Phase 2 Highlights: Reopening Plan for Massachusetts
Residents can now begin to receive routine in-office medical care, according to guidance from the Massachusetts Executive Office of Health and Human Services (EOHHS). On June 8, EOHHS announced that health care providers may resume in-person elective, non-urgent procedures and services, this includes routine office visits. However, providers must remain in compliance with current public health and safety standards. While EOHHS recommends that patients no longer defer necessary care, the emphasis remains on telehealth as the preferred means of providing that care. For the full Phase 2 Reopening Plan, visit here. Health New England updates are below on: “Do you need to talk to a doctor” section.

COVID-19 Frequently Asked Questions – For Employers


Last Updated 8/12/2020


Health New England continues to monitor the spread of coronavirus (COVID-19) on behalf of our members, employers, providers and brokers. As information is constantly changing, this page will be the best source for updated information—know that we are working through business decisions as quickly as possible to ensure we are meeting your needs.

COVID-19 Return-To-Work Guide

Health New England cares about the health and safety of your clients and employees. To help support your return-to-work transition and preparation efforts, we have compiled various easy-to-navigate online resources related to COVID-19 reopening guidelines. Learn more here.


NEW: Extension of COBRA Continuation of Coverage, Special Enrollment, Claim Filing and Appeal Deadlines

On April 28, 2020, the U.S. Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) issued guidance around deadline extensions and other relief to assist health plans, members, employers and other service providers impacted by the COVID-19 outbreak. This allows members additional time to meet certain deadlines for COBRA continuation coverage, special enrollment, filing claims for benefits, appeals of denied claims, and external review of certain claims.

In most cases, this means the normal deadline is extended so that it starts at the end of the “Outbreak Period End Date” and goes for the same number of days in the normal deadline. The Outbreak Period End Date is “60 days after the announced end of the national emergency or such other date announced by the DOL in a future notice.”

All guidance is retroactive to March 1, 2020. More details can be found in the DOL's EBSA COVID-19 FAQs. If you have additional questions, please call our Member Services team at (800) 310-2835 (TTY:711), Monday – Friday, 8:00 a.m. – 6:00 p.m.

*These COBRA extensions apply to employers with 20 or more employees.


What is Health New England’s business continuity plan?

We are prepared to operate effectively under conditions of increased absenteeism or quarantine by utilizing our technological capabilities for associates to work from home, if necessary.

Although the precautions to avoid the spread of COVID-19 may impact where staff works, we will still maintain full infrastructure capacity. This means we do not have to reduce critical functions because our day-to-day member and provider operations capabilities can be operated remotely minimizing impact to services and needed care.

What is Health New England’s coverage and cost sharing related to Teladoc and telehealth services for coronavirus (COVID-19)? 

Members should call their primary care provider (PCP) first. PCPs may have the ability to evaluate members over the phone (telehealth) in order to limit potential exposure in physician offices. If a PCP isn’t available, most Health New England members* have access to Teladoc® for non-emergency medical issues.

Health New England members can access telehealth services from all in-network providers that are offering these services. Health New England members who have access to telehealth services through Teladoc, Health New England’s telehealth platform, can also use that service. Health New England is waiving all member cost-sharing for COVID-19 and non-COVID-19 related medically necessary telehealth services.* The waiver of member cost sharing has been extended until the end of 2020 for most plan members.** Our 24/7 Nurse Advice Line at (866) 389-7613 is available for free to all members as well.

While there is no specific treatment for coronavirus at this time, most symptoms of the virus can be managed at home under the direction of your PCP or a Teladoc physician. Go to https://www.teladoc.com/coronavirus/ for more information about Teladoc and to schedule a virtual visit.

*Some self-funded employer groups do not participate in Health New England’s Teladoc benefit, and/or have decided to not waive member cost sharing for telehealth services. Please check your plan materials for additional information.

**Health New England’s Medicare Advantage Members may be limited to cost share waivers only throughout the declared state of emergency.


If employees lose their health coverage due to COVID-19, what are their options?

If you or your company is impacted by COVID-19, you may qualify for state or federal health insurance programs including Health New England plans through the Health Connector (the Massachusetts Exchange), an intermediary (HSA Insurance), or MassHealth (Massachusetts Medicaid).

