Stop Loss Updates

June 21, 2021

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 mid-year in order to implement the following changes to policies with 2020 effective dates:

  • 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. Any plan changes that will continue into the following plan year must be included in the plan document.

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

How is Symetra supporting policyholders that are impacted by large COVID-19 claims?

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

Will Symetra continue to cover stop loss claims under the policy for plan members who no longer meet the plan's eligibility requirements as a result of the impact of COVID-19?

Will changes in enrollment have an impact on aggregate coverage?

Under Notices 2020-29 and 2021-15, the Internal Revenue Service is providing increased flexibility to section 125 cafeteria plans during limited timeframes outlined in each notice, including allowing employees who previously declined coverage to enroll in the employer provided health coverage. If an employer amends its Plan to allow employees to make midyear election changes pursuant to Notices 2020-29 and/or 2021-15, will Symetra extend coverage under the stop loss policy to those 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?

Will Symetra accept an employer's or administrator's extension of timeframes as required by EBSA Disaster Relief Notice 2021-01, issued on February 26, 2021 (“Notice 2021-01”)?

Will Symetra accept COBRA enrollments required by the American Rescue Plan Act?

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