Stop Loss Updates

May 20, 2020

Symetra is closely following the Coronavirus Disease 2019 (COVID-19) pandemic. We want to reassure you that our operations continue to deliver the quality service that you expect from us during this critical time. In alignment with Symetra’s guiding principles of Value, Transparency and Sustainability, we are implementing the following practices, effective retroactively to March 1, 2020:

COVID-19 Diagnostic Testing and Treatment

Symetra will not require employers to amend their plan documents in order to implement the following changes:

  • Waiving deductible and/or out-of-pocket charges for:
  • COVID-19 testing (including serological tests to detect antibodies) and treatment
  • Telemedicine or virtual doctor visits
  • Waiving prior-authorization requirements on diagnostic testing of COVID-19 that may have otherwise applied
  • Paying for out-of-network COVID-19 testing as in-network lab claims, if access for in-network COVID-19 testing is unavailable
  • Allowing early refills of prescription medications

Symetra will accept these charges as “covered expenses” under the stop loss policy, and will not require mid-year changes to aggregate factors or premiums.

In addition to these updates, below are answers to some of the most common questions being asked about how COVID-19 may affect Symetra stop loss coverage.


Frequently Asked Questions

What is the grace period if I’m unable to pay premium on time?

Will Symetra continue coverage under the stop loss policy claims from employees that no longer meet the plan's eligibility requirement as a result of the impact of COVID-19?

Will changes in enrollment have an impact on aggregate coverage?

Under Notice 2020-29, the Internal Revenue Service is providing increased flexibility to section 125 cafeteria plans during the calendar year 2020, including allowing employees who previously declined coverage to enroll in employer provided health coverage. If an employer amends its Plan to allow employees to make midyear election changes pursuant to Notice 2020-29, will Symetra extend coverage under the stop loss policy to these newly-enrolled individuals?

Are the COVID-19 experimental treatments, such as the FDA's authorization of the emergency use of drugs, devices and therapies considered "covered expenses" under the policy?

Can we suspend the waiting period so that new enrollees in the plan can be covered immediately?

If you have any questions or need additional assistance, please contact your Symetra stop loss representative.