Montgomery County Public Schools

New Benefit Guidelines Released Due to COVID-19 for Plan Participants and Beneficiaries Affected by the Pandemic

The Department of Labor and the Internal Revenue Service released new guidelines to benefit plans due to the COVID-19 pandemic.

MCPS-provided medical insurance plans are eliminating financial barriers for members to ensure that employees and their family members covered by an MCPS health insurance plan receive the medically necessary services to detect and treat COVID-19.

• CareFirst will waive copays and out-of-pocket expenses—for out-of-network visits—for testing, diagnosis, and treatment of COVID-19 as well as telemedicine copays. (Out-of-network providers can balance bill amounts over allowable charges.) CareFirst will maintain these provisions until the COVID-19 national emergency ends.
• Kaiser Permanente of the Mid-Atlantic States will waive cost sharing for testing, diagnosis, and treatment of COVID-19 through December 31, 2020.

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.

2. 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.

3. 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.

4. 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.

5. 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 $2,700 in a medical FSA and up to $5,000 in a dependent care FSA.
2. Individuals who choose to cancel their FSA are eligible to claim only the expenses incurred up to the plan cancellation date.
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 2020 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.

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 ERSC website. Detailed information regarding FSAs, including a list of qualifying expenses also is available on the ERSC website

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.