Critical Health Alert; Last Updated: April 23, 2020 4:30 P.M. EST
We understand that the COVID-19 pandemic may require customers to unexpectedly furlough, temporarily lay-off or reduce hours/salary for employees.
As a response to these unique events, and assuming premium continues to be remitted to MetLife:
For group life, dental, AD&D, vision, accident & health and legal coverage, MetLife is willing to allow employees who are furloughed, temporarily laid-off or have reduced hours/salary to continue their coverage for 12 months from the date of the furlough, temporary lay-off or reduced hours/salary (collectively, “temporary salary reductions”). Premiums need to be remitted for coverage to remain active.
For purposes of group life, the coverage amounts will not be reduced as a result of temporary salary reductions and will remain in effect just as they were prior to the furlough, temporary lay-off or reduced hours/salary. Accordingly, premium needs to be remitted based on the volume for the regular (non-reduced) coverage amounts.
For group disability, MetLife is willing to allow employees who experience a furlough, temporary lay-off or have reduced hours/salary between March 1, 2020 and May 31, 2020, to continue their coverage for 90 days from the date of the furlough, temporary lay-off, or reduced hours/salary. Coverage amounts will not be reduced as a result of temporary salary reductions and will remain in effect just as they were prior to the furlough, temporary lay-off or reduced hours/salary. Accordingly, premium needs to be remitted based on the volume for the regular (non-reduced) coverage amounts.
In all instances, if your group policy allows for longer periods of continued coverage under any of the circumstances outlined above, we will honor the longer period of time.
In addition, if your coverage is self-insured, and you are not comfortable with the timelines outlined above, please contact your Account Executive for alternatives.
For Group Life, AD&D, Accident and Health, Dental and Vision, if your employee’s employment is terminated and coverage lapses due to non-payment, and they return to work or are re-hired within 6 months, MetLife will reinstate their prior coverage amount without needing to provide evidence of insurability, where applicable, or satisfying benefit eligibility waiting periods. For accident and health coverage, any limitations for pre-ex conditions will be applied from the reinstatement date.
For disability coverage, if your employee’s employment is terminated and coverage lapses due to non-payment, and they return to work or are re-hired within 3 months, MetLife will reinstate their prior coverage amount without needing to provide evidence of insurability, where applicable, or satisfying benefit eligibility waiting periods. In addition, the pre-ex provision will be applied as if there was no interruption in coverage.
MetLife will continue to review the needs of our clients during this time and if additional flexibility is needed based on the duration of this pandemic, we may modify our reinstatement position.
We understand these are challenging times for many businesses. As an accommodation to our clients, In the event premiums cannot be paid during the contract grace period, we will be extending grace periods for the lesser of 90 days from premium due date or July 31, 2020, unless a different grace period is required by law. ? This policy will be applied for all premiums due 3/1/2020 and forward, as well as apply to any premium within the current 30-day grace period. MetLife will continue to monitor the situation and will provide additional guidance as it becomes available.? We are also monitoring state specific mandates and will comply with those mandates. As the coronavirus situation continues to evolve, MetLife will review this guidance for necessary actions and provide updates where the guidance or process has changed.
For insured business, rates in effect during the current policy period would not be affected. For self-funded business or for absence administration, the terms of the applicable Administrative Service Agreement will apply.
Please know that each claim received will be reviewed consistent with policy terms and applicable insurance law.
Life Insurance: For Group Life Insurance (Basic, Optional, Dependent, GUL and GVUL), there are no policy limitations that would limit a claim payment resulting from COVID-19, provided the individual met all other certificate requirements.
Accidental Death and Dismemberment (AD&D): AD&D policies do not cover diseases. Therefore, death due to COVID-19 is excluded, as are all deaths caused by disease.
Hospital Indemnity: Because COVID-19 is a viral infection it would be considered a sickness and the Sickness Hospital benefits (admission and confinement) would be payable provided the individual met all other certificate requirements.
Accident Insurance: The definition of an “accident” includes that it is not a sickness so this condition would not be covered under our standard accident plan for COVID-19. However, it would be covered if the accident plan included Sickness Hospital benefits (admission and confinement) and would be payable provided the individual met all other certificate requirements.
Critical Illness/Cancer Insurance: Because COVID-19 is not a listed “covered condition” it would not be covered under any of our Critical Illness product versions.
Disability Insurance: There are no policy limitations that would apply for COVID-19. MetLife will evaluate each claim in accordance with the terms of the policy and use claim processes already in place for disability claims.
For employees with the MetLife AXA Travel Assistance1 program we provide medical evacuation/repatriation if an employee was exposed to COVID-19 or is in a high-risk area or country. The employee would be eligible for evacuation/ repatriation services, and AXA would coordinate the employee’s return.
