FAQs for Employers and Producers – Self-funded groups

Updated April 12, 2021


We recognize the challenges COVID-19 and the associated state and federal guidance on businesses poses to you, your employees, and your business. Our top priority is connecting your employees to care and supporting you, our valued business partners, during this evolving crisis.

The following information is a compilation of the most frequent questions we have received to date. We have attempted to provide responses that apply in the broadest sense. As always, your account executive is available to answer questions specific to your plan. If you have stop-loss coverage, please check with your carrier for direction as well.

Any benefits changes you make should be reflected in your Summary Plan Description (SPD). Please contact your Regence account executive to modify your Regence-produced SPD.

Frequently asked questions

Member support FAQ
 What steps have we taken to support our members?

The health of our members is our top priority. Read the latest actions we’re taking to support our members.

  • COVID-19 vaccinations, testing and treatment

  • COVID-19 vaccinations are covered with no member cost share. The federal government is paying for enough vaccine doses to immunize every American during the course of the pandemic. Administrative fees will be covered by health plans, including self-funded plans. Grandfathered and retiree only plans are not required to cover administration without cost-sharing.

  • No pre-authorization is required for COVID-19 testing if determined necessary by a medical professional.

  • No-cost diagnostic (antigen and molecular) testing, including provider visit. This includes high-deductible health plans with HSAs. Tests must be performed at a CLIA-certified lab, or the test manufacturer must have FDA Emergency Use Authorization.

  • Groups may opt-in to have no cost shares (deductibles, copayments and coinsurance) or pre-authorization for members’ COVID-19 treatments at in-network providers into 2021.

  • We also cover COVID-19 antibody tests at no member cost share when ordered by a member’s attending physician and part of appropriate medical care. Tests must be performed at a CLIA-certified lab, or the test manufacturer must have FDA Emergency Use Authorization.

  • As with drug testing for employment, insurance does not cover testing for employment, surveillance, or extracurricular activities, such as travel, school, sports or summer camps.

Enhanced support for high-risk members

  • We’re in contact with high-risk members using our case management services to ensure they have the support they need.

  • As we learn of members hospitalized with the virus, we are reaching out to provide personalized support.

  • We’re moving members on infused medications from hospital to home settings or infusion centers.

Access to needed medications

  • Members may receive early refills of most medications through the end of the declaration of emergency in the state where their plan is issued.

  • Members can request a 90-day refill of medications for chronic conditions such as heart disease, asthma, diabetes and others. Some drugs are not eligible for extended day supply, including controlled substances and certain specialty drugs (ineligible drugs are those in the “Narcotics” section or marked “SP” on our drug lists).

  • Members with prescription coverage through Regence can order home-delivery prescriptions through the AllianceRx Walgreens Prime website.

Enhancing coverage for virtual care

To help slow the spread of infection and ease pressure on doctor’s offices and emergency rooms, we’ve enhanced coverage for virtual care:

  • Some members, upon groups’ opt-in, have access to telehealth vendors that provide services such as video visits and secure messaging with doctors and nurses, and home health visits in select areas. These options may differ by employer, and employers can consult their summary of benefits coverage (SBC) for their specific telehealth offering. Groups that don’t have embedded telehealth are encouraged to contact their Account Executive for information on available options and instructions for opting-in.

  • Employees should sign-in or create an account on regence.com, or download the Regence app, to learn about the virtual care options included in their plan. A flyer and video on regence.com contain all the instructions for doing this; be sure all employees have access to these instructions.

  • We’ve expanded the services that can be delivered by providers using virtual care options and we’re paying them the same as we would for in-person treatment for our fully-insured line of business into 2021. Self-funded groups may opt-in to this expansion.

  • Self-funded groups may also waive the member deductible for telehealth vendor services and virtual care services.

  • If a self-funded group opts-in to the expansion of virtual care, members’ own providers, including PCPs, behavioral health specialists, and others, may provide virtual care services. If members don’t have a doctor or therapist, they should call Customer Service for help finding one.

