State of TPAC
During this difficult time, TPAC’s top priority is continuing to provide the support and services that our partners need. We know your business processes are being tested right now and you probably have a lot of questions. We’re here to help
Like many of you, our business and our area have been directly affected by the COVID-19 outbreak. We are incredibly fortunate in being able to conduct business on a remote basis, but many of our neighbors have not been so lucky.
Plan Ammendment Information
for COVID-19 Testing
April 3, 2020
We have received several inquiries asking if plan amendments will be needed to support the temporary plan modifications that have been
Important Updates for Clients with Excess Loss Contracts
May 26, 2020 Update
On May 4, 2020, the Department of Labor and other federal regulators issued an extension of certain statutory deadlines intended to minimize the possibility of participants and beneficiaries losing benefits during the COVID-19 pandemic. The extension begins March 1, 2020 to correspond with the beginning of the National Emergency and will expire 60 days after the end of the National Emergency, this is referred to as the Outbreak Period.
During the Outbreak Period the following limits are affected:
- 30 or 60 day Special Enrollment Period
- 60 Day election period for COBRA continuation
- The date for making COBRA payments
- The date for individuals to notify the Plan of a qualifying event
- The claim filing period
- The date to file an appeal of an adverse benefit determination
- The date to file a request for an external review after receipt of an adverse benefit determination or a final internal benefit adverse benefit determination
- The date for file information to perfect a request for external review upon finding out that the request was not complete
We suggest that you review the guidelines carefully to determine the appropriate action to be taken.
TPAC and Pan-American will support you when following these guidelines with no adjustment to the current excess loss rates. Additionally, no amendment to the Plan Document is required. However, we will look for verification of eligibility and compliance with the rule in the event of an excess loss claim.
May 11, 2020 Update
With TPAC approval, a Plan may be amended to allow for the coverage of eligible treatment of COVID-19 (Coronavirus) without any applicable deductible, co-pay or coinsurance for treatment incurred from March of 2020 through July of 2020. There is no change to the terms or rates of the Excess Loss Contract and all other plan provisions and exclusions apply. Certain Plans, at the discretion of TPAC Underwriters, such as MEC only Plans, are exempt. Each Plan amendment will require TPAC’s approval.
March 24, 2020 Update
In addition to the 3/16/2020 directive and in compliance with the Families First Coronavirus Response Act, no cost share will apply for items and services furnished to an individual during health care provider office visits, telehealth visits, urgent care center visits, and emergency room visits that result in an order for or administration of the COVID-19 test (“the test”), but only to the extent such items and services relate to the furnishing or administration of the test or to the evaluation of an individual for purposes of determining the need of such individual for the test. TPAC will support you with this directive if these services become part of an excess claim.
With respect to eligibility, in the event that the Contractholder would like to continue coverage for their employees during a COVID-19 related leave of absence, furlough, reduction of hours or similar reason that results in the employee being unable to satisfy the plans eligibility requirements and the eligible employee or eligible dependent has an excess claim, TPAC will support you if continuation of coverage for no more than 12 weeks was allowed for the employee for COVID-19 related leave of absences beginning 3/1/2020 through 5/31/2020.
If the Contractholder is unable to meet their premium obligations, TPAC will extend the current grace period for premium remittance from 30 days to 90 days for March, April, and May premium due dates. Excess loss claims will be pended until the appropriate premium is paid.
March 16, 2020 Update
We have had several inquiries related to COVID-19. Many of the questions being asked are ultimately the decision of the Contractholder; however, we want to share our position in supporting those decisions.
- If cost sharing was waived for COVID-19 testing and becomes part of an eligible excess claim submission, it will be reimbursed in the manner it was paid.
- If cost sharing was waived for virtual visits or telemedicine and becomes part of an eligible excess claim submission, it will be reimbursed in the manner it was paid.
- If early refills of medication to ensure that participants have a 30-day supply becomes part of an eligible excess claim submission, it will be reimbursed in the manner it was paid.
At this time, we are not requiring that each Plan Document be amended to reflect this agreement. Additionally, there is no additional cost to the Contractholder for this agreement.
Coronavirus Resources and Information
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention is a great resource for learning more about COVID-19 and recommended precautions to take to prevent infection. Visit the link here.
Minnesota State Department of Health
The Minnesota Department of Health has created an excellent resource page that provides situation updates for TPAC’s home state. Visit the link here.