Proof must be established that the employee does not have COVID-19 even if the evacuation is for another reason. In addition, destination countries are implementing more stringent screening practices at points of entry. Access to and clearances for air and ground ambulance providers, as well as other transportation options, are becoming more challenging to secure as action is taken to contain the spread of the virus.
For employees with MetLife’s Employee Assistance Program (EAP)2 we provide 24/7 confidential access to professional support to help employees manage stress, anxiety, grief, financial concerns, and much more. Employees can connect to support by phone, video, or chat anytime, anywhere, and they have access to a vast library of online resources for coping with trauma, building resiliency, self-care, and managing change.
Our EAP program also offers manager consultations and webinars to support leaders in dealing with sensitive workplace situations.
MetLife is committed to helping employees get maximum value from their benefits. Once we receive a MetLife Group Disability claim, we automatically look at whether the employee has hospital indemnity coverage. If they do, we will inform and guide the employee so they can understand and use the benefits available to them.
For our Optional Life and MetLife Legal Plan customers, employees have access to Will Preparation3 services including telephone or in-person consultations with an attorney in the MetLife Legal Plan attorney network. Covered services include preparing important planning documents like a power of attorney, which is a document that allows someone to conduct transactions on another person’s behalf, and a health care proxy, where someone can appoint another person to make medical decisions on their behalf.
We know the kinds of questions your employees are asking themselves—this site is designed to answer as many of them as possible. From financial tips to expert-backed ways to stay calm and mindful, we’ll show them how to improve their financial health now while guiding them to build a more confident future. And with new content added regularly, the Financial Wellness hub evolves with their needs.
PlanSmart Financial Wellness
For customers with PlanSmart Financial Wellness4, the financial education and guidance available may be helpful in managing finances during times of increased market volatility such as we’ve seen in recent weeks.
For our Life Insurance policy customers, licensed Grief Counselors are available from Lifeworks5 for insured employees and their dependents if they experience a loss, regardless of cause of death, or are diagnosed with a potentially life-threatening disease such as COVID-19. Whether it’s help coping with a loss or a major life change, confidential counseling sessions can be tailored to meet the individual needs.
For other questions and assistance please reach out to your MetLife Representative
Claimants are unlikely to satisfy the definition of disability in the applicable plan solely due to being quarantined. If the claimant develops COVID-19 or even some other qualifying sickness while quarantined, and it meets the definition of disability within the policy, benefits would be reviewed for payment.
We will review each leave request on a case-by-case basis. However, in order to qualify for FMLA, quarantined employees would need to satisfy the definition of a “serious health condition” or be caring for a child if the school or place of care has closed or childcare provider is unavailable due to a public emergency regarding COVID-19, among the other FMLA eligibility requirements. If the employee is unsure if the claim will be approved, we encourage the claim to be submitted for review. For additional guidance on FML compliance related to COVID-19, please refer to the DOL guidelines at https://www.dol.gov/agencies/whd/pandemic/ffcra-questions.
For all other questions regarding inforce IDI policies, please contact your Account Manager, Account Executive or MetLife representative.
The ADA protects employees from disability discrimination by requiring reasonable accommodations to ensure equal access to employment (e.g. allows an individual with a disability to have an equal opportunity to apply for a job, perform a job’s essential functions, or enjoy equal benefits and privileges of employment.) Individuals seeking protections under the ADA must meet the definition of disability under the law. The possibility of getting sick, without a medical condition/impairment, does not meet ADA disability standards. That being said, COVID-19 is an evolving pandemic, and each claim will be reviewed based on its individual facts. For example, if an employer mandates an employee to not work due to potential COVID-19 exposure or symptoms (i.e., mandatory quarantine), the employee may qualify for ADA protections on the ground that he or she is being “perceived as having an impairment.” It may be helpful for employers to review the EEOC guidance on how employers should respond to direct threats as they relate to pandemic influenza.
If an employer mandates an employee to not work due to potential COVID-19 exposure or symptoms (i.e., mandatory quarantine), the employee may qualify for ADA protections on the ground that he or she is being “perceived as having an impairment.” The normal reasonable accommodation review should take place, and a reasonable accommodation may include job protected leave. On the other hand, an employee without any symptoms or potential exposure who chooses to self-quarantine as a preventive measure would likely not qualify for ADA protection. That being said, COVID-19 is an evolving pandemic, and each claim will be reviewed based on its individual facts.
If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality, as required by the Americans with Disabilities Act (ADA). Employees that are concerned about potential exposure should refer to CDC guidance for how to conduct a risk assessment.
Although there is no EEOC guidance yet on COVID-19, the EEOC has published guidelines for employers on their website (https://www.eeoc.gov/facts/pandemic_flu.html) with respect to other pandemics which may be helpful.
The Health Screening Benefit would be payable for a Coronavirus laboratory screening test (regardless of the test result), subject to the requirements for payment of that benefit and the other terms and conditions of the certificate.