Expanding resources for self care

To help members address a wide range of emotional and physical health needs, we’ve broadened access to three useful tools:

  • Active&Fit – members have free access to 200 on-demand digital workout videos and daily live workouts from Active&Fit. Enrollment in Active&Fit is not required; Regence members need only to access the Active&Fit website from their Regence account page and register there to receive access to the workout videos.

  • Regence Empower™ – provides members tips for staying healthy, what to do when sick, and advice to help slow the spread of the disease. Includes self-guided programs for managing stress, enhancing physical activity, and building resilience, along with personal challenges supporting sleep, nutrition, physical activity, and social and emotional well-being.

  • Symptom Checker – offers members timely guidance and support to help them determine whether medical attention is needed. Not intended to replace a clinical assessment or the judgment of health care professionals.
Eligibility FAQ
 How is eligibility defined for employees on self-insured plans?

We follow the self-insured plan sponsor’s definition of an eligible employee and guidance on plan administration for the following scenarios:

  • Keeping furloughed employees covered under the health plan

  • Waiving waiting period for employees returning to the plan after a lay-off, furlough or termination

  • Adjusting required hours for plan eligibility
Plan & benefits FAQ
 Can we maintain our self-funded plan if we’re required to temporarily close?

Yes, as long as there is active enrollment on the plan. If all employees are terminated from a plan, the contract will cancel and will need to be reinitiated. Minimum enrollment for self-funded groups is 51 employees. For groups returning with fewer than 51 employees, fully insured plan designs are available.

 Can we have a special COVID-19 open enrollment period to allow employees who waived earlier on the plan to enroll?

Yes. We follow the plan sponsor’s definition of open enrollment and special enrollment periods. Some state-based exchanges are offering special enrollment period for individual participants.

 Can we change or modify our plans midyear?

Yes. Self-insured plan sponsors can modify benefits and allow for an election or downgrade to enrollment midyear.

 If we offer multiple plans, can we allow our employees to downgrade benefits midyear?

Self-insured groups may elect to allow members to change at their discretion.

 Will Regence modify rates for changes in enrollment greater than 10 percent?

Enrollment changes as a direct result to COVID-19 will not be subject to rerate.

 How is Regence administering coverage for COVID-19 vaccinations, testing and treatment?

We are applying no member cost share to COVID-19 vaccinations, and antigen and molecular diagnostic testing and the associated office visit as prescribed by federal mandate. This includes high deductible health plans. Testing must be ordered by a physician. We also cover COVID-19 antibody tests at no member cost share when ordered by a member’s attending physician and part of appropriate medical care. Tests must be performed at a CLIA-certified lab, or the test manufacturer must have FDA Emergency Use Authorization. As with other tests for employment, such as drug tests, antibody tests for employment purposes are not covered by insurance.

Self-insured customers may opt-in to non-federally mandated benefits for COVID-19 including treatment at no cost to employees or family members.

 Does Regence have the ability to report COVID-19 claims separately?

Yes. Using TrendSmart, our reporting and analytics tool, plan sponsors can request CPT-specific reports, including those for COVID-19.

 What behavioral health options are available to our employees?

Your health plan may include an Employee Assistance Plan (EAP) benefit. Telehealth vendors also provide behavioral health services. In addition, under the optional virtual care expansion, members’ regular providers may be able to offer telehealth services.

 Can we add a telehealth vendor to our plan?

Yes, you can add Doctor on Demand. Call your account executive to learn more. Self-funded groups may also opt in to the expansion of services that can be provided through virtual care options. Many of our contracted network providers offer telehealth services for primary care visits, behavioral health, and more. These visits are covered with the same cost sharing provisions of your plan, as an office visit. This is separate from the existing telehealth benefit in some contracts that provide for limited telehealth services and provider reimbursement at the telehealth rate.

 What does the optional expanded telehealth policy cover?

