COVID-19 Updates

At Maestro Health, we continue to monitor the COVID-19 situation and its impact to the health benefits of our clients and their employees. For the latest, please read the information below.

Election Updates
Due to ongoing changes to employment status and increasing updates on family benefit coverage needs, we have received many questions about permissible changes to benefit elections. Therefore, we have laid out guidelines to consider for determining permissible qualified life event changes under your Section 125 cafeteria plan.

The guidelines also summarize the newly released Department of Labor regulations on employer requirements for group health plan coverage during the COVID-19 related Emergency Paid Sick Leave Act and the Emergency Family and Medical Leave Expansion Act.

You can download the guidelines here.

HSA and FSA Updates
On March 27, President Trump signed the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Portions of the act address changes to Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

Here are the impacts:

• High-Deductible Health Plans with an HSA can offer coverage for telehealth and remote care services before individuals reach the deductible and still be eligible for HSA contributions.
• The effective date is March 27, 2020 for plan years beginning before January 1, 2021.
• Over-the-counter medicines and drugs are eligible for reimbursement from a Healthcare FSA or HSA without a prescription.
• Medical supplies needed for quarantine and social distancing are eligible for reimbursement from a Healthcare FSA or HSA.
• Menstrual care products, including tampons, pads, and liners, are eligible for reimbursement from a Healthcare FSA or HSA
• The eligibility for these expenses may be retroactive to January 1, 2020.

Here are the next steps:

• Employers must amend their FSA plan documents to permit over-the-counter medicines and drugs as an eligible expense. Maestro Health is working to draft a plan amendment. Once completed, your Customer Experience Manager will reach out to you.
• Employees may submit mobile or manual requests for reimbursement of these new eligible expenses at any time, and retroactively for expenses incurred on or after January 1, 2020.
• The Maestro Health debit card for the Healthcare FSA and HSA is subject to expense approval based on merchant code and the utilization of the Information Inventory Approval System (IIAS) barcode programming. SIGIS is actively working on updating IIAS barcodes for these new eligible expenses but this may take a while. Until this is completed, if the card is successfully swiped and we are able to manual substantiate the expense with a detailed receipt, Maestro Health may approve the reimbursement. Unfortunately, employees may still experience denials at the point of sale until IIAS programming is completed.

The Maestro Health leadership team continues to meet daily to discuss how we can best serve our clients. We thank you for your trust and patience in this rapidly evolving environment. If you have any questions or concerns, please don’t hesitate to reach out.

On March 18, President Trump signed the Families First Coronavirus Response Act (Response Act), followed on March 27 by the Coronavirus Aid, Relief and Economic Security Act (CARES Act). There are stipulations of these acts that may impact changes to your current health plans. Please see a summary of the changes below:

UNDER THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT (RESPONSE ACT)

Emergency Family and Medical Leave Expansion
Expansion of the Family and Medical Leave Act (FMLA) includes leave due to a “qualifying need related to a public health emergency.” Employees are eligible for up to 10 weeks of paid leave, at two-thirds of the employee’s regular rate of pay subject to a limit, if certain criteria are met.

Emergency Paid Sick Leave Act (EPSLA)
Requires employers to provide a specified amount of paid sick leave, in addition to the employer’s existing paid leave policy, at the regular rate of pay up to specific limits. It applies to all employees who are unable to work (or telework) and who meet certain conditions.

These provisions will apply from April 1, 2020 through December 31, 2020.

Please make sure all of your employees have access to this poster from the Department of Labor.

UNDER THE CORONAVIRUS AID, RELIEF AND ECONOMIC SECURITY ACT (CARES ACT)

Testing and Preventative Services

Testing
All group health plans are required to cover COVID-19 approved diagnostic testing, including in vitro diagnostic testing, telehealth appointments and visits to providers’ offices, urgent care centers and the emergency room that result in orders for diagnostic tests. Coverage shall not impose cost-sharing (i.e., deductibles, copayments and coinsurance) and cannot be subject to prior authorization or other medical management requirements.

Preventative Services
All group health plans are required to cover qualifying preventive services related to COVID-19 without cost-sharing. Preventive services would be considered any item, service or immunization that is intended to prevent or mitigate COVID-19 and is evidence-based with an “A” or “B” rating by the U.S. Preventive Task Force recommendations or an immunization recommended by the Advisory Committee on Immunization Practices of the CDC. Health plans are required to cover these services within 15 days after the date services are recommended.

Payment for COVID-19 Tests

• In-Network rates: If your health plan has a negotiated in-network rate with a provider for testing, then that negotiated rate will still apply.

• Out-of-Network rates: If your health plan does not have a negotiated rate for testing with a provider, your health plan must reimburse the provider in an amount that equals the cash price listed by the provider on a public website.

HSA and FSA

Telehealth and High-Deductible Health Plans (HDHPs)
High-Deductible Health Plans with an HSA can offer coverage for telehealth services before individuals reach the deductible and still be eligible for HSA contributions.