Claimants would not satisfy the definition of disability in the applicable plan solely due to being quarantined. If the claimant develops COVID-19 or some other qualifying sickness while quarantined, the claim would be reviewed per the requirements of the plan.
Unfortunately, MetLife is unable to support direct billing when MetLife is not the recordkeeper. Where MetLife is the recordkeeper, or for ported certificates MetLife does and will continue to handle direct billing.
If the family, beneficiary or claimant is unable to obtain a death certificate because of delays from their local medical examiner's office, we have a Funeral Director Affidavit available that may be used in certain situations. The Funeral Director should call MetLife at 1-800-638-6420 to have an Affidavit sent.
MetLife is leveraging its existing Business Continuity Plans due to the global pandemic. For our Dental business these plans include continued staffing to respond to inquiries from customers, plan members and dentists as well as process and pay claims. MetLife remains committed to ensuring our customers, plan members, and dentists get the service they expect.
MetLife dental plans provide coverage for dental services delivered through tele-dentistry. The coverage is handled the same as if the patient was receiving the dental services in a dental office. Dental services that can be delivered through tele-dentistry typically include problem focused exams and re-evaluations. The coverage is subject to the plan terms and conditions. Dentists can verify benefit coverage using MetLife’s web portal, www.MetDental.com as well as MetLife’s interactive voice response (IVR) capabilities. To the extent a state has enacted mandates regarding tele-dentistry due to the COVID-19 pandemic, MetLife will fully comply.
We are working remotely and operating our regular business hours. Our Client Service Center is open Monday through Friday, 8 am – 8pm ET, and we are operationally prepared to handle all calls and claims. Members can reach out to us at 800-821-6400 with any questions or concerns.
Our attorneys can provide consultations over the telephone, and many can consult via virtual meetings. While our attorneys will do their best to handle all inquiries in a timely manner, our e-panel attorneys are also available to answer general questions online. Members can submit questions and a Network Attorney will respond to within 24 to 48 hours.
During this period of uncertainty, MetLife will make an exception to extend the Grace Period for premium payment to 90 days after the Premium Due Date, for customers with a policy Grace Period less favorable than 90 days. Customers with Grace Periods greater than 90 days will retain the Grace Period in their policy. This policy will be applied for all premiums due 3/1/2020 and forward, until this crisis is deemed over, as well as apply to any premium within the current 30-day grace period. MetLife will continue to review the situation and will provide additional guidance as it becomes available.
What is the MetLife Legal Plan Disaster Relief COVID-19 plan?
MetLife Legal Plans is happy to offer the Disaster Relief plan to our plan sponsors affected by COVID-19. This plan extends consultation and document review services to all of a current group sponsors’ employees, even those not currently enrolled, at no cost to them, through the July 31, 2020. Employees can contact our Network Attorneys to get answers to questions related to legal issues they may be facing as well as have attorneys review estate planning documents or insurance forms.
How do employees use the MetLife Legal Plans Disaster Relief Plan?
Employees should be able to access the service within two to three business days after this is discussed with your Account Executive. To use the service, the employee can call the MetLife Legal Plans Customer Service Center at 800.821.6400. They will need to identify their employer, the last four digits of their SSN or employee number and indicate that they are interested in the document review and consultations services being offered.
Employees also have access to a self-help document library to complete wills, living wills and power of attorney documents. They can access the library by visiting info.legalplans.com and entering access code 9790010 and clicking on “Self-Help Documents” in the “Covered Services” tab. Or clicking here: https://info.legalplans.com/9790010/CoveredServices/?coveragecode=979#tab-forms
Will we know how many of our clients are using the MetLife Legal Plans Disaster Relief Plan?
Yes. We will be able to track how many clients enroll and the utilization.
What are MetLife Legal Plans’ portability options for furloughed, temporarily laid-off or reduced hours/salary employees?
Beginning April 1, 2020 through May 31, 2020, we are offering employees that would like to keep their plan benefits due to a COVID-19 related leave of absence, unpaid leave, or termination the option to either port their plans for three months or choose our standard 12-month portability.
How do employees apply for portable enrollment for MetLife Legal Plans?
Employees can call our Client Service Center at 800.821.6400, Monday-Friday (8am - 8pm ET) to enroll in the portable plan. Employees must enroll within the month of April or May and within 30 days from their last date of employment. Enrollment is prepaid via remittance of a lump sum payment equal to the legal plan’s monthly rate times three months (or 12 months if you choose our standard portability plan). Under portable enrollment, dependent definitions are the same as those for active employees and the covered services and exclusions are the same as those under the current plan. Members can visit members.legalplans.com or call 800.821.6400 for plan details.
How long will MetLife Legal Plans offer this three-month portability plan?