To help prevent the spread of infection and ease pressure on doctor’s offices, urgent care centers and emergency rooms, we have temporarily expanded the services available through our virtual care benefit for our fully insured and Medicare customers. Self-funded groups may opt-in to this expansion. Under the expansion, any contracted provider may now offer virtual care services, even on a non-HIPAA-compliant platform. This includes routine preventive appointments with members’ primary care doctors and behavioral health providers. This expansion will remain in effect through each state’s emergency declaration. The member’s coinsurance and deductible will apply to these services, however self-funded groups may opt to waive deductibles for telehealth and virtual care services.

 How is Regence complying with the DOL guidance on COBRA deadlines?

This rule applies to ERISA groups only. COBRA remains an employer-specific responsibility. The following represents our understanding at this point in time.

The DOL, IRS and HHS guidance under the EBSA Disaster Relief Notice 2020-01 extends certain COBRA timeframes and deadlines for participants to consider coverage elections and benefits decisions.

Specifically, Final Rule provides plan participants, beneficiaries, qualified beneficiaries, and claimants with relief from meeting the below referenced periods and dates during the period of March 1, 2020 until 60 days after the announced end of the COVID-19 National Emergency (or such other date announced by the Agencies in a future notice):

  • The 30-day period (or 60-day period, if applicable) to request a special enrollment;
  • The 60-day election period for COBRA continuation coverage;
  • The date/deadline for making COBRA premium payments;
  • The deadline for individuals to notify the plan of a qualifying event or determination of disability;
  • The deadline within which employees can file a benefit claim, or a claimant can appeal an adverse benefit determination, under a group health plan’s or disability plan’s claims procedures;
Vaccines FAQ
 Which COVID-19 vaccines are covered?

All vaccines must receive approval or emergency use authorization from the U.S. Food and Drug Administration (FDA) before they can be distributed to the public. The federal government is paying for enough vaccine for every American to be vaccinated during the course of the pandemic.

Vaccine administration is covered at no out-of-pocket cost for Medicare, fully insured and most ASO members. Grandfathered and retiree only plans are not required to cover administration without cost-sharing. However, we have chosen to cover the administrative fee for fully insured grandfathered plans without cost-sharing.

Balance billing is not permitted. From CDC: “Providers that participate in the CDC COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient.”

 When can members get a COVID-19 vaccine?

Vaccines will be distributed in phases, with health care workers and people who live and work in long-term care facilities getting vaccinated first. The Centers for Disease Control and Prevention (CDC) then recommends that other essential workers such as first responders get the vaccine, followed by those older than age 65 or who have high-risk medical conditions, and then the general population. Individual states will make the final decision about distribution priority. Members are urged to check their state health department websites for priority distribution or talk to their doctor or pharmacist about when they will be eligible. As vaccine supply and distribution increases, more people will be able to get the vaccine.

 Where can members get a COVID-19 vaccine?

The CDC is working with hospital systems and pharmacy chains across the U.S. to administer the vaccines. Each state’s health department will have specific information about vaccine prioritization and distribution.

 What are we doing to support COVID-19 vaccinations in the community?

We are working to encourage all members to work with their medical provider to get vaccinated. Regence is working with our community partners, public officials and others to ensure that underserved communities and people of color – groups that have been disproportionally affected by the pandemic – are vaccinated.

 Where can people go for more information?

Members will need to check their state’s health department website or call their doctor or pharmacist to find out when and where they can receive the vaccine.

The CDC provides these resources to learn more about the COVID-19 vaccine:

General

 Who pays for the vaccine?

Currently, the vaccine itself won’t cost consumers anything regardless of insurance coverage. The federal government is buying enough vaccine doses to immunize every American. The Centers for Medicare and Medicaid Services or private insurance pays for the administration of the vaccine. Older legacy plans may pass administration costs on to their members.

 What is the anticipated impact of COVID-19 on health plan rates?

While is too early to tell if COVID will have an impact on rates, we estimate very little to no impact.

 What is the difference in cost between the COVID-19 vaccines vs. the flu shot?

The administrative fee for the flu vaccine is around $7 versus the fee for administering the COVID-19 vaccine, which is currently around $45. In addition to the administrative fee, vaccine costs will vary based on manufacturer pricing. At present, all drug costs for COVID-19 vaccines are being covered by the government.

