For Stop-Loss employers and brokers

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.

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.

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.

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.

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.