In relation to honoring not excluding testing costs etc. without formal Plan Amendments, Amalgamated Life will follow the rules of the underlying plan document.

However, they will still need to be advised of any changes to the Plan document and Plan provisions. Amalgamated will apply a 60 day limitation to retroactively notify them of a change in the plan provisions

If a Plan needs to be amended or the state requirement mandates an amendment, the changes will be accepted in writing with commitments of a plan amendment asap at the end of the state of emergency. The day limitation to retroactively notifying them of a change in Plan provisions still applies.

As it relates to what happens to a Policy if a client lays off some of a work force due to COVID-19, Amalgamated will not enforce the change in membership provision in all coverages that have said provision. If all are laid off, as long as premium is being remitted on behalf of these individuals and the underlying Plan is continued, the policy will remain in effect.

If an employee is laid off and returns to work after not electing COBRA, waiting periods would be determined and imposed by the Plan Document. Amalgamated Life would follow the underlying Plan Document.

During COVID-19 crisis, Amalgamated agrees not to re-underwrite the laid-off employees as they return to work. Standard renewal underwriting procedures will be followed.

Our general stance is that we will comply with all state and federal mandates but any plan changes must be communicated in advance in writing.

If the plan sponsor maintains coverage for these employees under the plan, they would be covered under the stop loss contract. Amalgamated Life needs to be notified of these eligibility exceptions during the crisis, as well as at time of claim if the claimant is to be considered eligible by the plan.

It would be in the policyholder's best interest to amend the plan even if temporary. Amalgamated will apply a 60 day limitation to retroactively notify them of a change in the plan provisions.

Amalgamated will forgo “wet” signatures on policy forms, applications etc. and use confirmation emails until such time as people get back to work.

However, Amalgamated Life will require two separate authorizations via email with the attachments included, or a confirmation via phone call.

As it relates to paying claims without some documentation that would normally be received due to effected entities, Amalgamated Life will continue to adhere to the current processes and applicable rules as they existed prior to this COVID-19 outbreak. However, timely claim filing requirements will be waived for up to 60 days, or longer if required by law or regulation.

Amalgamated Life will follow all federal and state mandates that address catch up on premiums and extensions of grace periods.

Amalgamated Life Insurance Company COVID-19 Questions and Answers
April 7, 2020

At Amalgamated Life Insurance Company, we are closely monitoring the impact of COVID-19 and are committed to supporting our clients during these uncertain times.  We are striving to be as flexible as possible but we must abide by state and federal regulations.  Please take the opportunity to read the below list of questions and answers on how we are currently handling exceptions during this pandemic.