Massachusetts Health Connector and MassHealth

https://mahealthconnector.optum.com/individual/

Call Center: 1-877-MA-ENROLL (1-877-623-6765)

TTY: (877) 623-7773 for people who are deaf, hard of hearing, or speech disabled

HSA Insurance (intermediary)

https://www.hsainsurance.com

Customer Service: (781) 228-2222

Toll-Free: (877) 777-4414

Sales@hsainsurance.com

What if my company has to reduce hours and/or lay off employees due to COVID-19? Can I continue to cover these employees on my policy?

Health New England will reduce the minimum number of hours required to work from 30 to 0 in order for employees who are currently covered to stay eligible for coverage, assuming at least one employee of the company continues to actively work at least 30 hours per week.

Ultimately, the employer group can decide to absorb the full cost of premiums or full cost of COBRA, as long as (1) it’s done uniformly in a non-discriminatory fashion; (2) the reduction in hours/lay off is a temporary measure resulting from the COVID-19 pandemic; (3) you continue to pay your monthly bill; and (4) you do not terminate the employee(s).

COBRA coverage is determined by either a loss of coverage due to termination of employment or a reduction of hours. For employer groups that close permanently, their employees are not eligible for COBRA.

  • Small groups (fewer than 20 employees): Health New England will provide benefits to small employers in accordance with "mini COBRA" under state continuation.
  • Large groups (20 or more employees): Health New England will provide benefits to large employers in accordance with federal COBRA.

Please note: Employees who lose group health coverage may also obtain health coverage through the state Exchange program and may be eligible for premium assistance through the Exchanges (see previous question for more).

Will Health New England offer a special open enrollment period due to COVID-19?

At this time, Health New England will not be offering special open enrollment periods due to COVID-19 as the Division of Insurance (DOI) has not offered guidance around this topic.

Will Health New England waive enrollment waiting periods?

We will support our employer groups in their decision. The law permits employers to select waivers between 0-90 days. We recommend employers consult with their broker, consultant and/or legal counsel on the risk of waiving waiting periods mid-year. Self-funded groups should also consult their stop-loss carriers to ensure that such waiver is permitted.

What are qualifying events for coverage?

Qualifying events are defined by the IRS. If an employee meets one of the qualifying categories, they are able to enroll off-cycle. Currently, COVID-19 is not considered a qualifying event defined by the IRS.

What is Health New England’s premium assistance and hardship process?

For April, 2020 Premiums due on April 1st, 2020 Health New England will extend the statutory grace period, one time, for an additional thirty (30) days. On a case-by-case basis, groups may request and complete the COVID-19 Hardship Request Form to enroll in a payment plan. Consideration will be given solely as a result of the COVID-19 pandemic and its impact on an employer group’s ability to pay premiums in a timely manner.

If you have premium payment related questions, concerns or need a Health New England COVID-19 Hardship Request Form, please contact Accounting or our Member Services team:

Please review the Employer Reference Guide for information about Health New England’s current billing methods. View additional FAQs about our Premiums/Hardship process.

What can you do if you are experiencing mental health challenges with the COVID-19 situation?

In just a few weeks, the world has changed dramatically due to coronavirus (COVID-19). It can be difficult to face both personal and professional changes. If you are experiencing mental health challenges due to this pandemic, you are not alone.

As your local health plan, we would like to remind you of some resources that may be able to provide assistance:

  • Ask your employer or human resources department if they offer an Employee Assistance Program (EAP), which can provide confidential assistance with a variety of challenges, including mental health.
  • Access behavioral health care services from one of our in-network providers. Search for behavioral health providers or call our Member Services team for assistance finding a provider at (800) 310-2835.
  • Contact Teladoc® for behavioral health care services.* For more information, visit https://healthnewengland.org/bhteladoc or call 1-800-Teladoc (835-2362).
    *Teladoc Behavioral Health Services apply to fully funded groups and Health Connector members. Not all employer groups participate in this benefit. Please check your plan materials for details. Cost sharing applies to Teladoc Behavioral Health Services.
  • Call the Disaster Distress Helpline at (800) 985-5990, which is a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster, including disease outbreaks like COVID-19. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories.

As additional resources are made available, we will continue to do our best to provide updates. We are here with you…every step of the way as we continue our journey through these difficult times. 

For additional Coronavirus information, see our Coronavirus FAQ page and our Coronavirus Member Coverage and Cost Sharing page


We'd like to pass along this list of resources and recent COVID-related legislative changes compiled by the New England Employee Benefit Council (NEEBC). We have also seen great information about these changes coming from a variety of local Chambers of Commerce as well. As a reminder, we encourage all groups to work with their own legal experts in interpreting this information and how it applies to you and your employees.