Enrollment | Eligibility | Billing/Premium Payment | Coverage | Online Premium Payment | COBRA/ State Continuation/ Medicare Supplemental Insurance | Pharmacy | Advance Insurance of Kansas (AICK)
Updated April 13, 2022
BCBSKS employers can find answers to some common questions. We will continue to add to this list as more information is available.
Enrollment
If a plan participant is laid off and returns to full time status at a later date – will they have to meet the new hire waiting period to re-enroll?
A: No, BCBSKS will not require the employee to meet a new hire company imposed waiting period. The group has the option of still requiring it.
Will the submission time frame of submitting new enrollments be altered?
A: Not at this time. Please contact your BCBSKS rep if there are issues with submitting documents and documentation in a timely manner.
Will the issuance of ID cards and policies time frame be altered from current timeframes?
A: Not at the present time.
Since so many firms have reduced staff or simply closed – if the employer has not signed off on all the required renewal documents to assure their renewal – what do we do? This may prove to be difficult in reaching them at their homes.
A: Internal micro group will continue to be auto renewed under the current process. For other groups, if the group has contacted their BCBSKS rep and there are issues sending us the renewal documents or documentation then we will be flexible in working with them to renew coverage.
Eligibility
What are the layoff provisions; how long can active coverage be continued following a layoff?
A: As long as premiums are paid, BCBSKS will not be enforcing any work requirements on eligibility for coverage. This practice will end on March 31, 2022.
If a group wanted to change their eligibility to include part-time, 20 hours per week, would BCBSKS be able to immediately accommodate?
A: Employees who are currently eligible and enrolled in coverage as of March 16, 2020 may continue their active coverage, as long as premiums are paid, without working the group's required number of hours for coverage eligibility. We are not extending eligibility to include current part time employees or employees not previously working the required number of hours.
If a member is currently serving their waiting period and has not yet reached their effective date and are temporarily laid off / on furlough due to current events, how would this be handled? (not eligible until they return to work?) A: Employees who are currently eligible and enrolled in coverage as of March 16, 2020, or an employee who has been in the process of working in order to meet their company imposed waiting period, may join active coverage at the regularly scheduled effective date. As long as premiums are paid, we will allow them to retain that coverage whether they are working the required number of hours or not. This policy will end on March 31, 2022.
What is the policy for temporary relaxation of required number of hours for insurance eligibility?
A: Employees who are currently eligible and enrolled in coverage as of March 16, 2020 may continue their active coverage, as long as premiums are paid, without working the group's required number of hours for coverage eligibility. We are not extending eligibility to include current part time employees or employees not previously working the required number of hours. This policy will end on March 31, 2022.
If my business has been shut down due to COVID-19 mandates, what happens to my group? Can the business remain enrolled if hours aren't being worked?
A: Yes, the business may certainly remain enrolled. Employees who are currently eligible for coverage, or currently enrolled, may continue their active coverage, as long as premiums are paid, without working the group's required number of hours for coverage eligibility. We are not extending eligibility to include current part time employees or employees not previously working the required number of hours. This policy will end on March 31, 2022.
If a member is filing and receiving unemployment benefits as part of COVID-19, will this impact their policy remaining active?
A: Employees who are currently eligible and enrolled in coverage as of March 16, 2020 may continue their active coverage, as long as premiums are paid, without working the group's required number of hours for coverage eligibility. This policy will end on March 31, 2022.
Is there a minimum number of hours required to work weekly, if the 30-hour requirement is not enforced?
A: Employees who are currently eligible and enrolled in coverage as of March 16, 2020 may continue their active coverage, as long as premiums are paid, without working the group's required number of hours for coverage eligibility. We are not extending eligibility to include current part time employees or employees not previously working the required number of hours. This policy will end on March 31, 2022.
Will there be a participation number of eligible staff to be enrolled enforced – if so what is the number?
A: BCBSKS will not be enforcing enrollment participation or quotas at this time. This policy end on March 31, 2022.
Billing/Premium Payment
With many employers looking at a reduced workforce in response to COVID-19 recommendations, does BCBSKS intend to put a moratorium on the +/- 20% re-rate provision until employers fully understand the long-term work staff effects of the current market?
A: Yes, there will be a moratorium until March 31, 2022. We will not re-rate any existing enrolled groups between now and then.
A group wants to change their employee contributions to pay for more of the employee portion of the premium. Section 125 sees this as a qualifying event. Would BCBSKS support that? Would you allow enrollment changes with an employee contribution change?