At the end of May, we will evaluate whether to continue the three-month portability option in June. For those who enroll in the three-month program, we will evaluate at the end of the period whether to extend for an additional three-month renewal option.
*Standard Exclusions apply. See a full list of our exclusions here:
No service provided, not even consultation for:
1 Travel Assistance services are offered and administered by AXA Assistance USA, Inc. Certain benefits provided under the Travel Assistance program are underwritten by Certain Underwriters at Lloyd’s London (not incorporated) through Lloyd’s Illinois, Inc. Neither AXA Assistance USA Inc. nor the Lloyd’s entities are affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife.
2 EAP services provided through an agreement with LifeWorks US Inc. (LifeWorks by Morneau Shepell). LifeWorks is not a subsidiary or affiliate of MetLife.
3 Will Preparation is offered by MetLife Legal Plans, Inc., a MetLife company. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. Tax Planning and preparation of Living Trusts are not covered by the Will Preparation Service.
4 MetLife administers the PlanSmart Financial Wellness program, but has arranged for Massachusetts Mutual Life Insurance Company (MassMutual) to have specially trained financial professionals offer in-person financial education and, upon request, provide personal guidance to employees and former employees of companies providing the program through MetLife. Guidance and coaching online and by phone is provided by trained and credentialed financial planners through our alliance with EY (Ernst & Young LLP). PlanSmart Financial Wellness planner line access for COVID-19 relating financial questions is being offered to employers under 100 lives at no cost for a limited time. If you’d like additional details on this offer, please contact [email protected]. No MetLife customer relationship required.
5 Grief Counseling services are provided through an agreement with LifeWorks. LifeWorks is not an affiliate of MetLife, and the services LifeWorks provides are separate and apart from the insurance provided by MetLife. LifeWorks has a nationwide network of over 30,000 counselors. Counselors have master’s or doctoral degrees and are licensed professionals. The Grief Counseling program does not provide support for issues such as: domestic issues, parenting issues, or marital/relationship issues (other than a finalized divorce). For such issues, members should inquire with their human resources department about available company resources. This program is available to insureds, their dependents and beneficiaries who have received a serious medical diagnosis or suffered a loss. Events that may result in a loss are not covered under this program unless and until such loss has occurred. Services are not available in all jurisdictions and are subject to regulatory approval. Not available on all policy forms.
Group Life, Group Disability and Group Dental Insurance:
Like most insurance policies and benefit programs, insurance policies and benefit programs offered by Metropolitan Life Insurance Company and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations and terms for keeping them in force. Please contact MetLife for complete details.
The MetLife Cancer Insurance plan is based on the MetLife Critical Illness Insurance (CII) policy. MetLife Cancer Insurance includes only the Covered Conditions of Full Benefit Cancer and Partial Benefit Cancer.
METLIFE CRITICAL ILLNESS INSURANCE (CII) IS A LIMITED BENEFIT GROUP INSURANCE POLICY. Like most group accident and health insurance policies, MetLife’s CII policies contain certain exclusions, limitations and terms for keeping them in force. Product features and availability may vary by state. In most plans, there is a pre-existing condition exclusion. After a covered condition occurs, there is a benefit suspension period during which benefits will not be paid for a recurrence, except in the case of insureds covered under a New York certificate. MetLife’s Issue Age CII is guaranteed renewable, and may be subject to benefit reductions that begin at age 65. Premium rates for MetLife’s Issue Age CII are based on age at the time of the initial coverage effective date and will not increase due to age; premium rates for increases in coverage, including the addition of dependents’ coverage, if applicable, will be based on the covered person’s age at the time of the initial coverage effective date. Rates are subject to change for MetLife’s Issue Age CII on a class-wide basis. A more detailed description of the benefits, limitations, and exclusions can be found in the applicable Disclosure Statement or Outline of Coverage/Disclosure Document available at time of enrollment. For complete details of coverage and availability, please refer to the group policy form GPNP14-CI or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York.
MetLife's Critical Illness Insurance is not intended to be a substitute for Medical Coverage providing benefits for medical treatment, including hospital, surgical and medical expenses. MetLife's Critical Illness Insurance does not provide reimbursement for such expenses.
METLIFE'S ACCIDENT AND HOSPITAL INDEMNITY INSURANCE POLICIES ARE LIMITED BENEFIT GROUP INSURANCE POLICIES. The policies are not intended to be a substitute for medical coverage. The policies or their provisions may vary or be unavailable in some states. There is a preexisting condition limitation for hospital sickness benefits, if applicable. There are benefit reductions that begin at age 65, if applicable. And, like most group accident and health insurance policies, polices offered by MetLife may include waiting periods and contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or GPNP13-HI or contact MetLife.
Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife’s Group Hospital Indemnity Insurance is pending regulatory approval. Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See MetLife’s Disclosure Statement or Outline of Coverage/Disclosure Document for full details.