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COVID-19: Benefit Changes

Beginning August 1, 2021, Kaiser Permanente of the Mid-Atlantic States will reinstitute cost sharing for Covid-19 related services.

Beginning September 1, 2021, CareFirst will reinstitute cost sharing for Covid-19 related services.

Changes to health benefit plans

As a result of the new guidelines, the following changes are in effect until further notice:

  1. Any employee who is eligible for health insurance benefits who did not enroll during their 60-day enrollment period or during the Benefits Open Enrollment in October 2019, will be eligible to enroll in an MCPS health insurance plans. Employees can enroll their qualifying dependent(s) at the same time by providing appropriate supporting documentation.
  1. Any employee who experienced a qualifying life event such as marriage, birth or adoption of a child, or loss of non-MCPS coverage but did not enroll in an MCPS health insurance plan during their 60-day enrollment period or during the Benefit Open Enrollment in October 2019, also will be eligible to enroll in a plan along with their qualifying dependent(s) by providing appropriate supporting documentation.
  1. Any employee who wishes to drop an existing dependent may do so by providing supporting documentation to show that the individual has coverage elsewhere or by providing an affidavit.
  1. Employees are able to change their plan elections, such as changing from the CareFirst Point-of-Service to the CareFirst HMO plan or may switch plans from a Kaiser Permanente plan to a CareFirst plan. They can also add or drop qualifying dependents to their existing health insurance thereby changing the coverage level.
  1. Employees may add or drop parts of their health insurance plan. For example, an employee who is currently enrolled only in a dental or vision insurance plan can enroll into a medical and prescription plan.

Changes to claim and other deadlines

The following claim-related deadlines are extended to exclude from the deadline period days from March 1, 2020 until 60 days after the end of the national emergency.

  • Filing a claim
  • Filing an appeal of an adverse benefit determination (180 for group medical; 60 days for other ERISA benefits)
  • Filing a request for external review

In addition, the following COBRA plan provisions also are similarly extended.

  • 30-day deadline for employers to notify the plan administrator of the occurrence of a COBRA-qualifying event (e.g., employment resignations and termination, employee divorce, dependent age-off). MCPS will continue to make every effort to report the COBRA-qualifying event within the 30 days to Benefit Strategies, the MCPS COBRA plan administrator.
  • 14-day deadline for plan administrator (Benefit Strategies) to provide a COBRA election notice in the event of a COBRA-qualifying event. Benefit Strategies will continue to make every effort to provide the COBRA notices to eligible individuals.
  • 60-day deadline for qualified beneficiaries (former employees) to notify the plan administrator (Benefit Strategies) of the occurrence of a COBRA-qualifying event (e.g., divorce).
  • 60-day deadline to notify the plan of a determination of disability.
  • 60-day deadline for former MCPS employees or aged-off dependents to elect COBRA coverage.
  • 45-day deadline to pay the first premium and 30-day deadline to pay subsequent premiums.

Changes to Medical and Dependent Care Flexible Spending Accounts (FSA)

The Department of Labor and the Internal Revenue Service have released new guidelines affecting FSA elections. MCPS permanent employees who work a minimum of 20 hours a week in their permanent positions can enroll in medical and dependent care FSAs. New employees have 60 days from their date of hire to open an FSA. Employees who missed the enrollment deadline have another opportunity to open an FSA as a result of these changes. These elections are valid for the calendar year.

Employees planning to take advantage of these changes should take note of the following:

  1. Employees may contribute up to $2,750 in a medical FSA and up to $5,000 in a dependent care FSA.
  2. Individuals who choose to cancel their FSA may continue to claim expenses beyond the cancellation date up to the amount contributed at the time of cancellation, through the end of the calendar year.
  3. Individuals who choose to reduce their election, can choose to reduce their election to an amount not below the amount they have already contributed or spent (whichever is highest). Amounts already contributed will not be refunded.
  4. Additional details on any changes to deadlines to incur expenses and reimbursements will be shared with all employees if and when available.

MCPS employees should submit a completed MCPS Form 450-3, Flexible Spending Account Calendar Year 2021 Election to make appropriate changes.

Two permanent changes have been made to Medical-FSA-eligible expenses under the federal Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The act was signed on March 27, 2020. Both changes are retroactive and effective for expenses incurred on or after January 1, 2020:

  • Over-the-counter (OTC) drugs and medicines no longer require a prescription to be eligible. This includes products such as cough syrup, allergy medicines, and pain relievers.
  • Menstrual care products (i.e., tampons, liners, pads, cups, etc.) now are eligible.

