considered a disability or a continuous leave, because the person is working and is not experiencing an income loss. However, they may qualify for intermittent leave due to necessary medical treatment.
A covered individual is quarantined as a preventive measure, but shows no symptoms and has not been diagnosed with exposure to COVID-19. Are they considered disabled according to the group disability policy, and/or does the medical condition meet the definition of a serious health condition per federal and state leave regulations?
No. In order to be eligible for disability benefits, the individual must be unable to perform work duties as the result of a medical condition. For federal and/or state medical leaves, the individual’s doctor must certify that the individual has a serious health condition before Symetra can approve leave.
A covered individual is unable to work because they need to care for a family member who has been diagnosed with exposure to COVID-19, and/or is showing flu-like symptoms. Does the medical condition meet the definition of a serious health condition for eligible state paid family leave?
The family member’s doctor must certify that the family member has a serious health condition before Symetra can approve paid family leave.
A person is at home caring for a family member who is showing flu-like symptoms. The family member has not consulted a physician. Does the medical condition meet the definition of a serious health condition for eligible state paid family leave?
No. The family member’s doctor must certify that the family member has a serious health condition before Symetra can approve paid family leave.
Does Symetra’s group life policy exclude, or limit, any of a covered individual’s benefits if they contract and pass away from COVID-19 after traveling to a country for which the CDC has issued a travel health notice?
No. Symetra’s group life insurance policy does not have any such limitations or exclusions.
A covered employee is quarantined for two weeks (14 days) as a result of a COVID-19 diagnosis. During the quarantine period, they use vacation or sick time so there is no income loss and therefore they are not considered disabled at that time. However, they are still sick after the two weeks, unable to return to work, and therefore apply for short-term disability benefits. Do the quarantine days count towards the elimination period?
Yes. This is like any other condition where an employee chooses to use sick time or paid time off (PTO), and that counts towards the elimination period.
What resources are available to support our employees?
Your Symetra group disability policy includes access to programs that can help employees during this challenging time.
- Employee Assistance Program (EAP): Employees can talk to a trained counselor over the phone for confidential assistance with challenges like finding child or elder care; or dealing with stress, anxiety or depression.
- Health care navigation: Available to employees on covered disability claims, this program provides access to resources to help with things like treatment cost estimates, claims and billing issues.
Are COVID-19 tests covered under the critical illness policy optional health screening benefit, and/or the scheduled benefit accident policy wellness sreening benefit rider?
COVID-19 screening is considered an eligible test under a Symetra scheduled benefit accident and/or critical illness policy. If your plan includes health screening/wellness benefits, then employees enrolled in these coverages who undergo a COVID-19 screening test are eligible to receive these benefits as outlined in your group policy.
If an employee's coverage was terminated due to a COVID-19-related layoff, furlough, reduction in hours, or change in status from full-time to part-time, are they able to reinstate coverage without being treated as a new entrant?
For employees whose coverage terminated on, or before, September 30 2020, we will allow them to reinstate coverage upon becoming eligible again for the same amounts that were in-force on the date their coverage terminated, provided that the following criteria are met:
- The employee becomes eligible again within 6 months of the coverage termination date
- Symetra has received all premium for all periods during which coverage was provided
- The employer provides documentation verifying that the employee was properly enrolled on the date coverage was originally terminated
Reinstated coverage is not subject to any new waiting periods or evidence of insurability requirements as long as the requested coverage amount is the same as the amount that was in-force on the date coverage ended. However, any preexisting condition limitation, or benefit waiting period, will apply to the same extent it would have applied before coverage was terminated.
It's important to note that if your group policy has a more generous reinstatement provision than the accommodation described above, then that provision would apply to any eligible employees.
What is the grace period if I am unable to pay premium on time?
We understand the COVID-19 pandemic may affect your ability to make timely payments on your Symetra coverages. Recognizing this, for premiums due in March, April, May, June or July 2020, we will extend the period to 90 days from the due date, inclusive of any premium grace period already included in the policy. As an example, since premiums are due on the first day of the month, April premiums usually due on April 1 are now due on June 30.
If repayment of these “deferred” premiums will result in a financial hardship, we will allow repayment in installments. Please work with your Symetra representative if you would like to repay the deferred premium using an installment plan.
As the COVID-19 situation changes on a daily basis, we will monitor our premium grace period policy and advise if future adjustments are needed. Be advised that we are also following any state-issued mandates regarding premium grace periods and will be communicating those regulated processes to you separately.
