COVID-19 Update for U.S.
Critical Health Alert; Last Updated: January 20, 2021 11:25 A.M. EST
[updated January 20 2021] Are employees who were actively at work prior to a furlough, temporarily lay-off or reduce hours/salary and enrolled for coverage, eligible for benefits while on furlough, temporarily lay-off or reduce hours/salary?
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; (1) employees who were furloughed, temporarily laid-off or had reduced hours/salary in 2020 to continue their coverage for up to 12 months from the date of the furlough, temporary lay-off or reduced hours/salary; and (2) employees who were furloughed, temporarily laid-off or had reduced hours/salary in 2021 to continue their coverage through 12/31/21. Premiums need to be remitted for coverage to remain active.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 and AD&D, 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, the furlough exception period has expired. MetLife will follow the terms of the certificate.
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.
What are MetLife’s reinstatement provisions if we re-hire employees who were laid off due to COVID-19 and can we waive benefit eligibility waiting periods, evidence of insurability, etc?
For Group Life, AD&D, Accident and Health, Dental and Vision, if your employee’s employment is terminated and they 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, unless coverage was continued under the plan during the period of unemployment, any limitations for pre-ex conditions will be applied from the reinstatement date.
For disability coverage, if your employee’s employment is terminated and they 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.
For MetLife Legal Plans, if your employee’s employment is terminated and the employee is re-hired within 6 months, MetLife will reinstate the prior coverage. Any matters for which an attorney-client relationship formed while the participant was not eligible for plan benefits will be excluded.
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.
Billing and Payment
[updated July 23, 2020] Will MetLife be making any changes or having leniency for payments?
We are no longer offering grace period extensions outside of those in our contract or those required to comply with state specific mandates. We continue to monitor the impact of COVID-19 and will revisit this position if needed.
If you are having any specific payment issues, please discuss them with your MetLife Service team.
Would any additional fees be imposed if a significant number of claims were submitted as a result of a pandemic event?
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.
Information on P&C billing policies
Billing & Payment Leniency
We are here to help, if customers are still experiencing impacts from COVID-19, they can contact us at 800-438-6381 to discuss alternate payment plan options. For customers affiliated with NYSUT, customer service can be reached at 866-697-8822 (866-NYSUT-22) for all questions and/or changes.
Are there any plan or policy limitations that would impact a COVID-19 related claim?
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: COVID-19 must be listed as a “covered condition” for a benefit to be payable under the critical illness plan. Some plans may include COVID-19 as a covered condition in the Infectious Disease category if the group client chooses to include it. There is often a hospital stay requirement.
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.
MetLife Additional Resources
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.
Employee Assistance Program (EAP)
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.
MetLife Legal Plans and Will Preparation
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.
MetLife’s Financial Wellness Hub
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
Disability & Leave FAQs
For claimants who are quarantined because of exposure to COVID-19 but are not themselves afflicted with the disease, will these claimants be considered disabled?
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.
[updated March 30, 2020; 11:10am EST] For claimants who are quarantined because of exposure to COVID-19 but are not themselves afflicted with the disease, will these claimants qualify for FMLA?
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.
[updated July 23, 2020] What are the steps MetLife is taking to support inforce Individual Disability Insurance (IDI) policies?
- 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.
- We will follow the policy provisions and treat each claim on its own merits. IDI policies have elimination periods of 90 or 180 days, which must be satisfied before benefits become payable. The policies provide benefits only for disabilities that result from a sickness or injury.
- Claimants are unlikely to satisfy the definition of total disability in the applicable policy solely due to testing positive or being quarantined. If a claimant develops COVID-19 or some other qualifying sickness while quarantined, and it meets the definition of disability within the policy, benefits would be reviewed for payment.
- (Updated July 23, 2020) We are no longer offering grace period extensions outside of those in our contract or those required to comply with state specific mandates. We continue to monitor the impact of COVID-19 and will revisit this position if needed. If you are having any specific payment issues, please discuss them with your Account Manager, Account Executive or MetLife representative.
For all other questions regarding inforce IDI policies, please contact your Account Manager, Account Executive or MetLife representative.
Americans with Disabilities Act (ADA) FAQs
Will ADA be an avenue for individuals to request ‘work from home’ accommodations, to limit exposure, due to fear of contracting COVID-19?
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.