 What is the status on vaccine options, including efficacy rates and FDA approval of each (including those in the pipeline)?

We follow the New York Times vaccine tracker for the latest on vaccines and suggest you do too.

 How do we determine eligibility and timeline for scheduling?

For the most accurate and up-to-date information on vaccine eligibility, prioritization and distribution, the best source is your state’s public health department website:

OREGON

WASHINGTON

UTAH

IDAHO

 Does blood type make a difference with how hard you are hit with COVID-19?

This is currently unclear; more scientific studies are needed in this area

 What steps do we need to take to ensure that everyone understands the importance of being vaccinated?

Lead by example. Everyone can contribute to community health by:

  • Getting vaccinated when it’s your turn.
  • Practicing the three Ws: wear a mask when in public, wash hands frequently, watch your distance from those outside your household.
  • Stopping the spread of misinformation. Check your information sources before sharing information about the pandemic with anyone. When in doubt, rely on your state health department, the FDA or the CDC.

Safety & Efficacy

 What is the length of efficacy for the various COVID-19 vaccines?

Medical experts do not know for sure. The CDC will be your best source of information about vaccines for COVID-19.

 Do we have a choice of vaccine, and which is best?

Medical experts advise getting whichever vaccine is available to you. They all protect against serious illness and death.

 Is it a live vaccine? Does it provide immunity, or just protect against severity?

The current vaccines do not contain the coronavirus or inactivated virus. NPR offers a great explanation on what vaccine efficacy means. Getting vaccinated can dramatically reduce the chance of you getting COVID-19. If you still get infected and have symptoms, the vaccine can protect you against serious illness. Currently with people who’ve been vaccinated and still contracted COVID-19, the death rate is zero and one person was hospitalized.

 How can we trust the clinical trials – were they done for long enough?

Vaccines are developed by teams of world-class scientists with many years of education and experience. All vaccines undergo extensive safety trials. We refer people to the New York Times vaccine tracker for a plain language explanation of how vaccines are developed and what phase COVID-19 vaccines are currently in.

Vaccines undergo rigorous clinical trials to prove safety and effectiveness before they receive approval from the Food and Drug Administration (FDA) for broad distribution. Clinical trials involve tens of thousands of people who volunteer to receive the vaccine. The FDA grants emergency use authorization only if independent analysis confirms the vaccines are safe and effective.

The Pfizer and Moderna vaccines have an effectiveness rate of more than 95%. While these vaccines are new, the technology behind them has been studied for years.

The vaccines do not contain the virus or inactivated virus. You cannot get COVID-19 from the COVID-19 vaccines.

 Regarding the Pfizer and Moderna vaccines; does your second dose have to be the same type as the first?

We suggest following CDC recommendations: "The safety and efficacy of a mixed-product series have not been evaluated. Both doses of the series should be completed with the same product."

 Are the current vaccines effective against the new strains? Are they being tested and/or modified to respond?

The emergence and transmission of virus strains is highly dynamic. We suggest referring to the CDC for the most current information on virus strains.

 What are the short-term side effects of the vaccines?

The majority of people will experience no side effects other than a sore arm. About 10% may have flu like symptoms for a couple of days as the body develops antibodies. This is normal and generally not cause for alarm. A small number of people have had a very serious reaction (anaphylaxis) that is treatable. Currently anyone receiving a vaccine is asked to stick around for a 15 to 30-minute observation period just to be safe. There have been no reported deaths as a result of getting the COVID-19 vaccine.

 What are the long-term side effects of the vaccines?

The CDC offers an excellent resource on vaccine safety and monitoring.

 Once a person is vaccinated, can they still transmit the virus?

Medical experts do not yet know. It’s best to continue practicing safety protocols: masking, distancing, washing hands frequently.

 Does the vaccine change your DNA? Or cause a gene mutation in humans?

No

 Is J&J also an MRNA vaccine?

No. J & J is not a mRNA vaccine but a vector-based vaccine using a modified adenovirus using a double stranded DNA to cause the host cell to produce mRNA and spike proteins resulting in an immune response (antibodies) ready to attack a COVID-19 virus.