A: A group may certainly increase the portion of the premium that they are paying on behalf of the employee. However, we will not be accepting enrollment changes due to that change, as this is not a qualifying event.
Will BCBSKS help business owners who are affected by COVID-19 with premium forgiveness?
A: We understand these are trying and unprecedented times, but we are unable to forgive premiums. We will be paying for a number of medical services with no cost share to the member to help them receive care with no financial burden. The U.S. Small Business Administration (SBA) began offering emergency disaster loans to Kansas businesses and non-profit organizations on March 21, 2020, in response to the COVID-19 pandemic. The disaster declaration applies to all 105 Kansas counties.
Eligibility for Economic Injury Disaster Loans is based on the financial impact of the COVID-19. SBA loans may be used to pay fixed debts, payroll, accounts payable and other bills. The interest rate is 3.75 percent for small businesses and 2.75 percent for private non-profit organizations.
There may be additional federal financial relief that comes from Congress to help businesses and employees during this pandemic. If that occurs, we will be sure to share that information as it becomes available.
Coverage
Is BCBSKS covering the cost of COVID-19 testing?
A: In accordance with the Families First Coronavirus Response Act signed into law March 18, 2020, BCBSKS will be waiving member cost-share (co-pays, deductibles) for the following services associated with the testing of COVID-19 through the duration of the declared public health pandemic.
- Medically necessary diagnostic tests related to COVID-19;
- Cost of visit to doctor's office, urgent care, telehealth, and emergency room used for diagnostic testing of COVID-19;
- Related services (flu tests, respiratory illness tests) provided during urgent care, emergency room, or in-person or telehealth provider visits that result in an order for or administration of a covered diagnostic test for COVID-19.
If you are looking for a place to receive COVID-19 testing in Kansas, consult with your primary care provider or you can visit gogettested.com/Kansas for a list of testing sites near you.
For fully-insured business, how are you covering treatment of COVID-19 – doctor visits and hospitalization?
A: Effective Jan. 1, 2022, BCBSKS members will be responsible for member cost-sharing (copays, deductibles) for COVID-19 treatment. This includes coverage for treatment administered at a doctor's office, telehealth, urgent care facility and emergency room, as well as inpatient hospital stays.
If a self-funded business wants to waive copays and out-of-pocket costs for treatment of COVID-19, will BCBSKS allow this to be covered under the stop loss?
A: Yes, this will be covered under a group's BCBSKS stop loss. Coverage across both fully insured and ASO lines of business can be found at bcbsks.com/coronavirus.
Will BCBSKS cover the cost of the coronavirus (COVID-19) vaccine?
A: The vaccine will be available to all Americans free of charge. The federal government is funding the cost of the vaccine. Certain vaccine providers may charge an administration fee for giving the shot, but that cost will not be passed on to the patient, regardless if they have insurance or not. BCBSKS will cover that cost for our members. Any member that receives a bill for the administration fee for the vaccine should submit a claim to BCBSKS. Providers will be able to get reimbursed for the uninsured population through a government relief fund. For more information about the vaccine, visit the KDHE website.
Is my understanding correct that BCBSKS is working through a potential global response to the coronavirus and looking to identify a solution for current BCBSKS/American Well clients in which all employees (not just those on the medical plan) would have access to telemedicine at no cost? Can you confirm if this would include all employees the group would want to see covered (part-time, etc.)?
A: BCBSKS is encouraging patients and providers to lower the spread of disease and use social distancing technology such as telemedicine. It is important to note that an employee's regular, local primary care physician may be offering telemedicine, and a member should check with their provider. If not offered or if the employee is not enrolled with BCBSKS, they may access AmWell for services for a fee. Fully insured members are responsible for their cost-share (co-pay, deductible) for telemedicine and virtual services, with the exception of treatment for COVID-19. BCBSKS will cover the cost of COVID-19 treatment provided by telemedicine until Dec. 31, 2021. The State of Kansas is covering the cost of all telemedicine visits until Dec. 31, 2020.
Can I seek COVID-19 care or testing at an out of network provider?
A: Moving forward, if you seek COVID-19 care from a doctor or hospital (also called a provider) who isn’t contracting (also known as a non-contracting provider) with Blue Cross and Blue Shield of Kansas, it may result in additional costs for you as the patient. Blue Cross will no longer be covering the full cost of COVID-19 testing and treatment provided by non- contracting providers. We will now pay the same amount that we pay for services at providers who do contract with us. This may result in a bill from the provider where you received care. Please be aware of this change. It is important to “know before you go.” Visit bcbsks.com/find-a-doctor or call 800-432-3990 (toll-free) to make sure your doctor or hospital is contracted with us. However, if you have a medical emergency, always seek care at the closest emergency room.
