UPDATES FROM FALLON HEALTH
Federal guidance suspends some health plan timelines for employees during pandemic
The COVID-19 pandemic—and resulting declaration of national and state emergencies—continues to have an impact on health plans and commercial insurance coverage. 

Recently, federal regulators temporarily suspended limits on timelines that commercial members and employer groups must normally adhere to for certain types of actions. This suspension is in place to ensure that individuals who might have missed key deadlines during the COVID-19 outbreak will not have a loss or lapse of their group health coverage or a denial of a valid claim for benefits.

What deadlines are affected by timeline suspension?
This federal guidance affects certain deadlines for:

  • COBRA continuation coverage

  • Special enrollment periods

  • Claims for benefits

  • Appeals of denied claims

  • External review of certain claims

It also includes benefit claims and denial appeals for disability, retirement and other plans. 

How the timeline suspension works
For each of the affected timelines, the clock stopped running on March 1, 2020, and will not restart until 60 days after the declared national emergency ends—whenever that turns out to be. The days within that time period will not be counted toward the timeline.

More specifically, the federal guidance suspends certain timelines for:

  • Notifying the health plan of a qualifying life event or determination of disability.

  • Making enrollment changes off-anniversary due to a qualifying event. This must usually be done within 30 days of the event. (In some cases, for example if an employee lost MassHealth coverage, this may be a 60-day timeline.)

  • Notification, election and initial payment for COBRA, such as:
  • 60-day election period for COBRA continuation coverage.
  • The date for making COBRA premium payments.

  • Submitting a claim for benefits.

  • Filing an internal or external appeal, including appeals of an adverse benefit determination. 

Examples
Here are a few examples of how this may affect health plan members:

  • Members normally have 180 days to file an internal appeal. If a member was notified of a claim denial 80 days before March 1 of this year, the new guidance will give them until 160 days after the national emergency ends to file an appeal—that is, 60 days after the emergency ends, plus the 100 days they had remaining as of March 1.

  • If a member was notified of a claim denial on May 4, 2020, they will have until 240 days after the national emergency ends to file an appeal—60 days after the emergency ends, plus the 180 days they would normally have.

  • If an employee’s hours are reduced during the national emergency and the employee was provided a COBRA election notice on April 1, 2020, they can elect COBRA coverage up to 60 days after the end of the national emergency.

Your Account Manager can provide more information if you have questions.
New contact tracing initiative in Massachusetts
The Baker-Polito Administration recently launched the COVID-19 Community Tracing Collaborative to monitor and reduce the spread of the coronavirus. Under the direction of the state’s COVID-19 Response Command Center, Partners In Health will coordinate with the Massachusetts Department of Public Health and the Executive Office of Health and Human Services to help collect vital information about those who tested positive for the disease.

How does it work?
It’s important for your employees to understand how the tracing program works and respond to the call if they receive one. If someone tests positive for COVID-19—or is a close contact of someone else who does—they may receive a call or text. The Caller ID should show as “MA COVID Team” with an 833 or 857 area code. The person will be asked to provide names and phone numbers of their close contacts (i.e., people they were less than six feet away from, for more than 15 minutes, for up to two days before developing symptoms).

Someone who tests positive will also be connected with support and resources they may need while in quarantine. The Community Tracing Collaborative will then alert the people identified as close contacts.

If the initial call isn’t answered, the Community Tracing Collaborative will leave a voice message. If they still can’t reach the person, program staff may attempt an in-person outreach visit.

What Community Tracing Collaborative will NOT do
Please let your employees know that if they get a call, it’s important to verify that it’s coming from the Community Tracing Collaborative. Be aware that a representative of this program will not:

  • Give you the name of the person you may have been exposed to

  • Disclose your identity to anyone they may contact on your behalf

  • Disclose your information to other agencies, including immigration

  • Ask for a Social Security number, financial information, or health insurance information

Translation services are available in more than 250 languages for these calls. For more information about the program, visit the Community Tracing Collaborative resource page .
Coping with COVID-19
Free webcasts for the business community
To help provide a forum for answering questions raised by the coronavirus pandemic, Fallon Health is sponsoring two webinar series for the business community.

Worcester Business Journal webcasts
Panelists on the Worcester Business Journal's live webcast series, Coping with COVID-19 share their insights on how businesses can weather the current crisis. The next event—a discussion of Survival strategies for the nonprofit community —will be held today (Thursday, May 14) at 1:30 p.m. Several local nonprofit leaders will discuss how their operations have changed and how they are forecasting the rest of the year.

You can also see the WBJ’s past webcasts, including one featuring Fallon’s Chief Human Resources Officer Jill Lebow as part of a panel discussion: HR Strategy: Contingency Planning During the Crisis .

Chamber of Commerce webinars
Fallon is also sponsoring a new Worcester Regional Chamber of Commerce’s webinar series. It features timely, valuable information to help minimize the impact of COVID-19 on your businesses, employees, colleagues, and customers.

The Impacts of the COVID-19 Stimulus Bill will be held on Tuesday, May 19, at 10 a.m. You can also access previous webinars in the series .
Health and wellness
Managing anxiety
Nearly everyone experiences anxiety at one time or another. It can be a normal reaction to situations or events. However, when things are constantly changing and the future is unknown, as they are now due to COVID-19, anxiety may be heightened and become more of a problem. 

Recognizing feelings and identifying the source of worry can be helpful in beginning to manage anxiety . These signs of anxiety are common and may need to be addressed:

  • Restlessness, nervousness or tension

  • Headaches or muscle aches

  • Tightness in the chest, pounding or racing heart

  • Shortness of breath

  • Sleepless nights or restless sleep due to mind racing

  • Fatigue from lack of sleep

  • Trouble concentrating

  • Unable to control worries

  • Depression

  • Disruptions in completing daily activities

More information is available through the National Anxiety Foundation .
In case you missed it …
Visit our website for previous COVID-19-related messages for employers. We’ve posted PDF versions of the messages for you there.