Fallon Health wants to do everything we can to help our members maintain their health care coverage during the COVID-19 crisis. And we want to work closely with you to facilitate achieving that goal, since we know you share it.
There are some questions that we’ve heard from clients throughout our service area. Since you may have the same questions, we’re sharing the answers here. They’ll be in effect for the duration of the Massachusetts state of emergency.
The best source of information on your individual premium payment/rating questions is your Enrollment & Billing Representative. Call the telephone number listed on your premium invoice to reach your representative.
Q: Will Fallon be offering extensions for businesses and individuals that can’t pay premiums on time?
A: We’ll work closely with our customers with regard to premium payment deadlines. If customers are unable to make payments because of being shut down or having employees quarantined or hospitalized, we will work with them directly.
Situations will be taken into consideration on a case by case basis. For example, we may be able to offer electronic payment options or to extend the payment due date to avoid termination.
We’ve heard of questions about how to handle employees’ health coverage. Here are some of the most common questions:
Q: What happens to employees’ health coverage if a business has to furlough them, suspend their employment or temporarily lay them off?
Q: If an employee is quarantined and can no longer work the minimum number of hours required for health plan coverage, can the employer keep that person on the plan without offering COBRA?
Q: Some businesses have employees who are not able to work remotely. Because the business can’t pay them on an ongoing basis, these employees are in the unusual situation of taking unpaid leave for an unknown period of time. How can an employer in this situation continue the employees’ health plan coverage?
A: If employees are furloughed, have their work suspended, are laid off temporarily, take a reduction in salary, have had hours reduced or can’t work remotely, they remain eligible for the health plan as long as the employer continues to remit monthly premium payments.
It is the employer’s responsibility to identify the employees who are still eligible for health plan coverage.
Q: What happens if employees are terminated at this time and are no longer offered group coverage?
A: If employees are terminated and don’t have access to group coverage through the employer, the rules for COBRA administration will apply.
Q: What happens if the employer group must close their business?
A: If the employer group no longer exists, COBRA will not be available to employees. Loss of coverage due to the closure of an employer group is considered a qualifying event for purchasing individual health insurance coverage.
Even in these difficult circumstances, Fallon is working hard to make sure we are supporting businesses’ efforts to move forward. This goes for new and existing clients.
Q: Will Fallon’s timeline for renewals be changing? How about for new business quotes? Will Fallon allow mid-year changes to plans of benefits for clients who are looking at ways of saving money?
A: Our goal is to be as flexible as we can to accommodate your needs. Your Account Manager can assist you with questions specific to your unique situation.
Our underwriting department and sales team will release renewals according to the usual schedule, and our new business quotes are also expected to be released in anticipated timeframes.
Clients who don’t receive renewals at the expected time can reach out to their Account Manager.
Please know we remain committed to continuing to provide you with the highest level of service.
Q: How will Fallon address open enrollment over the next several months? What accommodations will you make for clients who don’t have online resources?
A: Fallon recognizes the need to adapt our usual open enrollment activities to the changing circumstances presented by this situation. We will work with our clients, both existing and new, to provide the support businesses and employees need. We will provide information virtually and will make staff available for outbound calls to prospects and members. We will also make conference lines available for group calls. Electronic enrollment kits and presentations are also available.