Your Benefits and COVID-19
COVID-19 IMPORTANT BENEFIT UPDATES & ANNOUNCEMENTS
Currently, there is no cost to Highmark Delaware and Aetna members who receive virtual telemedicine services. This applies to members who receive telemedicine through their primary care provider or other physician as well as those who use Highmark Delaware’s or Aetna’s telemedicine vendors.
If you are in need of telemedicine services for an acute issue, you can use the following vendors provided through Highmark Delaware or Aetna:
- Highmark Delaware Members: AmWell or Doctor on Demand
- Aetna Members: Teladoc
For more information, you can visit the following pages based on your State health plan:
The YMCA of Delaware has received guidance from the Centers of Disease Control and Prevention (CDC) and the Diabetes Prevention Recognition Program (DPRP) to continue delivering the Diabetes Prevention Program (DPP) through virtual sessions. The YMCA of Delaware encourages participants to not only maintain the lifestyle changes they have already made, but to continue their progress through the DPP.
Virtual meeting spaces have been created for all the classes that are in the weekly core phase of the program to continue program delivery and will continue to be covered under the State of Delaware Group Health Insurance Program (GHIP).
Families First Coronavirus Response Act passed on March 18, 2020, requires the State of Delaware Group Health Insurance Plan to cover without any member cost sharing, COVID-19 tests AND health care provider visits (in and out of network), urgent care visits, and emergency room visits that result in an order for or administration of the test. This Act applies to State of Delaware members in a Aetna or Highmark Delaware plan and expands the Group Health Insurance Plan’s previous notification on March 6, 2020, that COVID-19 testing would be covered at 100%.
State of Delaware Aetna and Highmark Delaware members have access to telemedicine services through Teladoc (Aetna Members ), Doctor on Demand and Amwell (Highmark Delaware members ) as well as virtual telemedicine services provided by their primary care or other physician. For the next 90 days, all copays and coinsurance for telemedicine will be waived. This is expanded to include members in the Aetna CDH Gold and Highmark Delaware First State Basic plans and to include virtual telemedicine services in all State of Delaware plans.
As part of our commitment to place the highest priority on the health, safety and wellbeing of State of Delaware employees, EAP+Work/Life support services from HealthAdvocate are available to all State of Delaware employees, effective immediately and through June 30, 2020. This means that these services are also available to your temporary, casual seasonal and benefit eligible employees who are not currently enrolled in a State of Delaware Highmark Delaware or Aetna health plan. Also see the attached Health Advocate flyer “Feeling worried about coronavirus?”
100% coverage for COVID-19 testing will be available to members in a State of Delaware State Group Health Plan through Aetna or Highmark Delaware. Copays or coinsurance for COVID-19 testing will be waived.
COVID-19 BENEFIT RESOURCES & INFORMATION BY PROGRAM
Employee Assistance Program
COVID-19 FREQUENTLY ASKED QUESTIONS BY PROGRAM
Question: Are employees enrolled in the Disability Insurance Program (DIP) required to file an STD claim?
Answer: All employees enrolled in the DIP are required to file a Short Term Disability (STD) claim with The Hartford if the employee is ill and expects to be out of work for at least 30 calendar days.
(Reference: DIP Rules & Regulations, Rule 5.1)
Question: Are employees enrolled in the DIP who have been approved to telecommute by their employing organization, eligible to file an STD claim?
- Yes. Active employee means an employee who works on a regular basis in the usual course of State business.
- Employees will be considered actively at work on days they are scheduled to work if they are performing, in the usual way, all of the regular duties of the job on that day.
- Employees will be deemed to be actively at work on a day which is not one of their scheduled work days, if the employee was actively at work on the preceding scheduled work day.
(Reference: STD booklet posted on the Statewide Benefits Office (SBO’s) website.
Question: If an employee is quarantined due to exposure to or diagnosis of Coronavirus (COVID-19), will that be considered a disability and payable under the Short Term Disability (STD) program?
- Symptom-free quarantine that is either self-imposed or directed does not satisfy the definition of disability in the STD program. Quarantine is not a qualifying medical condition and an employee that has been quarantined and has not tested positive for COVID-19 would not meet the definition of Disability.