Where can I find more information regarding the coronavirus (COVID-19) vaccine?
A: You can find more information in our Member FAQs, on the KDHE website and the CDC website. Administrative Service Only (ASO) groups can choose to waive or not waive member cost share. Please check your plan to see which applies to you. *BCBSKS members: Please check your contract for this benefit. Not all plans include telemedicine coverage.
Online Premium Payment
Am I able to pay our group's monthly premium online? Can I use a credit card?
A: During the pandemic, we began offering online, one-time payments for group health and dental premiums.
The ability to pay by credit card ends April 30, 2022.
COBRA/ State Continuation/ Medicare Supplemental Insurance
Who is eligible?
A: Anyone with a loss of coverage on or after 03/01/2020 may enroll in or reinstate COBRA or Individual Coverage without being subject to typical timelines.
Would the normal election, premium payment, and other provisions and timelines of Kansas Continuation apply?
A: Enrollments and/or payments to reinstate coverage may be received until 60 days after the announced end of the COVID-19 National Emergency. They will be considered timely. All COBRA eligibility requirements still apply. The effective date must be the day following cancellation of group coverage. A gap between active and COBRA coverage is not allowed. The member is billed for all necessary premiums to make the policy current.
What documentation is needed to verify loss of coverage?
A: All normal documentation necessary to verify the loss of coverage is required.
When is enrollment effective?
A: Enrollment may be effective first of the month following the member's loss of coverage or first of the month following notification to BCBSKS.
Can I re-enroll if my policy was cancelled due to non-payment?
A: Policies cancelled due to non-pay within the CARES Act timeframe may be reinstated without being subject to normal Request for Reinstatement (RFR) regulations.
If a member can no longer afford COBRA, will BCBSKS extend coverage beyond the grace period? A: BCBSKS is unable to extend COBRA coverage beyond the grace period. If a member has exhausted COBRA or qualifies for another special enrollment period, they should check for coverage and determine their eligibility for subsidy on the federal marketplace at healthcare.gov.
At what point would an employer, subject to the federal COBRA rules, have to offer COBRA?
A: When the employee, and/or the employee and their dependent(s), has a loss of coverage, COBRA continuation rules would apply.
At what point would an employer, subject to the Kansas Continuation rules, have to offer Kansas Continuation?
A: When the employee, and/or the employee and their dependent(s), has a loss of coverage, Kansas continuation rules would apply.
Would the normal election, premium payment, and other provisions and timelines of COBRA apply?
A: Yes, unless and until federal guidance to the contrary is received.
Are there changes to the Medicare Supplemental Insurance enrollment?
A: Members attempting to enroll in Medicare Supplemental Insurance coverage due to a loss of coverage may enroll without submitting a health statement. All other enrollment regulations remain as is. Employer groups with BCBSKS insurance can find more details with COBRA administration guidelines in the Group Administrator Manual.
Pharmacy
Is BCBSKS allowing an additional 30-day refill on maintenance medications?
A: BCBSKS is no longer allowing members to refill prescription medications before they are due to be refilled. This ended June 30, 2020. Members are encouraged to use their 90-day mail-in benefit.
If a self-funded business wants to cover an additional 30-day refill for maintenance medications, will BCBSKS allow this to be covered under the stop loss? A: BCBSKS is no longer allowing members to refill prescription medications before they are due to be refilled. This ended June 30, 2020. Members are also encouraged to use their 90-day mail-in benefit, if available by their group.
Will the cost share for drugs from retail pharmacies be waived or will it remain subject to the member's cost share? A. Drug costs relating to COVID-19 treatment will continue to be subject to the member's cost share. There isn't an FDA approved prescription drug therapy for COVID-19, but commonly used drugs prescribed for treatment are at or below the generic copay of $15 for most members.
Advance Insurance Company of Kansas (AICK)
Will the Coronavirus be covered under our Advance Insurance Company of Kansas short term disability policy if an employee chooses to apply? What is the process?
A: To receive benefits, an insured MUST be under the regular care of a physician and either diagnosed with the virus or ordered to be quarantine based on symptoms they are experiencing or actual exposure to the virus. Self-quarantining will not be covered. To apply for benefits, they would need to complete a disability claim form - AICK-18, available on our website www.advanceinsurance.com.