Benefit Strategies, the MCPS FSA administrator, is updating its system to ensure that FSA debit cards can be used to pay for the newly eligible expenses. In addition, individual merchants (drug stores, grocery stores, online retailers, etc. that accept FSA debit cards) will need to update their systems as well. These updates are expected to be completed by early summer, although some merchants may take longer. Until you are able to use the FSA card, you can use another form of payment for these items and submit a claim for reimbursement to Benefit Strategies through our secure online portal or mobile application, or by completing a Benefit Strategies claim form.

MCPS employees now have until December 31, 2020, to use their calendar year 2019 FSA balance(s). Per the original plan provisions, employees had until March 15, 2020, to use their 2019 funds. Employees have until March 15, 2021, to use their balance(s) from calendar year 2020.

The American Rescue Plan Act of 2021 (ARPA) has established a new annual limits for pretax contributions to dependent care FSAs. The annual limits are increased to $10,500 (up from $5,000) for single taxpayers and married couples filing jointly and to $5,250 (up from $2,500) for married individuals filing separately.

The Internal Revenue Service has announced that masks, hand sanitizer, and sanitizing wipes used to protect against COVID-19 now are considered eligible expenses under medical flexible spending account (FSA) plans. The addition of these Personal Protective Equipment (PPE) items to the list of FSA-eligible items is retroactive and effective for expenses incurred on or after January 1, 2020.

Employees and retirees may email or telephone ERSC at 301-517-8100 if they have specific questions regarding the impact of the changes to their specific situation. Comprehensive information regarding MCPS-provided health insurance plans is available on the Employee Benefits web page. Detailed information regarding FSAs, including a list of qualifying expenses also is available on the FSA web page.

Caremark/CVS Updates

Caremark/CVS Health is taking steps to care for our plan members and to help them adhere to their medications.

Relaxing Refill Restrictions

Caremark is waiving early refill limits on 30-day prescriptions for maintenance medications at any in-network pharmacy. Relaxing refill-too-soon limitations allows members to obtain maintenance medication prescriptions ahead of their normal fill schedule. This applies to all employee and retiree prescription plans. The 30-day early fill override is a temporary process in effect for the current COVID-19 emergency situation. 

Members to Refill Maintenance Medications

We know that access to needed medication is important to you and your family members during the uncertainty caused by COVID-19. We strongly recommend you take action now for individuals who have long-term maintenance medications to refill eligible maintenance prescriptions for 90-day supplies.  

MCPS has a 90-day prescription benefit for maintenance medications at CVS pharmacy and the option of home delivery from CVS Caremark mail service pharmacy with no delivery cost.  

Free Home Delivery from CVS Pharmacy

Beginning immediately, CVS pharmacy will waive charges for home delivery of all prescription medications. With the Centers for Disease Control and Prevention encouraging people at higher risk for COVID-19 complications to stay at home as much as possible, this is a convenient option to avoid coming to the pharmacy for refills or new maintenance prescriptions.

Subsidy Available to Certain COBRA Participants 

The American Rescue Plan Act of 2021 (ARPA) provides for a 100 percent subsidy of COBRA premiums from April 1, 2021 to September 30, 2021 for Assistance Eligible Individuals (AEIs). To qualify, AEIs must have experienced a COBRA qualifying event other than a voluntary termination of employment. The subsidy is not available to people who voluntarily left their jobs.

Please note the following:

  • Premiums for medical, prescription, dental, and vision coverage for all AEIs are subsidized at 100 percent during the coverage period.
  • To qualify as an AEI, a person must be COBRA-eligible as of April 1 or later and not be eligible for other coverage during the subsidy period.
  • The subsidy period lasts for up to six months (through September 2021) except for AEIs who exhaust their COBRA eligibility or qualify for other coverage. AEIs receiving the subsidy are required to inform the plan if they are eligible for other coverage.
  • AEIs who become COBRA-eligible after April 1, 2021, receive the subsidy through September 2021, even if they receive less than six months of premium subsidies.
  • The law establishes an extended election period of 60 days from receipt of the ARPA eligibility notice during which AEIs can enroll in subsidized coverage retroactive to April 1.
  • AEIs are limited to switching to a plan with the same or lower premium plan than they had prior to the qualifying event.
  • Employers are responsible for subsidizing the full premium plus the 2 percent administration fee. Companies will be reimbursed by credits against payroll taxes owed.

For further information, contact Benefit Strategies by telephone at 888-401-3539 or ERSC at 301-517-8100 or email ERSC.