For Stop-Loss employers and brokers

We support self-funded employers and their broker partners.

Take a look at our new flyer to learn more

 

Sun Life has been a trusted leader in stop-loss coverage for more than 35 years. Take a look at our new flyer to learn more about how we support self-funded employers and their broker partners.

We are actively monitoring the changing situation related to COVID-19 (or Coronavirus) and would like to share a few updates with you based on questions we have received about your Stop-Loss coverage. Our dedicated team of experts is committed to doing everything that we can to support you. You can count on us to continue to deliver excellent service and be a resource for information during this challenging time.

Answers to top questions

If a Plan is amended to include testing and/or treatment costs associated with COVID-19 (Coronavirus) with no member cost sharing, will you require the plan amendment be sent to you for approval? Is it possible, based on these changes, you might consider mid-policy year rate adjustments?

The health and well-being of our Client’s employees and members is our top concern. If your plan is amended during the current Stop-Loss Policy Year to allow for costs associated with testing or treatment for COVID-19 (Coronavirus) to be covered with no cost share, we will not require that the plan amendment be sent to us for approval and such a change will not trigger the Right to Recalculate provision in the Policy. This includes telemedicine services. Prior to renewing your Policy, we will require a copy of the plan amendment.

What if we are adding telemedicine services to the Plan for the first time or expanding telemedicine (such as including specialty services and mental health)? Will you require an updated plan document be sent to you for approval? Will you make mid-policy year rate adjustments based upon such changes?

Our goal is to support employees and employers through this difficult time. We support plan changes that increase access or add access to telehealth/telemedicine solutions. If your plan is amended during the current Stop-Loss Policy Year, we will not require that the plan amendment be sent to us for approval and will not change your premium for the current Policy Year based upon such changes.

However, in order to process claims accurately, we need to be made aware of any such plan changes as soon as possible. Please send an email detailing the changes or a copy of the plan amendment to our claims team at Stop.Loss.Claims@sunlife.com. Prior to renewing your Stop-Loss Policy, we will require a copy of the plan amendment.

If COVID-19 (Coronavirus) causes your current plan members to no longer meet eligibility requirements for coverage under your plan (for example, as a result of a furlough, reduced hours, or extending coverage through the end of the month for a terminated employee), and you want to change eligibility requirements to keep them on the Plan, how will stop-loss claims for them be handled?

We know that employers may need additional flexibility as a result of COVID-19 (Coronavirus). Employees whose eligibility under the plan is impacted by COVID-19 related actions can still be considered covered under the Stop-Loss Policy during the current Policy Year as long as the plan is amended to provide coverage for them, premium for them continues to be paid and their claims are funded. If your plan is amended during the current Stop-Loss Policy Year to permit such a change, we will not require that the plan amendment be sent to us for approval and such a change will not trigger the Right to Recalculate provision in the Policy. However, in order to process claims accurately, we need to be made aware of any such plan changes as soon as possible. Please send an email detailing the changes or a copy of the plan amendment to our claims team at Stop.Loss.Claims@sunlife.com. Prior to renewing your Stop-Loss Policy, we will require a copy of the plan amendment.

For employees who lose coverage under a plan as a result of a COVID-19 (Coronavirus) related action and elect to continue coverage through COBRA, will their claims be eligible for reimbursement under the Stop-Loss Policy?

When an employee or former employee elects to continue coverage through COBRA, eligible claims for the employee and covered dependents will continue to be covered under the Stop-Loss Policy as long as COBRA premiums are paid and the employee remains covered under the plan. This applies whether COBRA premiums are paid by the employee or another party on the employee’s behalf.

Are you willing to make any adjustments to the Right to Recalculate provision in the Stop-Loss Policy based on decreases in enrollment that may occur as a result of COVID-19 (Coronavirus)?

We know that employers may need additional flexibility as a result of COVID-19 (Coronavirus). As a result, we are adjusting our process around the Right to Recalculate provision. Decreases in enrollment of up to 30% of covered lives that occur between 3/1/20 and 12/31/20 will not be subject to a recalculation of rates, deductibles, or factors as a result of such a change. For decreases in enrollment greater than 30%, please refer to the provisions included in your Stop-Loss Policy. Decreases in enrollment include only those employees whose coverage under the plan has been terminated and who have not enrolled in COBRA coverage. To address Client-specific situations, please contact your Sun Life Stop-Loss Specialist.

The full Sun Life Stop-Loss FAQ is available here.

You can work with us digitally

Get your Stop-Loss claim reimbursements even faster!

We want to make sure that you get your claim reimbursements as quickly as possible. Our claims team is prepared to process reimbursements as usual with no anticipated changes to our standard turnaround time. Check out the below resources to ensure you get your stop-loss claims reimbursed as fast as possible:

For more information, reach out to your Sun Life Stop-Loss Sales Specialist with any questions. We are here to help you.

Engage with us virtually

If you have an upcoming meeting or event, we are ready to continue serving you and collaborating with you virtually. Speak with your Sun Life representative to learn more. We also invite you to learn about our current Broker education courses here.



This content is not to be considered legal advice. We recommend Clients speak with legal counsel specializing in labor and employment law to ensure your organization meets requirements

Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York. In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI). Product offerings may not be available in all states and may vary depending on state laws and regulations. Sun Life reserves the right to discontinue any service that is not insurance at any time. All products, brands, and names are the property of their respective owners.

SLPC 30172 5/20 Exp. 5/22