2019 Novel Coronavirus update: A review of the current need-to-know issues

Special Notice – March 17, 2020

In response to the spread of the 2019 Novel Coronavirus (COVID-19), on March 13, 2020 the World Health Organization declared the virus a pandemic. Federal and provincial governments across Canada have responded with unprecedented measures to ensure the safety of Canadians at home and abroad. Some provinces and municipal districts have also declared States of Emergency and enacted varying measures to secure and safeguard Canadians.

This Special Notice reviews some of the pressing issues facing our industry at this point in time and provides a summary of the many interpretations and opinions that have been provided to date. As the situation remains in a state of flux, all parties will need to consider the evolving context of the COVID-19 pandemic. Employers, plan sponsors and insurance providers will need to continually monitor and review their specific policies and procedures to ensure the best possible coverage and care for employees and plan members and seek appropriate expert advice as needed.

Issues to consider for plan sponsors, employers and plan members include:

Managing leaves of absence and coverage for short term
disability (STD)

Absences as a result of COVID-19 may be caused by a variety of reasons, including government-mandated social distancing, quarantine, or orders to remain out of the workplace.   Some employees may be suffering COVID-19 symptoms and are deemed unfit for work within the meaning of a group insurance plan.  Employees who are not covered through a group insurance plan could be eligible for a protected leave of absence depending on their provincial legislation.  Submission of claims for STD or Employment Insurance (EI) Disability should be made as for any other illness.

Other questions to be addressed might include:

• What happens if employees are not exhibiting symptoms of the virus or are under mandatory quarantine but need to stay at home for child-care or other reasons related to COVID-19?
• Will private plans consider other situations that do not meet the strict definitions of illness or STD but are related to the pandemic?
• Are employees eligible for EI benefits if they do not go to work but are symptom-free?

Generally, plan members who are not exhibiting symptoms but are self-isolated (even through a Public Health Office, medical professional, or as mandated through a State of Emergency) would not be considered eligible for an STD claim.  This would include those unable to work if they have to care for small children in the event of school or daycare closure.  Provincial legislation is proposed in Ontario to protect jobs in this instance but does not address income continuation other than possibly through EI.  While no specific regulation changes to EI have been made to date, the Government of Canada has announced that they will waive the one week waiting period for EI for those affected by COVID-19. Various provinces are also looking to waive the requirement for doctors’ notes for proof of illness.  We expect more details will emerge in the coming weeks.

Coverage for out of country travel

The latest official Government of Canada travel advisory suggests that Canadians avoid non-essential travel outside of Canada until further notice, and has recommended that those who are currently away, return while commercial flights are still available.  Insurers have generally used March 13, 2020 (the date on which the WHO declared COVID-19 a pandemic), as the demarcation point for the rules governing out of country coverage as follows:

• If travel began prior to March 13, insurers are “generally” continuing out of country coverage, and emergency illnesses related to COVID-19 are treated as any other emergency illness. This applies to travel anywhere out of Canada;
• If the travel out of Canada started after March 13, a number of insurers will not cover emergency expenses related to COVID-19 (or for some insurers, for any reason); and
• Individuals who were already out of country for non-essential travel on March 13 and whose travel coverage will expire while they remain under quarantine or travel bans, may be entitled to extensions of coverage depending on the terms of their plan or the insurer’s decision.

Plan sponsors, and individuals who are currently out of country (or plan on travelling during the period of the travel advisory), are encouraged to review the updates posted by their specific insurer and to refer to their specific plan details.

Drug payments, claims, and prescription medications

Issues related to drug payments, prescription medication and claims include:

Can plan members under quarantine request early refills of prescription medicines?

Depending on the provider, current standards allow for prescription drugs to be supplied in amounts that will cover a prescription for up to 100 days.  To help mitigate a potential shortage, a number of insurers have stated that there are no plans to amend the rules for early refills of prescriptions at this time.

What is the plan for coverage of drug claims filed out of the country?

The various insurers in our market have different philosophies regarding coverage for drugs and medicines for Canadians who are delayed abroad for longer than anticipated.  Processes and philosophies differ by insurer but all providers are working to ensure the safety and continued health of their insured members.  Providers have generally posted regular updates on their websites.

Will a COVID-19 vaccine be covered by current plans?

There is currently no vaccine available for the COVID-19 virus.  Any products currently marketed that purport to cure or combat COVID-19 are not covered.  Certain naturopathic remedies that help alleviate symptoms may be covered depending on your plan terms.  Further details on coverage of a vaccine will be provided when available and will depend on a plan’s specific provisions.

Other issues to consider

The full impact of the COVID-19 pandemic will not be known for some time.  Issues regarding current and future premium payments for benefit plans including EAP plans, economic impact, disability, drug and travel claims, will need to be carefully navigated for all parties involved.  In the meantime, as the situation remains fluid, further updates and details from health organizations, government and other key authorities should be continually monitored for up-to-date information.  If you have questions or concerns, please reach out to your Eckler contacts for information.