If the Insured Had a Continuous Confinement

Voya Employee Benefits | COVID-19 Resource Center

Frequently asked questions

General/Employee Support

What is Voya doing to help support the well-being of employees, clients and communities in this COVID-19 environment?

At Voya, we are committed to investing in the communities where we live and work. In addition to our normal charitable giving efforts we have engaged in several different ways to support the health and well-being of employees, clients and communities during this time of need. For example:

1. Voya collaborates with Americares on emergency response efforts, including their COVID-19 response initiative which focuses on the delivery of personal protective equipment (PPE) and other infection prevention and control (IPC) supplies to outbreak hotspots as well as training for frontline health workers. Americares has sent and continues to send shipments of PPE and IPC supplies to support partners across a growing majority of U.S. states with significant volume.
• Americares is prioritizing shipments to facilities providing direct health care services and is coordinating with health facilities as well as federal, state and city officials to ensure PPE is distributed to facilities in need.
• Americares has and continues to train healthcare workers to make enhanced, more-informed decisions when thinking about preparedness and response during the COVID-19 pandemic and future infectious disease outbreaks.
2. Additionally, we are continuing to provide financial assistance to our own Voya employees who have experienced loss due to/been affected by a government-declared disaster/emergency through an internal Voya Community Fund.
3. Finally, employees can volunteer or donate to help any Voya vetted nonprofit that supports COVID relief, and qualify for the match through Voya Foundation – Voya's charitable giving arm. For more on Voya's commitment to support employees, clients and communities, Voya Foundation .

Leave

What is Voya's business continuity plan for a pandemic, especially as it relates to leave claims?

Voya's business continuity plan provides the detailed steps necessary during a catastrophe to be functional within four hours with a recovery point objective of no data loss, and to enable manual processes to occur in the meantime. Outlined below is a brief description of the steps we take to ensure that our customers' employees do not experience a disruption in service in the case of such an event:

• Invoke the predefined call re-routing process to immediately route all calls to backup locations. This process is in place and is tested on a monthly basis to ensure reliability.
• Relocate any required incremental staff to backup locations, including their homes, to handle the call volume.
• Execute the technology and facility management business continuity plans.

If an employee is diagnosed with COVID-19, what leaves are they entitled to?

If an eligible employee has been diagnosed with COVID-19, they would qualify for FMLA and State leave.

If an employee's child, spouse or parent has COVID-19, what leaves are they entitled to?

If an eligible employee's child, spouse or parent has been diagnosed with COVID-19, the employee would qualify for FMLA and State leave.

If an employee has no symptoms and is in quarantine, what leaves are they entitled to?

If an employee has no symptoms, but is in quarantine, he or she would not qualify for FMLA leave. It does not meet the Department of Labor's definition of a serious health condition.

Short Term Disability Income Insurance

If an employee becomes ill due to COVID-19, are they eligible for an STD benefit?

If an employee is unable to work during a period of medically required confinement due to sickness, they could be considered to meet the definition of disability. Eligibility is dependent upon the contract/policy language, including the contract/policy's definition of disability.

Group Life Insurance

Do you consider COVID-19 vaccines as being 'experimental' treatments, and if so, would you deny a life claim that resulted from a negative reaction to the treatment?

Voya does not consider the COVID-19 vaccines as being 'experimental' treatments as they have been approved by the FDA, therefore we would not deny a life claim due to the insured receiving a vaccine.

Are COVID-19 related deaths payable under a Group Life/AD&D policy?

Claims that are submitted for Life Insurance death benefits related to COVID-19 would be payable to beneficiaries subject to the provisions in the policy and the certificate of coverage. Accidental Death and Dismemberment benefits would not be payable under the group's AD&D rider. The diagnosis of COVID-19 is an illness, which is excluded from AD&D coverage. Standard limitations and exclusions (if any) would apply.

Critical Illness/Specified Disease Insurance

Are Critical Illness/Specified Disease benefits payable for a diagnosis of COVID-19? If an employee has been diagnosed with COVID-19 and is ill, can they file a Critical Illness claim?

The insured is able to file a claim anytime they feel they have a covered event. Under Critical Illness Insurance, the Infectious Disease Benefit requires that (1) the insured individual be diagnosed with a severe infectious disease on or after their coverage effective date, and (2) the insured be confined in a hospital or a transitional care facility for a specified number of consecutive days. The Infectious Disease benefit is offered under the Quality of Life Module for CI2 and Module B under CI1 if the employer has elected to offer those modules. Under CI1, "Infectious Disease" is selected at the group-level and either included or not included in the module. We encourage insured persons to file a claim if they feel they are eligible for a benefit and ask that you refer to the policy and/or certificate for additional information.

Hospital Indemnity Insurance

If an employee has been diagnosed with COVID-19 and is ill, can they file a Hospital Indemnity Insurance claim?

Yes, an insured is able to file a claim anytime they believe they have a covered event. Hospital Indemnity Insurance provides benefits for insured individuals who may experience a hospital confinement. The diagnosis does not factor into their benefit eligibility as it is based on the confinement. When eligible, we would pay out the total number of days the insured is continuously confined up to the maximum allowed under the plan design. In the event an insured person dies, under HI1, the benefit would be paid to the estate.

Accident Insurance

If an employee has been diagnosed with COVID-19 and is ill, can they file an Accident claim?

An insured individual may always file a claim if they believe they are eligible for benefits. A determination will be made through the claims review and based on provisions of their coverage. In general, however, our Accident Insurance provides benefits for a covered accidental event that occurs on or after their coverage effective date. The diagnosis of COVID-19 would not be considered an accident, but instead an illness, which is excluded from coverage.

