Eligibility FAQ

As you continue to support your employees’ needs through the COVID-19 outbreak, we want you to know that the health, safety, and well-being of our employer group customers and members are our foremost concerns. Capital BlueCross and our family of companies are here to help during these trying times, and we continue to take a number of steps to ensure that members have access to care and coverage.

COVID-19 Guidance for Employer Groups

During this turbulent period, we recognize that employers may have to make adjustments to their workforce.

To help ensure groups understand all of their options, we have created the following FAQ to support business leaders as they consider the continuation of their health plan coverage. The FAQ include topics of interest for both fully insured and self-funded plans.

People who need coverage immediately, whether because of loss of their employer plan or because they are not eligible for employer-sponsored benefits, can call 833.550.7867 or email us.

Our team is ready to help anyone looking to secure an individual health plan, including one on the Federal Exchange, where enrollees can apply for help to pay their premiums. We will continue to work together during this unprecedented event. You can count on us. We will maintain regular contact through email when we have important news to share. Thank you, and we value your partnership.

Group Coverage FAQ

If I lay off all or part of my workforce in response to the COVID-19 crisis, can the company continue to cover those employees?

Yes. Your group’s health plan sets eligibility requirements that determine who may be covered. Capital BlueCross’ requirement that employees must work at least 20 hours per week to be covered is being waived for current groups. If your plan permits coverage to continue during a layoff, your employees should be covered during the COVID-19 crisis, as long as:

  • At least one common law employee (an employee who is not the owner or the owner’s spouse or dependent) remains actively employed
  • Coverage is offered on a uniform, nondiscriminatory basis to all employees
  • Premium or fee payments are kept current

If I have to lay off my entire workforce in response to the COVID-19 crisis, is Capital BlueCross able to offer other coverage to those employees?

Yes. If employees are laid off and employer-sponsored coverage has been lost, Capital BlueCross can offer individual plans. These individuals may email us or call 833.550.7867 to get help finding a plan that best suits their needs. Our team can help these customers determine if they’re eligible to receive government subsidy to help pay for their health plan or if they qualify for Medicaid. For those members over age 65, we can help them secure Medicare coverage, too. Alternatively, if your group is subject to COBRA, you should contact your COBRA administrator to determine whether your employees may be able to continue coverage under COBRA.


Do these coverage questions in the event of furlough or layoff apply to BlueCross Dental and Vision, as well as medical coverage?

Yes.


How soon does coverage become effective for members who enroll in an individual, ACA-compliant plan?

In most cases, coverage will begin on the first day of the following month. Those interested in an individual plan may email us or call 833.550.7867 to get help finding a plan that best suits their needs. Our team can help these customers determine if they’re eligible to receive government subsidy to help pay for their health plan or if they qualify for Medicaid. For those members over age 65, we can help them secure Medicare coverage too.


Will my group have COBRA continuation coverage?

Capital BlueCross does not administer COBRA Coverage. You should contact your COBRA administrator to determine whether your employees may be able to continue coverage under COBRA.


If I lay off part of my workforce today, will coverage extend until the end of the month?

Yes. Coverage would extend to the end of month for which premium or fees were paid, unless otherwise agreed between the group and Capital.


Will Capital BlueCross allow coverage to extend beyond age 26 to dependent children whose coverage would otherwise have ended?

Upon a group’s request, Capital BlueCross will extend coverage through May 31, 2020 to all dependent children who turn 26 before that date.


If a group terminates and later wants to resume coverage, will the group be treated as new?

If there is a lapse in coverage as a result of the COVID-19 crisis, the group will be treated as new, but during this emergency, they will not need to submit documentation regarding employee eligibility and minimum participation requirements. They must, however, meet all other underwriting compliance requirements. A new 12- month contract will begin and accumulators will reset after the group pays all outstanding amounts due to Capital BlueCross.


If a group’s enrollment drops by more than 10% during the COVID-19 crisis, will my rates be subject to change?

We will not adjust rates for groups whose enrollment changes as a result of the COVID-19 crisis. If your group is up for contract renewal during this time, please contact your account executive to determine whether enrollment changes will impact your renewal.


Will I have extra time to pay my invoices if I’m having financial difficulties resulting from the COVID-19 crisis?

Please contact your account executive to discuss your situation.


If I have to lay off a significant portion of my workforce in response to the COVID-19 crisis, will I need to change to a different product because I no longer qualify as a large group?

We will not require any changes of product in the middle of your contract period, but may reevaluate for your contract’s next renewal date.


Is there a time limit for how long an employee who has been laid off can remain on a health plan?