Over-the-Counter Medicines and Supplies

• Over-the-counter medicines and drugs are now eligible for reimbursement from a Healthcare FSA or HSA without a prescription.
• Menstrual products, including tampons, pads and liners, as well as any supplies needed for quarantine are now eligible for reimbursement through a Healthcare FSA.
• The eligibility for these expenses can be retroactive to January 1, 2020.

Note: Employers must amend their plan documents to permit over-the-counter medicines and drugs as an eligible expense. Maestro Health is working to draft a plan amendment. Once completed, your Client Experience Manager will reach out to you.

Other

Employer Tax Credit
Employers are eligible for a tax credit against Social Security Tax liability for paid qualified sick leave wages. Small Business Relief There are emergency grants available and a forgivable loan program for companies with 500 or fewer employees. If you are concerned about cash flow, you can immediately look into your eligibility for this assistance. Extended Unemployment Insurance Program There is a new program, Pandemic Unemployment Assistance, for self-employed and contract workers who are typically ineligible for unemployment assistance. There will also be $600 per week added to every unemployment check for the next four months.

We are monitoring legislative and regulatory changes closely. Additionally, the Maestro Health 3/3 leadership team continues to meet daily to address changes as they arise. In an effort to centralize our communications and better serve you, we’ve established a landing page with all of our latest updates and employee-facing resources around COVID-19 here.

If you have any specific or urgent questions regarding the impact to your health plan, please reach out to your Client Experience Manager.

We thank you for the trust you put in us as we make every effort to support you and your employees in this rapidly evolving environment.

At Maestro Health, we are continuing to closely monitor the COVID-19 situation and its impact to both our staff and also the clients we serve. We understand that during this time, plan payments may be difficult.

Right now, here’s what we can do for you:

• We can continue to process claims but will need to hold payments that have not been funded.
• For clients who have Flexible Spending Accounts (FSA) with us, we will temporarily cease any deactivation of FSA cards for outstanding receipt requests for 180 days. We want to ensure that members have access to their FSA funds during this time, and recognize that members may not be able to receive necessary documentation from their providers in a timely manner. We are not waiving the documentation requirement, just extending the timeframe before the member’s FSA card is deactivated.
• Many states have opened loan programs for small and mid-sized businesses. If you are concerned about cash flow, you can immediately look into your eligibility for this assistance.

The Maestro Health leadership team continues to meet daily to discuss which various actions we can take to best serve our clients beyond what we already put in place. We thank you for the trust you put in us as we make every effort to support employees in this rapidly evolving environment. We are working on a summary of the CARES Act signed on Friday, March 27, which we will send shortly.

Our Leadership Team has been monitoring the situation over the last several weeks and convenes daily to take actions to reduce the spread of the virus, ensure the health and safety of our employees and deliver the services that your members need.

From a Plan Administration perspective, we remain prepared to assist our clients and their broker partners with making rapid adjustments including:

• Implementing waived cost sharing for approved COVID-19 diagnostic test and any vaccines, if developed and approved by the Centers for Disease Control (CDC).
• Eliminating any prior authorization requirements for the CDC approved diagnostic test or any other diagnostic services related to COVID-19 testing. Services received beyond the CDC approved diagnostic test will be covered according to the plan.
• Temporarily waiving co-pays for Telehealth visits for clients who currently offer Telehealth.

We are updating our service center job aids to document plan changes to ensure information provided is accurate. If you would like to amend your plan for any of the items above, please contact your Client Experience Manager.

Our Nurse Case Managers, Health Coaches, and Dietitians are closely monitoring the availability of testing. Both Quest Diagnostics and LabCorp are now indicating that they have made testing available nationwide. We are encouraging members to contact state and local health departments for the latest information. Our clinical staff are following the latest guidelines and information provided by Centers for Disease Control and doing their best to keep members calm and appropriately informed.

Still, we understand this leaves many questions unanswered. One of our telemedicine partners is Teladoc. Teladoc has compiled materials and FAQs around seeking appropriate care during this time. If your members report feelings of fever, cough or difficulty breathing, urge them to call their healthcare provider in advance and seek care early. If you or your members have questions directly related to how your plan is covering testing and care related to COVID-19, please contact your Client Experience Manager or our Customer Service team directly. Above all, follow the directions of your local health authorities and CDC guidelines.

Now more than ever, health and wellbeing are top of mind. Our team’s commitment to serving your members is unwavering, and we’ll continue working hard to do just that. We will continue to keep you, our valued clients, and our employees at the center of our planning and decision making.

We thank you for the trust you put in us as we make every effort to support members in this rapidly evolving environment.

Maestro Health is closely monitoring the latest developments of COVID-19 (coronavirus) as it continues to spread. We are working with AXA Group and federal, state and local agencies to ensure we are prepared if Maestro Health needs to take additional actions in any of our operational locations.

Here’s what Maestro Health already has in place as a precaution:

• We’ve armed staff with the tools and support they need to telecommute, including access to laptops, Virtual Private Networks (VPNs) for remote access, cloud-based collaboration applications and telephony services.
• We have a diversity of functions across all offices and have the ability to bring in external support for outsourced call center and claims processing services, if needed.
• Our last Disaster Recovery and Business Continuity Program test was completed on Monday, February 24, 2020.