How the Johnson & Johnson Covid-19 Vaccine Works - The New York Times (nytimes.com)

 Is it true that there are nanoparticles contained within these injectable technologies?

Yes. The Novavax is an example of such a vaccine technology. How the Novavax Covid-19 Vaccine Works - The New York Times (nytimes.com)

 What is the status of vaccine development for children under 16?

According to the Mayo Clinic, "Several companies have begun enrolling children as young as age 12 in COVID-19 vaccine clinical trials. Studies including younger children will begin soon."

 Is there anyone who shouldn’t get the vaccine?

Please consult with your doctor if you have any questions about getting vaccinated, whether related to allergies, pregnancy, or other medical or health conditions.

 What alternatives are available outside of taking these "experimental vaccines?"

Clinically we would not consider these approved vaccines as experimental since they have completed the research. They are all new but not experimental.

Medical evidence shows that getting a COVID-19 vaccination can help keep you, your family, your community, and your country healthy and safe. By getting vaccinated, you can act to help end the damage to the economy, prevent more illness and deaths in America, and eliminate COVID-19.

These vaccines have undergone rigorous clinical trials to prove safety and effectiveness before they receive permission from the Food and Drug Administration for broad distribution. Clinical trials involve tens of thousands of people who volunteer to receive the vaccine. The FDA grants emergency use authorization only if independent analysis confirms the vaccines are safe and effective.

 What plans are being discussed with Asuris in regard to the use of Ivermectin?

Asuris health plans cover FDA-approved treatment for COVID-19. Ivermectin is not approved for the prevention or treatment of COVID-19. The clinical evidence is very mixed with Ivermectin and there are no national recommendations for the use of Ivermectin in the management of CV19 infection.

After the vaccination

 Is it still necessary to wear a mask after receiving the vaccine?

Yes, please keep practicing safety protocols until the majority of people in your community have been vaccinated.

It takes a few weeks for your body to build up immunity after vaccination. In addition, while the vaccines have a high efficacy rate for preventing serious illness, you may still be susceptible to getting the virus and transmitting it to others.

As the virus mutates, the original vaccines may also not be as effective. Therefore, continuing diligence with public health measures will remain important until the incidence of new viral cases is minimal.

Check with your state or local health department on safety protocols for your community.

 How long before no more need for masks and social distancing?

That really depends on us. If we continue to mask up, keep our distance, wash hands frequently, we will help stop the virus from spreading. Most experts anticipate fall/winter of 2021 as vaccinations ramp up and public health safety measures continue. Your state and local health departments will be your best source of information about community safety protocol.

 What are the metrics and anticipated timeline for herd immunity from COVID-19?

Medical experts do not know for sure. Herd immunity occurs when the vast majority of a population is immune from an infection. For highly infectious viruses such as measles, herd immunity occurs when 92 – 94% of the population is immune. At 70 – 80% herd immunity, we would start to see a reduction in case rates. The CDC will be your best source of information about herd immunity for COVID-19.

 I’ve heard that people that have survived COVID-19 feel they have protection and may not need a vaccine. Can you address this?

If it’s been more than 90 days since you’ve had COVID-19, medical experts recommend getting vaccinated. It is unclear how long natural immunity lasts.

Reinfection with COVID-19 is occurring and many times with more severe symptoms than the initial infection.

Workplace

 Are there any opportunities for onsite vaccination clinics? (like with the flu shot)

Not at this time.

 Can we require employees to be vaccinated before returning to onsite work? And require proof of vaccination?

Please consult your legal counsel.

 How can we encourage or incentivize our employees to get the vaccine?

Please consult your legal counsel.

Resources

The recording of the full webinar is available for playback and future reference here. If you need ongoing updates related to COVID-19 and our efforts to support you at this time, please contact your account manager.

Additional Resources:

Centers for Disease Control and Prevention (CDC)
World Health Organization (WHO)
New York Times vaccine tracker
Oregon Health Authority
Washington Department of Health
Utah Department of Health
Idaho Department of Health