Can employees request job protected leave as an ADA accommodation, if placed on extended quarantine due to COVID-19 exposure, either self or medically imposed – if they do not have any signs of illness?
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, how do we alert others and still maintain confidentiality as required by the ADA and other laws that protect personal health information?
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.
If an employee has a medical condition that places the employee at higher risk for severe illness if they contract COVID-19, how does the ADA apply to this situation?
The EEOC recently updated their guidance regarding this situation, which is available at https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws.
Given the expanded definition for “high risk” employees being able to request ADA accommodations are you modifying your ADA products to recognize this expanded definition?
Yes, our existing ADA Workforce Solutions process supports the expanded EEOC guidelines.
Given the expanded definition for “high risk” employees being able to request ADA accommodations do you expect any significant volume increases due to this additional type of accommodation need?
We are monitoring claim volumes, across all claim types, to assess COVID related impacts.
Where can I go for additional information related to COVID-19 and the ADA?
In response to the COVID-19 pandemic, EEOC recently updated prior pandemic guidelines for employers on their website: https://www.eeoc.gov/facts/pandemic_flu.html. The EEOC also released FAQs regarding COVID-19 and the ADA. These were recently updated and we encourage you to review the latest guidance which now includes details on the ADA and vaccinations (see section K) available at: https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws.
Accident & Health FAQs
If the Health Screening Benefit is included in a Critical Illness, Accident or Hospital Indemnity Insurance certificate, would the Health Screening Benefit be payable if someone received a laboratory screening test for the Coronavirus?
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.
Life Insurance FAQs
An employee was exposed to COVID-19 while on an airplane and is now under quarantine. Under the Life Insurance policy, is the employee considered Totally Disabled and eligible for Waiver of Premiums?
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.
[updated April 07, 2020; 3:00pm EST] If a customer is unable to direct bill employees while not actively at work because of COVID 19, can MetLife direct bill and collect premiums from our group customers’ certificate holders when MetLife is the not the Recordkeeper?
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.
What are alternate submission methods, other than paper, for employer and claimant statements when death occurs?
Is MetLife able to process a life claim without a death certificate?
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.
Dental Insurance FAQs
What business continuity measures are in place for MetLife’s network of Dentists and Dental Offices?
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.
[updated April 07, 2020; 1:40pm EST] Does MetLife provide benefit coverage for dental services delivered through tele-dentistry?
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.
Are employees going to be charged for additional personal protective equipment (PPE) costs from dental providers?
Currently, members who have services performed by a network provider should not incur any additional costs for infection control, including PPE, per our network contracts with our providers. These costs are not considered a separate billable dental procedure and cannot be billed to a participant or to MetLife. If a member is surcharged by a network provider for PPE upfront, they should report this charge to MetLife by calling us at 1-800-GETMET8 (1-800-438-6388). MetLife has an established grievance process to fully resolve these charges and track these types of issues which allows us to educate providers accordingly.
If a member receives services from an out-of-network provider, they may be responsible for any additional PPE charges billed by the provider.
P&C State Specific Requirements & Variations
Update July 23, 2020
Information for Policyholders
Please click here to see FAQs on COVID-19 business continuity information for individual policy holders
MetLife Legal Plan FAQs
Will there be any disruption of service due to the pandemic?
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.
Will plan members be able to access attorneys during this time?
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.
What is MetLife Legal Plan’s premium payment grace period policy during this crisis?
(Update July 23, 2020) We are no longer offering grace period extensions, outside of those in our contract or those required to comply with state specific mandates. We continue to monitor the impact of COVID-19 and will revisit this position if needed. If you are having any specific payment issues, please discuss them with your MetLife Service team.
Information relating to MetLife Legal Plans Disaster Relief support
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.
Information relating to Continuation of Coverage (Portability)
What are MetLife Legal Plans’ portability options for furloughed, temporarily laid-off or reduced hours/salary employees?
Beginning April 1, 2020 through July 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, May or June 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 July, we will evaluate whether to continue the three-month portability option. 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:
- Employment-related matters, including company or statutory benefits
- Matters involving the employer, Network Attorneys, MetLife and affiliates
- Matters in which there is a conflict of interest between the employee and spouse or dependents, in which case services are excluded for the spouse and dependents Appeals and class actions
- Farm and business matters, including rental issues when the plan member is the landlord
- Patent, trademark and copyright matters
- Costs and fines
- Frivolous or unethical matters
- Matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits