COVID-19

Health Insurance & The COVID-19 Vaccines

As we step closer to the availability of the vaccine to the general population, employer groups will be considering many variables for their employees, including the availability of the vaccine, how their workforce fits into the phased rollout, vaccine costs, and what can be done now to prepare. In an effort to help local organization navigate these topics within the framework of their employer-sponsored medical plans, the Capstone Benefits Team has consolidated the most recent guidance being provided by the largest health insurers in our area:

Independence Blue Cross:

IBX does not specifically address how the plans will cover vaccinations, however the federal government has committed to providing the vaccine itself to the American public at no cost)

Click to Read More: IBX COVID Vaccine Update

Aetna:

  • Aetna will cover the cost of COVID-19 vaccines and their administration without cost sharing for Aetna members in all plans. Our coverage aligns with requirements in the CARES Act and the recent federal regulation. The requirement also applies to self-insured plans.

  • COVID-19 vaccinations will be available at pharmacies, including CVS, as well as doctors’ offices at other clinical sites of care. HHS recently announced a federal government partnership with large pharmacy chains and community pharmacies to access and administer COVID-19 vaccines as they become available.

Click to Read More: Aetna Vaccine FAQs

Cigna:

  • Will the vaccine be considered a preventive service waiving cost share for an employer’s workforce?

    • Any vaccine that receives FDA approval and is recommended by CDC (in partnership with guidance from ACIP), will be covered as a preventive service.

  • Will my health plan with Cigna cover the cost of a COVID-19 vaccine?

    • The vaccine will be covered as a preventive service. Initially, the cost of the vaccine serum will be paid by the government. We expect that providers’ charges for administering the vaccine will be paid under your Cigna medical plan, the same as any other immunization administration charge. We also expect that members enrolled in plans that cover preventive services at 100% will incur no additional cost.

 Click to Read More: Cigna - Understanding COVID19 Vaccines

United Healthcare:

  • When COVID-19 vaccines are authorized by the FDA, members will have $0 cost-share (copayment, coinsurance or deductible), no matter where they get a vaccine, including when two doses are required, as outlined below:

  • Employer and Individual health plans: Members will have $0 cost-share at both in- and out-of-network providers through the national public health emergency period. This applies to fully insured and self-funded commercial health plans.

Click to Read More: UHC Preparing for COVID-10 Vaccine Authorization

For more information or company-specific questions, please contact Sr. VP of Benefits, Joseph Fox:

Email: jtfox@capstoneinsgroup.com

Update: Workers Compensation Coverage for COVID-19

The COVID-19 pandemic has brought the discussion of “presumption laws” to the forefront, as states examine whether workers’ compensation should cover workers if they contract COVID-19 on the job.

What is a “presumption law”?

A presumption law describes the conditions where an employee injury is presumed to have happened on the job and should be compensable under workers compensation coverage. The burden of proof for most work-related injuries typically rests on the injured worker. However, under presumption laws, the burden falls on the employer.

What is changing due to COVID-19?

A key exclusion for nearly all presumption laws in the past is that they have not covered infectious diseases, since proving that a person was infected on the job is typically very difficult. With so many frontline healthcare and other essential workers infected with COVID-19, many states are moving to add the infectious disease to their list of presumptions, especially for certain occupations.

State Updates: (As of 10/10/20)

  • California (CA) - Recently passed legislation establishes a rebuttable presumption that all employees who are diagnosed with COVID-19 acquired the illness at work. Updated guidance now requires CA employers to report all COVID-19 employee incidents to their workers’ compensation carrier, regardless of occupation. Employers who fail to report “may be subject to civil penalties of up to $10,000.”

    Updated FAQ: Workers’ Compensation Presumption (SB 1159) Frequently Asked Questions

  • New Jersey (NJ) - Recently passed legislation dramatically expands access to workers’ compensation benefits for “essential workers” infected with COVID-19. Retroactive to March 9, 2020, COVID-19-positive workers in New Jersey who qualify as “essential employees” are now entitled to a rebuttable presumption that the employee’s infection is causally related to the employee’s employment, so long as the infected individuals worked somewhere other than their own residence at the time of infection.

Other states with updated WC guidance addressing COVID-19 :

States with legislation still pending:

If you have any questions regarding your obligations under these updated or proposed guidelines, please contact us:

Business Insurance: commercial@capstoneinsgroup.com

General: info@capstoneinsgroup.com

Home Office: 215-542-8030