- A positive test for COVID-19 is not by itself a disabling condition. An employee would only be considered disabled if they were sick and unable to perform the essential duties of their occupation due to sickness. (Reference: DIP Rules & Regulations – Rules 6.3 & 6.4)
- As with any employee illness, The Hartford will make its coverage determinations based on the specific facts associated with each employee’s claim.
Question: If an employee is quarantined but does not test positive for COVID-19, will the employee be considered disabled and awarded STD benefits?
Answer: No. A quarantine is not a qualifying medical condition so the employee would not meet the definition of a disability in the STD program.
Question: If an employee is quarantined and does test positive for COVID-19, will the employee be considered disabled and awarded STD benefits?
Answer: It depends. A positive test for COVID-19 is not by itself a disabling condition. The employee would only be considered disabled if they were sick and unable to perform the essential duties of their occupation due to the sickness.
Question: What is the definition of Total Disability in the STD program?
Answer: Total disability or Totally Disabled means that an employee is prevented by:
- Mental Condition;
- Substance Abuse;
- Pregnancy; or
- Loss of license due to medical condition;
from performing the essential duties of their occupation, and as a result, the employee is earning 20% or less of their pre-disability earnings.
Question: When should employees who believe they meet the definition of disability in the STD program, file a claim with The Hartford?
Answer: The current STD claim filing process will remain unchanged and employees are highly encouraged to file their STD claim with The Hartford by the 15th calendar day of absence if they are ill and unable to perform the essential duties of their occupation, to allow sufficient time for The Hartford to obtain medical documentation for a claims determination by the 30th calendar day of absence from work.
(Reference: DIP Rules & Regulations, Rule 9.1.1 and 9.2.1)
Question: If an employee’s STD claim is denied or STD benefits are not extended, can an employee appeal the decision?
Answer: Yes. Employees will be advised of their right to file an appeal by The Hartford.
(Reference: DIP Rules & Regulations, Section 11.0; Appeals – STD Claim Determinations)
If you have a question related to your Disability Insurance benefits, please email SBO.
Information Coming Soon
If you have a question related to your Employee Assistance Program (EAP) benefits, please email SBO.
Question: Can I make a change or stop my Dependent Care FSA?
Answer: Employees who experience a change in their daycare provider needs or experience a significant change in cost due to school closings may submit a FSA Election Change Form within 31 days of the qualifying event date. COVID-19 related examples include:
- Daycare or Preschool has closed or reduced hours due to COVID-19
- Before/After School Program is not required due to COVID-19 school closings
- Spring Break or other alternate care is not required due to COVID-19
Forms should be submitted directly to the Statewide Benefits Office as soon as possible. Once your need for child care resumes, you may make an additional change to your Dependent Care FSA.
Question: Can I make a change or stop my Health Care FSA?
Answer: Employees may make a change during the plan year if they experience a qualifying event. Qualifying events include marriage or divorce, change in employment status (that affects eligibility for health insurance), birth or adoption, change in Medicare eligibility or death. Employees who experience a qualifying event may submit an FSA Election Change Form within 31 days of the qualifying event date. Forms should be submitted directly to the Statewide Benefits Office.
Question: Will the Grace Period for the 2019 Plan Year be extended?
Answer: No, the Grace Period is set by the IRS and cannot be extended. However, the Statewide Benefits Office is extending the claim submission deadline to June 30, 2020 for the 2019 FSA Plan Year. Claims MUST still have been incurred during the Plan Year(January 1, 2019 – December 31, 2019) or accompanying Grace Period(January 1, 2020 through March 15, 2020).
Question: ASIFlex requested follow-up documentation for one of my card swipes, but my provider is too busy or is currently unreachable. What do I do?
Answer: ASI Flex has made the business decision to not inactivate debit cards during the immediate crisis. The letters asking for such documentation will soon indicate that the documentation must still be submitted but that ASI will not suspend the card for lack of documentation at this time.
Question: How should I submit my claims?
Answer: ASIFlex, the State of Delaware’s provider for the Flexible Spending Account (FSA) Program, has provided additional recommendations for submitting claims during this period, including:
- Use electronic claim filing options: the ASIFlex MobileApp (free on Google Play or the App Store); ASIFlex Online (sign into account detail); or ASIFlex toll-free fax (faxes are received through a secure server)
- GO GREEN and sign up for electronic communications and direct deposit. Employees can sign up by logging into their account or by completing the Go Green form .