Some employers may have an Accident policy that includes a Sickness Hospital Confinement Rider, which provides benefits for insureds who experience a hospital confinement due to an illness, which would include COVID-19. After satisfying any applicable waiting periods, Voya will pay daily hospitalization confinement benefits for the total number of days of continuous confinement, up to the plan's daily maximum. Please review your Group Policy or Certificate of Coverage and any riders for additional information.

If an employee experiences an accidental injury covered under our Accident plan, can they file a claim if they received services via telemedicine?

Yes, under Voya's Accident plan, both the Initial Doctor Visit and Follow-up Doctor Treatment benefits would be eligible for payment if covered services were received via a virtual or telemedicine visit. These benefits do not require the insured to physically be in a hospital or a physician's office to be eligible for benefits.

If an insured receives treatment via a virtual visit for covered Physical or Occupational Therapy or Speech Therapy, these claims will be eligible for benefit payment.

Emergency Room and Urgent Care Facility would not be eligible for benefit payments for virtual or telemedicine visits, as both require services or treatment to be received in those locations, as defined in the policy.

For all benefits, the accidental injury must occur while the insured is covered under the policy. Appropriate documentation confirming the telemedicine services must be provided with the claim submission, including confirmation that the treatment sought for the accidental injury occurred within the plan's benefit timeframes.

Note that this communication does not confirm eligibility for a benefit. Filing a claim may require any necessary medical records or proof of claim as determined during the review process.

Are COVID-19 related deaths covered under Accidental Death Benefits on the Accident Insurance plan?

Accidental Death and Dismemberment benefits would not be payable under the group's Accident Insurance plan for a death from the COVID-19. The diagnosis of COVID-19 is an illness, which is excluded from Accident coverage.

Supplemental Health - General

If an employee has been tested for COVID-19, can they file a Wellness Claim?

Supplemental Health coverages may also include a Wellness Benefit, which pays an annual benefit if an insured undergoes a covered health screening test. A COVID-19 screening test, as well as a COVID-19 antibody/serology test, would be considered a covered health screening under this benefit regardless of the result of such test. Voya will consider virtual telemedicine wellness examinations as eligible wellness benefits.

If the insured is covered under multiple Supplemental Health products offered by Voya that include the wellness benefit, they are eligible for an annual wellness payment under each coverage. Please review your Group Policy or Certificate of Coverage and any riders for additional information.

If an employee has been vaccinated for COVID-19, can they file a Wellness Claim?

Yes, COVID vaccines and other immunizations such as influenza, pneumonia and other vaccines are covered under the Wellness benefit rider.

Note that a COVID-19 screening test, as well as a COVID-19 antibody/serology test, is also considered a covered benefit under the Wellness benefit regardless of the result of such test.

Do pre-existing condition limitations apply to COVID-19 diagnoses? If an insured hasn't been tested, would COVID-19 symptoms alone be considered a pre-existing condition? Will we allow customers to make plan changes to remove any pre-existing condition limitations from their plans?

It is highly unlikely that a pre-existing limitation exclusion would preclude us from paying a COVID-19 infectious disease benefit under a CI or HI policy. Experiencing COVID-19 symptoms alone would not necessarily exclude benefit payments under the pre-existing condition limitation exclusion if the insured did not seek medical treatment for the condition prior to the effective date of their plan. If a customer's plan includes a pre-existing condition limitation, infectious disease claims submitted during the limitation period will be reviewed and paid according to the certificate language. We will consider plan changes and review requests on a case-by-case basis. These changes, if agreed to, may likely include premium adjustments.

We encourage insured persons to file a claim if they believe they are eligible for a benefit, and ask that you refer them to the policy and/or certificate of coverage for additional information.

Stop Loss

Stop Loss Insurance is offered by Voya Employee Benefits. This coverage is underwritten by ReliaStar Life Insurance Company and ReliaStar Life Insurance Company of New York, members of the Voya® family of companies (the company):

Will Voya recognize the COVID-19 vaccine as an eligible expense under the Stop Loss policy?

Yes. As it relates to the eligibility of new drugs that are approved by the FDA and released to the market, generally speaking, any drug is considered as an eligible expense under our Stop Loss policy when (1) the FDA has approved it for marketing, (2) it is used for the purpose for which it is approved, and (3) it is covered under the plan sponsor's medical plan document. We will not require an updated plan document or prior notification related to the plan sponsor covering the COVID-19 vaccine.

Please note it is our understanding the cost for the vaccine will initially be covered by the United States government and that only the cost of the administration of the vaccination applies.

If any testing fees or costs related to COVID-19 are being treated as preventative coverage under the employer's specific medical plan for the foreseeable future, will these costs be covered under specific or aggregate coverage?

Yes. If any testing fees or expenses related to COVID-19 are considered eligible expenses under the employer's plan due to COVID-19, they will be considered eligible under the Stop Loss policy.

If an insured is diagnosed with COVID-19 and incurs significant medical expenses during treatment, will those costs be considered eligible under the company's Stop Loss policy?

Yes. Any expenses will be considered eligible under the company's Stop Loss policy as long as those expenses are eligible under the employer's plan. This also includes waiving health plan deductibles, co-pays, coinsurance, virtual visits, and telemedicine and, early refills of medication to ensure participants have a 30-day supply.

If these expenses were not covered under the plan at the time of underwriting and the employer is making a mid-year plan change, this does not require an amended plan document to be submitted, but does require written notification of such changes.

As stated in our Policy, Voya must be notified of any Material Changes within 31 days. Please review your policy for additional information and notify your client representative of any material changes. We will not rerate or change aggregate factors, premium or coverage under the Stop Loss policy solely as a result of this change.

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Source: https://presents.voya.com/eb/Covid19/Employer/Faq

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