Each employer’s eligibility requirements determine who may be covered under the employer’s health plan. Capital BlueCross is not setting time limits for how long an employee who has been laid off can remain on the health plan. If the employer’s plan permits continued coverage during a layoff, all employees will typically retain coverage, as long as:

  • At least one common law employee (an employee who is not the owner or the owner’s spouse or dependent) remains actively employed
  • Coverage is offered on a uniform, nondiscriminatory basis to all employees
  • Premium or fee payments are kept current

If a group drops an employee’s coverage during a layoff, must the employee meet the eligibility-waiting period when returning to work before coverage will resume?

Each employer’s eligibility requirements determine who may be covered under the employer’s health plan. Employer groups have the discretion to waive the waiting period when an employee returns to work, as long as you apply your policy uniformly. We will continue to administer the group health plan, including eligibility and enrollment requirements, according to the group’s direction.


Does Capital BlueCross plan to change when it releases group renewals?

No. We continue to operate our business, and we expect to release renewals on normal timelines.


Some employers may be terminating employees to enable them to file for unemployment. If the employer continues to pay premiums/fees for their employees, will Capital BlueCross allow these employees to remain under active coverage?

Each employer’s eligibility requirements determine who may be covered under the employer’s health plan. If the employer’s plan permits continued coverage during a layoff, all employees will typically retain coverage during the COVID-19 crisis, as long as:

  • At least one common law employee (an employee who is not the owner or the owner’s spouse or dependent) remains actively employed
  • Coverage is offered on a uniform, nondiscriminatory basis to all employees
  • Premium or fee payments are kept current

If employees are laid off and employer-sponsored coverage has been lost, Capital BlueCross can offer individual plans. These individuals may email us or 833.550.7867 to get help finding a plan that best suits their needs. Our team can help these customers determine if they’re eligible to receive a government subsidy to help pay for their health plan or if they qualify for Medicaid. For those members over age 65, we can help them secure Medicare coverage, too. Alternatively, if your group is subject to COBRA, you should contact your COBRA administrator to determine whether your employees may be able to continue coverage under COBRA.


Will Capital BlueCross extend commercial group contracts beyond their end dates?

No, we will not be extending contract periods. We will apply business as usual processes.


Will Capital BlueCross allow retroactive enrollment changes for 4/1 and 5/1 groups that could not get open enrollment selections from employees in time?

Capital BlueCross continues to be open for business and is accepting enrollment elections through our usual processes. Groups should make every attempt to submit changes before the effective date. If, as a result of the impacts of COVID-19, you are unable to make final decisions in a timely manner, please work with your sales executive or Producer Support to provide information to help us accommodate the late enrollment.


Will Capital BlueCross relax the maximum number of COBRA persons that can be enrolled in a plan to allow more than 20% of the total enrolled?

For a new group applying for coverage with effective dates of April 1, 2020 to June 1, 2020, we will not enforce the 20% cap on COBRA continuants. Nor will we enforce this ceiling for any existing group.


I have employees whose spouses lost the family’s health coverage when they lost their jobs because of the COVID-19 crisis. Can these employees start coverage with our group?

Yes. If the group plan covers spouses and dependents, and these employees meet the group’s eligibility criteria, the employees and dependents can start coverage since the loss of a spouse’s health coverage is considered a valid life status event for a special enrollment period (SEP). You must send us changes and enrollment within 60 days of the life status event. In the absence of another valid life status event, however, a previously uninsured employee and/or dependents will not be allowed to enroll.


I have employees who can no longer afford their health plan because of spouses’ lost jobs as a result of the COVID-19 crisis. Can these employees switch plans?

Yes. If the group plan offers another benefit option, these employees can switch plans since the loss of a spouse’s health coverage is considered a valid life status event for a SEP. You must send us changes and enrollment within 60 days of the life status event. In the absence of another valid life status event, however, a previously uninsured employee and/or dependents will not be allowed to enroll.


I have employees whose spouses lost health coverage for themselves and their children. Can these employees now add spouses and dependents to our employees’ existing health plan?

Yes. If the group plan covers spouses and dependents, and these employees meet the group’s eligibility criteria, these employees can add a spouse and dependents since the loss of a spouse’s health coverage is considered a valid life status event for a SEP. You must send us changes and enrollment within 60 days of the life status event. In the absence of another valid life status event, however, a previously uninsured employee and/or dependents will not be allowed to enroll.


The information on this site is intended to provide general guidance in response to the COVID-19 public health emergency. Capital BlueCross does not provide medical advice. Please consult your legal and human resources counsel for information specific to your business. Capital BlueCross does not assume any liability associated with your use of, or reliance on, any of the suggested guidance provided here.

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