Stop Loss Updates
June 3, 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?
Symetra is offering the COVID-19 Deductible Savings Endorsement with all Symetra Stop Loss policies with effective dates from January 1—December 31, 2021 in approved states. Offered at no additional cost, this endorsement provides an opportunity for a reduced Specific deductible when a covered claimant has a primary diagnosis of COVID-19. For details, including state availability, contact your Symetra representative.
What is the grace period if I’m unable to pay premium on time?
We understand the COVID-19 pandemic may impact your ability to make timely payments on your Symetra coverage. Recognizing this, for premiums due in March, April, May, June or July 2020, we will extend the date your premium is due by one month—or longer, if required by state mandates. For example, premium due on April 1 is now due May 1, plus the grace period as outlined in your policy.
For premium due on or after August 1, 2020, the grace period extensions will end and the grace period set forth in the Stop Loss Policy will apply.
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.
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?
For policies with 2020 effective dates, Symetra will continue coverage under the stop loss policy for claims from employees and eligible dependents that no longer meet the plan’s eligibility requirements as a result of the impact of COVID-19 on the employer’s workforce (including claims from employees experiencing a furlough or reduction in hours), provided that the employer continues to treat such employees as eligible under the plan, and premiums for such employees continue to be paid.
We are not requiring the employer to amend their plan document mid-year to continue this coverage. However, the plan document must be updated for the following plan year.
Will changes in enrollment have an impact on aggregate coverage?
For employers that have purchased aggregate coverage, please note that enrollment changes in your plan (including enrollment changes due to the impact of COVID-19) affect the calculation of the aggregate attachment point, which in turn affects whether an aggregate excess loss benefit becomes payable under the policy. If you have any questions about how enrollment changes in your plan could impact your aggregate coverage, please contact your Symetra stop loss representative.
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?
At this time, Symetra will not extend stop loss coverage for employees or dependents that were permitted to enroll in the plan through a midyear election, including a midyear election that complies with Notice 2020-29. Midyear election changes currently allowed by the plan and by applicable Treasury Regulations (for example, when an employee experiences a "life event" such as a marriage, birth, adoption of a child, and various employment status changes) will continue to be permitted.
We will continue to monitor developments in this area and advise if future adjustments are needed. If you have questions about how a potential amendment to your plan could impact your stop loss coverage, please contact your Symetra stop loss representative.
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?
On March 31, 2020, the U.S. FDA launched a program designed to expedite the development of potentially safe and effective life-saving COVID-19 treatments. The program is known as the Coronavirus Treatment Acceleration Program (CTAP). The program's goal is to bring new therapies to sick patients as quickly as possible, while at the same time supporting research to further evaluate whether these medical countermeasures are safe and effective for treating patients infected with the virus.
For policies with 2020 effective dates, if an employer accepts experimental COVID-19 treatment options as covered expenses under the plan, Symetra will accept the charges as covered expenses under the stop loss policy; the plan document must be updated to include such therapies and treatments for the next plan year. The treatment options must be provided in accordance with the FDA's Coronavirus Treatment Acceleration Program (CTAP) guidelines that are in effect at the time of administering the treatment in order to be covered by the stop loss policy. The employer may choose to amend its plan to cover such treatment options, but Symetra will not require an amendment as a condition of extending stop loss coverage until the next plan year.
Can we suspend the waiting period so that new enrollees in the plan can be covered immediately?
An employer that wants to shorten or eliminate the waiting period for new enrollees under the plan may accomplish this through a plan amendment. Symetra will approve any plan amendment of this nature without changing any other terms of the stop loss policy. If the plan amendment has a retroactive effective date, premiums for the stop loss coverage in respect of the new enrollees will be due from the respective enrollment dates. Please note that claims in respect of any employee who has not completed the waiting period under the plan (as amended) will not be covered under the stop loss policy.
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”)?
Symetra will accept all extensions of timeframes that are required by Notice 2021-01 without a plan amendment, a change in premiums during the policy period, or any further action on the part of the employer. Please note, however, that Symetra will not accept the extension of any timeframe beyond the period required by Notice 2021-01. Specifically, Symetra will not accept the extension of the timeframe applicable to any individual beyond the earlier of:
- The date that is one year from the date that the individual was first eligible for relief; or
- The date that is 60 days after the announced end of the COVID-19 National Emergency.
Will Symetra accept COBRA enrollments required by the American Rescue Plan Act?
Symetra will accept all COBRA enrollments required by the American Rescue Plan Act (“ARPA”) without a plan amendment, a change in premiums during the policy period, or any further action on the part of the employer. Please note that upon receipt of a stop loss reimbursement request, Symetra will verify the supporting documentation applicable to each individual enrolled under COBRA. Reimbursement requests with respect to any individual who is not eligible to enroll for COBRA under ARPA, and not otherwise eligible for or properly enrolled under COBRA, will not be covered under the stop loss policy. The stop loss policy's eligible claim period will still apply; if an individual retro enrolls and claims are paid outside of the eligible claim period, those claims will be denied.
If you have any questions or need additional assistance, please contact your Symetra stop loss representative.