Employer Group Plan Provisions | Self-Funded FAQ

Yes, as long as the Plan Sponsor applies the waiver uniformly for all eligible plan participants.

Yes, the Plan Sponsor can amend the Plan Document for a period of time or indefinitely. Please note: All Plan Amendments must be reviewed and approved by the stop loss carrier to ensure continuity of coverage.

Yes, testing and related services are now a Federal requirement and all health plans and insurance coverage (stop loss) must cover. Reference: H.R. 6201 Families First Coronavirus Response Act.

We’ve taken two important measures to ease help the current strain on providers and their facilities while bolstering access to care:

  1. To reduce the administrative burden on provider offices, we’ve suspended authorization and referrals through June 30, 2020.
  2. To encourage members to receive care without leaving home, we’ve expanded telehealth services. Telehealth appointments related to COVID-19 testing and diagnosis are no cost to members.

PacificSource is working with self-funded sponsors to eliminate cost-sharing measures.