Plan document and eligibility questions - Stop Loss

• Will you as a carrier honor not excluding testing costs etc. without doing formal plan amendment or would we have the ability to do a retroactive plan document amendment at the conclusion of the crisis.  How will other and potentially future government mandates be handled?
  • Response:  Amalgamated Life Insurance Company will follow the rules of the underlying plan document.  However, we will need to be advised of any changes to the plan document and plan provisions.  We will apply a 60 day limitation to retroactively notify us of a change in the plan provisions.
  • We will honor not excluding testing costs etc. without doing a formal plan amendment, however this must be administered by the plan for all covered individuals as we do not administer 1st dollar claims.  We will apply a 60 day limitation to retroactively notify us of a change in the plan provisions.
• For any other plan changes that may be occurring to deal with this crisis, would you accept these changes in writing without a signed plan document change until the end of this state of emergency?
  • Response: If the need to amend the plan or the state requirement mandates etc. the changes will be accepted in writing with commitments of a plan amendment as soon as possible.  We will apply a 60 day limitation to retroactively notify us of a change in the plan provisions.
• What happens to a policy if a client lays off more than 10% of my work force due to COVID-19?
  • Response: During the crisis, we will not enforce the change in membership provision in all our coverages that have this provision.
• What happens to a policy if a client has to lay off or furlough all of my work force due to COVID-19?
  • Response: If premium is being remitted on behalf of these individuals and the underlying plan is continued, then the policy will remain in effect.
• Would a waiting period or new underwriting guidelines apply for any current employees who were laid off, then return to work if they do not choose Cobra?
  • Response:  Waiting periods are determined and imposed by the plan document.  We would follow the underlying plan document.  During the crisis, we agree not to re-underwrite the laid off employees as they return to work. Standard renewal underwriting procedures will be followed.  
• How would you view claims from employees who are not actively at work because they have no scheduled shifts?
  • Response:  If the plan sponsor maintains coverage for these employees under the plan, they would be covered under the stop loss contract.  Amalgamated Life Insurance Company needs to be notified of these eligibility exceptions during the crisis, as well as at time of claim if the claimant is to be considered eligible by the plan. It would be in the policyholder’s best interest to amend the plan, even if temporarily.  We will apply a 60 day limitation to retroactively notify us of a change in the plan provisions.
• Will clients need to amend plan documents to include a temporary layoff provision if one does not exist or could this be done retroactively?  These employees are typically not being terminated but are essentially being furloughed until their business can re-open.  Most of our client employers seem to want to be able to continue coverage without interruption during this time. 
  • Response:  If the plan sponsor maintains coverage for these employees under the plan, they would be covered under the stop loss contract.  Amalgamated Life Insurance Company needs to be notified of these eligibility exceptions during the crisis. We will apply a 60 day limitation to retroactively notify us of a change in the plan provisions.
• If a Stop Loss client adds a mid-year open enrollment to their plan, will you cover those individuals under your Stop Loss policy?
  • Response:  Individuals who previously waived coverage in any of the plan sponsor medical plans and enroll during the special open enrollment period will not be considered eligible under the Stop Loss Policy.
  • The plan sponsor can cover them in the self-funded plan but their claims will not be considered eligible under our stop loss policy. The decision is based on the fact that our reinsurer will not cover these individuals. We also suggest you seek outside counsel, as this may also be a violation of Section 125 regulations.
• Are you willing to make any adjustments to the right to change any Specific Premium or Aggregate Premium Rates and Monthly Aggregate Factors and the Minimum Annual Aggregate Deductible provisions in the Stop-Loss policy based on decreases in enrollment that may occur as a result of COVID-19?
  • Response:  We understand that many employers are looking for additional flexibility as a result of the Covid-19 pandemic. In response, we are adjusting our threshold regarding our right to re-calculate and the Minimum Annual Aggregate Deductible provisions. For 1/1/2020-4/1/2020 effective date cases, decreases in enrollment of up to 15% of covered lives that occur between 3/1/20 and the policies' renewal date will not be subject to mid-policy period recalculations of rates, deductibles, or factors as a result of the change.  For 1/1/2020 cases that have decreases in enrollment greater than 15%, please refer to the provisions included in the stop loss policy. For cases with 5/01/2020 effective dates, moving forward policy thresholds will be amended on a case by case basis at time of renewal.
  • We will also amend our Minimum Annual Aggregate Deductible provisions to reflect up to a 15% decrease in enrollment from 4/1 forward.
  • Please note decreases in enrollment include only those employees whose coverage under the plan has been terminated and not enrolled in COBRA. In order to address specific client situations please contact your carrier representative.
• Can you confirm that you are willing to be compliant with all emerging state mandates regarding health benefit plans that may impact stop loss policy administration, even if you are not releasing a state specific update to the market? 
  • Response:  If the mandate is inclusive of Stop Loss policies then yes. 
• It appears that at least a few of the BUCA administrators are now waiving cost shares for inpatient hospital admissions on the their fully insured business and giving the option to self-funded side as well.  https://www.modernhealthcare.com/insurance/aetna-waives-cost-sharing-covid-19-inpatient-hospital-admissions.  If a policyholder agrees to this change how will your stop loss policies react? What type of prior notification do you need if a client chooses to implement this policy?
  • Response:  Amalgamated Life Insurance Company needs to be notified of these changes in plan design and eligibility rules. It would be in the policyholders' best interest to amend the plan even if temporary. We will apply a 60 day limitation to retroactively notify us of a change in the plan provisions.
• For clients that offer multiple plan designs. Would the carrier be open to allowing a special period in which enrolled individuals were given the opportunity to change plans mid-year?  The purpose of this is for people on low deductible high co-insurance plans to be able to choose a more cost effective plan for them. For example: a high deductible health plan. 
  • Response:  Amalgamated Life Insurance Company needs to be notified of these changes in plan design and eligibility rules. It would be in the policyholders' best interest to amend the plan even if temporary.

                   We will apply a 60 day limitation to retroactively notify us of a change in the plan
                   provisions. We will still be governed by state and federal mandates.