The 90-day premium grace period applies to the following Symetra group benefit products:
- Basic and supplemental life
- Short- and long-term disability
- Critical illness/specified disease
- Fixed-payment plans
We will continue to monitor the situation and will keep you updated on new information from states or other legislative bodies. If you have questions, or need assistance, please contact your Symetra Account Manager.
Is your claim review process affected with teams working remotely?
There is currently no interruption in claim service because of an increase in the number of people working remotely.
With remote work in place for most teams, what measures are in place to protect claimant medical history and other protected information?
All employees use a secure VPN connection when accessing Symetra systems remotely. All printed material, including claim correspondence, is sent to a secure Symetra facility.
We self-insure our short-term disability plan. Can we request special handling for COVID-19 related claims?
Yes. You can exercise “reservation of authority” to circumvent the medical merit piece of the plan’s definition of disability and approve claims. Please contact your Symetra Account Manager if you would like to request changes to claims handling.
As my FMLA administrator, how will Symetra support the new Emergency Paid Sick Leave Act?
The Emergency Paid Sick Leave Act generally requires most private employers with fewer than 500 employees --and most public employers --to pay up to 80 hours of sick pay to employees with COVID-19-related absences. Because we do not directly administer sick pay programs, we will not track leaves or administer sick pay under the Emergency Paid Sick Leave Act. We will, however, administer any FMLA claims associated with COVID-19, including leaves that qualify as “Public Health Emergency Leave” under the new Emergency Family And Medical Leave Expansion Act.
Our group uses Symetra for FMLA administration. How will you support our employer responsibilities under the new Emergency Family and Medical Leave Expansion Act?
The Emergency Family and Medical Leave Expansion Act generally requires private employers with fewer than 500 employees—and most public employers—to provide up to 12 weeks of job-protected leave and up to 10 weeks of paid benefits if an employee cannot work due to the need to care for a child because of COVID-19-related school and daycare closures. This special type of FMLA leave is referred to as “Public Health Emergency Leave” and will be administered as part of our usual FMLA Absence Management Program services.
How will Symetra support changes to New York's Disability Benefits Law (DBL) and Paid Family Leave (PFL)?
New York DBL and PFL laws now provide job-protected sick leave and compensation to employees who are under a qualifying mandatory or precautionary order of quarantine or isolation. For employees working at companies with fewer than 100 employees, a portion of this compensation is payable through COVID-19-related DBL and PFL benefits. Because all of Symetra's existing DBL/PFL customers have 100 or more employees, these employees will not qualify for these COVID-19-related DBL or PFL benefits.
PFL benefits are also available for eligible employees who have a minor dependent child under a qualifying mandatory or precautionary order of quarantine or isolation. These PFL benefits are available for the duration of the quarantine/isolation.
New Jersey recently modified its Temporary Disability Benefit (TDB) law to support the current COVID-19 crisis. How will Symetra support these changes?
Changes to the New Jersey TDB law waive the benefit elimination period for COVID-19-related illnesses and now mandate coverage in circumstances of quarantine. Our claim system has been updated to support these changes.
What is Symetra's response to the expansion of Oregon's family leave program to include school and daycare closures?
The state of Oregon has expanded its family leave program to include absences related to care of an employee's child whose school or place of care has been closed in conjunction with a statewide public health emergency declared by a public health official. Symetra has implemented procedures and training to administer this expanded leave as part of our absence management services.
Federal and state governments are monitoring the COVID-19 situation and making updates to mandated benefits. We are tracking this regulatory environment and have updated information about the Families First Coronavirus Recovery Act (FFCRA) and other state leaves.
Please contact your Symetra representative for more information.
Symetra® is a registered service mark of Symetra Life Insurance Company.
The virus to which individuals are exposed is SARS-CoV-2. The disease it causes is COVID-19. For readability, these questions and answers use the term “COVID-19.” Where appropriate, readers should read COVID-19 as the SARS CoV-2 virus.
Symetra Life Insurance Company is a direct subsidiary of Symetra Financial Corporation. First Symetra National Life Insurance Company of New York is a direct subsidiary of Symetra Life Insurance Company and is an indirect subsidiary of Symetra Financial Corporation (collectively, “Symetra”). Neither Symetra Financial Corporation nor Symetra Life Insurance Company solicits business in the state of New York and they are not authorized to do so. Each company is responsible for its own financial obligations. Group benefits are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004. Not available in any U.S. territory. In New York, group benefits are insured by First Symetra National Life Insurance Company of New York, New York, NY. Mailing address: P.O. Box 34690, Seattle, WA 98124. EAP and health care navigation programs are not available in all states.