COVID-19 UPDATE - Eligibility Guidelines Extended Through March 31
January 28, 2021
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina have extended the end dates of the Group Eligibility Rules and Guidelines for our Fully Insured Group lines of business until Mar. 31, in response to the impact the COVID-19 pandemic continues to have in the workplace.
While many questions can be addressed by our standard Premium Billing & Payment guidelines, we understand the need to remain flexible during this extraordinary time. We will continue to work alongside our customers to keep individuals insured as we have demonstrated during this pandemic. Should local or federal authorities provide new or “emergency” guidelines or provisions, we will amend our policies consistent with such guidance.
Most inquiries continue to be related to eligibility and the “actively at work” provisions of our contracts. As we have explained in previous communications, we offer this guidance on how we are determining eligibility during this time:
Actively at work
BlueCross and BlueChoice® understand that employers may need to displace workers and amend work schedules during this crisis. Effective through Mar. 31, 2021, BlueCross and BlueChoice will deem an employee to be actively at work, for eligibility purposes, so long as the employer:
- Considers the employee to be “employed.”
- Is collecting contributions toward insurance, unless 100 percent company paid.
- Is paying the insurance premiums for that employee in a timely manner.
Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees, and employee contributions must be no greater than those in effect immediately before March 1, 2020.
Group size
BlueCross and BlueChoice understand that some groups may downsize or lay off workers. Effective through Mar. 31, 2021, the group will remain active with BlueCross or BlueChoice at the group’s current premium structure and/or rating methodology until the group’s renewal as long as:
- At least two full-time employees remain on the group policy.
- The group is collecting contributions toward insurance, unless 100 percent company paid.
- The company is paying insurance premiums in a timely manner.
Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees, and employee contributions must be no greater than those in effect immediately before March 1, 2020.
Renewals
BlueCross and BlueChoice will continue to meet market and regulatory provisions for offering timely renewals. Unless any temporary impacts to group size are sufficiently significant and anticipated to be permanent, or the group’s average number of employees on business days changed by a sufficiently significant amount since their last annual renewal to cause the group’s market segment to change (from large to small), the group will be renewed under the rating methodology in place at the time of the last renewal.
COBRA and continuation
Generally, employers with greater than 20 lives will qualify to offer COBRA coverage to displaced employees, while employers with fewer than 20 lives may qualify for state continuation coverage. BlueCross and BlueChoice also can offer individual coverage options to displaced workers. Please contact your marketing representative to review options.
Returning employees
Employees rehired or returning to full-time status on or before Mar. 31, 2021, will not be subject to a waiting period.
Helping employees find other insurance coverage
If individuals lose coverage due to a loss of eligibility, BlueCross and BlueChoice will work with agents and employers to assist with transitions to other types of coverage. We can help assess options and eligibility for Medicare, Medicaid, individual coverage or even short-term products.
Please continue to remind your customers who are our members that updated information regarding COVID-19 and any related changes in their coverage can be found on our websites.
If you have questions, please contact your BlueCross or BlueChoice account representative.