Minimum Essential Coverage (MEC) and MEC-Select Plans
Frequently Asked Questions
Updated April 21, 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 Minimum Essential Coverage (MEC) and MEC-Select plans.
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 or May 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.
If you have questions or need additional assistance, please contact your Symetra representative or call 1-800-497-3699.
What measures are in place to continue benefits for employees who lose their group coverage as a result of COVID-19?
Symetra is committed to partnering with our employer customers and your employees who may lose coverage because of the impact of COVID-19. As a reminder, your Select Benefits Fixed-Payment Insurance Policy has continuation of coverage provisions that cover employees in the event of a temporary layoff or illness/injury, as long as the required contribution or premium is paid. Specifically:
If an employee is temporarily laid off or on a leave of absence, they may continue receiving coverage for at least two months following the date they were last actively at work.
If an employee is unable to work due to an injury or illness, including COVID-19, they may continue receiving coverage for at least six months following the date they were last actively at work.
Your policy may have longer durations than the examples above. Contact your Symetra representative for your exact duration.
Is your claim review process affected with teams working remotely?
We expect 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.
If a covered individual was not at work on their coverage effective date, or on the effective date of an increase in coverage because they were quarantined, are they still eligible for the new or increased coverage?
Eligibility for new or increased coverage depends on whether the covered individual was ill and whether they had the ability to perform their occupation remotely during a period of quarantine.
Do Minimum Essential Coverage (MEC) plans have to cover the cost of COVID-19 testing at 100%?
Under the Families First Coronavirus Response Act (FFCRA), MEC plans are required to cover, with no cost-sharing to the member, items and services provided to a member during health care provider office visits that result in an order for, or administration of, COVID-19 testing. This includes in-person visits, telehealth visits, urgent care center visits and emergency room visits.
Does the MEC plan document need to be amended to include COVID-19 testing?
Symetra will administer this mandated coverage without a plan amendment, but we recommend that plan sponsors amend their plans. Symetra will make an amendment available.
Do members covered under a MEC plan have to visit a network provider for COVID-19 testing?
The FFCRA does not require services related to COVID-19 testing be performed by a network provider.
Will the Select Benefits Fixed-Payment Insurance policy cover COVID-19 testing at 100%?
Select Benefits 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 the certificate’s Schedule of Benefits.
Will the Select Benefits Fixed-Payment Insurance policy 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 “healthcare facility” (Hospital, Hospital ICU Licensed Nursing Facility) and there must be a charge for Room and Board.
Select Benefits policies, insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, are not available in all U.S. states or in any U.S. territory. They are not a replacement for major medical or other comprehensive coverage and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions. For costs and complete details of the coverage, contact your Symetra representative.