- Avoid paper processing and refrain from mailing paper claims.
All questions or concerns regarding the status of your FSA account should be directed to ASIFlex at 1-800-659-3035 or access your account online.
Question: Will the Grace Period for the 2020 Short Plan Year be extended?
Answer: No, the Grace Period is set by the IRS and cannot be extended. The Grace Period for the 2020 Short Plan Year is July 1, 2020 through September 15, 2020. The deadline to submit claims is currently October 15, 2020.
If you have a question related to your Flexible Spending Account benefits, please email SBO.
Question: Is the State's Annual Benefits Open Enrollment (May 4-20, 2020) still going to occur?
Answer: Yes, the State is required to hold an annual open enrollment which must take place prior to the start of the plan year. The timing of the annual open enrollment period must allow both benefit eligible employees to make changes and benefit vendors to receive and process any changes before the start of the plan year on July 1st.
Question: Can I enroll a dependent in the State of Delaware Group Health Insurance Plan (GHIP) if he/she loses employment due to COVID-19?
Answer: According to the Eligibility and Enrollment (E&E) Rule 3.06 , a State employee may enroll a dependent and/or spouse due to loss of employment, in the State Plan without waiting for the next Open Enrollment period as long as the request is made within 30 days of the loss of coverage.
Question: If I am a benefit eligible State employee, covered under the State plan, but am laid off due to COVID-19, will I still have coverage?
Answer: According to E&E Rule 7.01 , coverage ends on the last day of the month in which the employee terminates employment. Coverage under the State plan can be continued under COBRA pursuant to E&E Rule 6.05 .
If a State employee whose position was involuntarily terminated after he/she has been employed for a full year returns to a full-time State position, he/she will be eligible for State Share immediately upon returning. Refer to E&E Rules 8.03 for more information.
Question: Will I still be covered under the State health plan, if I am a full-time benefit eligible employee (I work 30 or more hours per week), but my hours are reduced due to COVID-19?
Answer: According to E&E Rule 7.02 , coverage ends as of the end of the month in which the employee ceases to be an eligible employee for coverage (due to some change such as a reduction in the number of hours the employee works). Coverage may be continued under COBRA. Please refer to E&E Rule 6.05 .
Question: Who do I contact if I need to add my spouse/dependent to my State health plan due to termination from their place of employment and loss of coverage?
Answer: Contact your Human Resources/Benefits Office within 30 days of termination of coverage to add your spouse/dependent to your State health plan.
Question: If I enroll my spouse/dependent in my State health plan, due to a qualifying event, when will their coverage become effective?
Answer: Changes in coverage made outside of the annual Open Enrollment period, must be made within 30 days of a qualifying event, pursuant to E&E Rule 4.07 . All forms must be completed and supporting documentation submitted to your Human Resources/Benefits Office within 30 days of the request. If you are enrolling your spouse or dependent due to loss of coverage, the effective date coincides with the date of the loss of coverage.
If you have a question related to your Health Plan benefits, please email SBO.
Question: What are my options for obtaining prescriptions during the COVID crisis?
Answer: There are ways you can achieve peace of mind with your medications during this time without concern. Here are a few ideas:
- Looking for a longer-term supply? Ask your doctor for a prescription for a 90-day supply of your medication instead of a one-month supply. Your pharmacist can help you obtain the new prescription.
- Want to avoid public places? Use Express Scripts Home Delivery, which can deliver up to 90-day supplies right to your door with free standard shipping.
- Concerned about your medications? Express Scripts pharmacists are available 24/7/365 to answer your questions, offer counseling and support, and even help you transfer your medications to home delivery.
Question: What are options for members to get prescription refills early during the COVID-19 crisis?
Answer: ESI’s disaster medication access policy allows patients to have 3 early refills per prescription during an emergency. The prescription must include available refills and the early refills are subject to clinical review by the pharmacist.
Members also have the option to obtain prescription refills via mail order. Find out more.
In addition, many retail pharmacies are offering a mail order option for members. Encourage your employees to contact their local pharmacy for more details.
If you have a question related to your Prescription Plan benefits, please email SBO.
Question: Can I still use my EyeMed Benefit?
Answer: Yes. EyeMed is committed to maintaining service and helping you manage through these challenging times. EyeMed will follow all COVID-19 guidance and protocols provided by the Centers for Disease Control and Prevention (CDC), and state and local public health departments. It recommended that you follow CDC guidelines regarding routine eye exams, including postponing routine visits.
Should you lose or break your glasses or require replacement contact lenses, members are encouraged to utilize online, in-network options, including Glasses.com, ContactsDirect, Ray-Ban.com, LensCrafters.com, and TargetOptical.com. Utilizing online providers also helps assure you practice safe social distancing and avoid unnecessary risk outdoors. Your benefits are applied on these sites during checkout and your glasses are mailed right to your home. Understanding the circumstances, many of these online providers are offering free, expedited shipping and no-cost returns for extra convenience.
Question: Will Provider offices be closed, or office hours impacted due to COVID-19?
Answer:: Yes. You should expect that numerous provider offices will be impacted due to federal, state and local restrictions, staffing, safety and other conditions. It is highly recommended that EyeMed members call their provider directly to verify amended location hours or closing. You have 24-hour access to provider contact information via EyeMed’s provider locator on eyemed.com or the EyeMed mobile app (available on iPhone and Android). You may also call EyeMed Customer Care Center directly at 1.866.939.3633 (or your group-specific number on your ID card). Check with online providers to verify available offers.
Question: Can I order eyewear online using my benefits?
Answer: Yes. You have multiple options to order prescription eyewear and contact lenses online using your EyeMed benefits. If you have a valid prescription (within the last 24 months for eyewear and within the last 12 months for contact lenses), this may be an ideal solution to practice social distancing and mitigate outdoor risk. EyeMed is also actively reviewing opportunities to extend prescription requirements and provide assistance if you lost your prescription. Online, in-network options include: Glasses.com, ContactsDirect, Ray-Ban.com, LensCrafters.com, and TargetOptical.com. It’s easy to order, your benefits are applied automatically, and your glasses will be delivered right to your home. Understanding the circumstances, many of these online providers are offering free expedited shipping and no-cost returns for extra convenience. Check with online providers to verify available offers.
Question: What if I am unable to visit a provider and experience an eyewear emergency?
Answer: If you are directly impacted by COVID-19, glasses or contact lenses should be the last thing you need to worry about. If you’ve lost, broken or damaged your eyewear, please contact the EyeMed Customer Care Center to discuss your benefit options. Alternatively, please contact EyeMed Customer Care Center if you are unable to leave your home or locate an open provider and you do not have a valid prescription. You may be eligible to receive an emergency pair of replacement Adlens Adjustable Glasses (subject to availability). These temporary, emergency glasses can be adjusted to switch focus for reading, computer and distance.
Question: What if I visit an out-of-network provider?
Answer: EyeMed members are highly encouraged to use an in-network provider, including EyeMed online options—if possible. 97% of EyeMed members use an in-network provider. If you’d like help finding a nearby in-network provider, please contact EyeMed Customer Care Center at 1.866.939.3633. EyeMed will help direct you to an in-network provider, as well as help verify their hours of operation.
If an in-network provider isn’t an option, the best option to assure the fastest turnaround for an out-of-network claim is to submit your claim electronically (verses submitting a paper claim) by signing into your member account on eyemed.com.
Question: Are Telehealth services available for exams?
Answer: No in-home solutions are available for eye exams. At this point in time, telehealth exams for eye health still require an office visit and are available in very few locations.
Question: What EyeMed service options do I have?
Answer: COVID-19 will make each of our lives more challenging. But if you have questions, EyeMed is here for you with three service options. EyeMed Customer Care Center is available during normal business hours at 1.866.939.3633. They can direct you to a nearby in-network provider, as well as help you determine their potentially amended hours of operation. You also have 24/7 service via eyemed.com and the EyeMed mobile app (available on both iPhone and Android). Using these tools, you have access to provider contact information, your benefits and eligibility, and more. If you prefer to self-service online, it is highly encouraged that you identify your provider’s contact information via our provider locator on eyemed.com, and then call the provider office directly to verify their potentially amended hours of operation.
If you have a question related to your Vision Plan benefits, please email SBO.