Plain-English Answers to Your COVID-19 Insurance and Benefits Questions

Will business interruption insurance pay for my lost collections due to office/business closure?

Most likely, no. In the absence of an Act of Congress, Commercial business interruption insurance generally requires direct physical damage to a covered property as a trigger. When in doubt, file a claim since only your insurance carrier can make a final determination.

Does the declaration of a national or state emergency, mandatory business closure, or stay-at-home order change my business interruption insurance claim eligibility?

In the case of COVID-19, no. Business interruption insurance typically includes a “civil authority” provision that extends business interruption coverage when access to an insured office is specifically prohibited by the government or similar authority, but this provision still requires direct physical damage to property in the immediate vicinity of an insured office. Only an unprecedented and potentially unconstitutional Act of Congress can cause an insurer to provide coverage that is not otherwise present within the policy contract.

Will malpractice insurance provide for defense and indemnity expenses if a patient alleges exposure and infection due to dental services?

Yes, assuming the exposure and infection relates to a “dental incident”. However, specific claim circumstances must be examined in order to determine coverage, and exceptions will exist. For example, exposure that occurs in a reception area or dental office building when no dental services are rendered would likely be disclaimed by malpractice insurance but very likely be covered by General Liability insurance.

Does the declaration of a national or state emergency, mandatory business closure, or stay-at-home order change how my malpractice insurance responds?

It may. For dentists, professional associations like the ADA and most state dental associations initially recommended that dental offices cease all non-emergency operations. Most healthcare organizations were similarly guided to cease performing elective procedures. More recently, governments and civil authorities legally mandated the total closure of dental offices except in cases of emergency. Failure to comply with laws or mandates can trigger exclusions within the malpractice insurance policy.

As a further result of mandatory closures and stay-at-home orders, some insurers or programs that use “warranty statements” within their applications and policies are proactively imposing coverage restrictions associated with COVID-19.  Meanwhile, insurance programs like the Professional Protector Plan and Physician’s Protector Plan utilize policy language that defers to dental licensing and regulatory authorities to govern coverage.  When in doubt, contact the company or your agent/broker for guidance.

Are malpractice insurers providing COVID-19 risk management and standard of care guidance?

Generally, malpractice insurers and program administrators are providing resources and risk management guidance.  This guidance often includes heightened infection control protocol and specific discussion and informed consent concerning COVID-19.  Nevertheless, standard of care remains defined by the average level of care exercised by a prudent provider in the community. 

Will my insurance company provide me with premium payment relief during the COVID-19 outbreak?

Most insurance companies are voluntarily offering extended grace periods for premium payment and some are working on ways to provide discount credits or deferred payment opportunities to policyholders whose businesses are shut-down or in cases where normal business operations are significantly limited. Additionally, insurance regulatory authorities in some states mandate policy cancellation forbearance and extended premium payment grace periods. Policyholders should consult with their insurers directly to determine what premium concessions are available.

Does health insurance cover business-owners or employees who become sick or need testing?

Medical needs associated with contracting the coronavirus are generally a covered health insurance claim.

If an employer furloughs or reduces hours for some or all employees in response to the COVID-19 National Emergency, can the company continue to cover those employees on their fully insured group health insurance plan?

For most carriers, YES. Most carriers are temporarily relaxing their requirement that employees be actively working to be eligible for coverage and will allow you to cover your reduced hour employees, as long as you pay the monthly premium. Please note that you must offer this coverage on a uniform, non-discriminatory basis.

What continuation of coverage applies if my health plan is fully insured and one or more employees are terminated as a result of COVID-19?

If at least one active member remains on the group plan, standard COBRA and state continuation protocols apply. State Continuation applies to groups of under 20 employees and groups of 20+ employees must adhere to Federal COBRA guidelines. It is the employer’s responsibility to notify employees of their continuation rights.

What if employees are terminated and they do not elect COBRA or it is not available? What other health insurance options do they have?

If employees are terminated and either they do not elect COBRA or it is not available, then the involuntary termination of the group health plan is a qualifying event for them to enroll in an individual health plan. Individuals must elect health coverage within 60 days of the termination, or they will have to wait until the next annual open enrollment period. In addition, some state Exchanges are opening a special enrollment period for Individuals to enroll in health plans as a result of coronavirus. Details and deadlines vary by state.

What if I have to terminate all of my employees and I am the only one left on the health plan?

The impact on the plan varies by carrier. Some carriers allow for “owner-only” groups while others require at least one full-time W-2 non-related employee to be enrolled. Either way, in most cases, your group plan will not be in jeopardy until the renewal date. Keep in mind that involuntarily losing group health coverage is a qualifying event to enroll in an individual health plan.

Will carriers waive any rehire waiting period for re-hired employees who were terminated due to COVID-19?

Most carriers will waive waiting periods for those employees who are rehired after the pandemic.

Are medical carriers considering off-renewal changes for small businesses that may be financially impacted? What if I want to elect a different plan?

Responses vary by carrier. Some carriers permit off-renewal plan changes and others do not.

Can employers use credit cards to pay premiums for fully insured group health plans?

No, most carriers are unable to accept credit card payments for group premium.

Does workers compensation provide benefits if an employee contracts the coronavirus?

Employees who contract the novel coronavirus virus due to a work-related exposure can experience a covered workers comp/employer’s liability claim. Your insurer will evaluate each claim on its own specific circumstances.

Will individual or group long-term disability income insurance provide benefits if I become ill?

Yes, if you remain ill long enough. The effects of the novel coronavirus and related COVID-19 disease can be a covered long-term disability income claim provided the sickness duration meets your waiting period. The most common waiting period for individual disability income benefits is 90-days.

Will overhead expense disability insurance provide benefits if I become ill?

Yes, if you meet the waiting/elimination period. The most common business overhead expense disability waiting period is 30-days.

Will group short-term disability insurance provide benefits if I become ill?

Most likely, yes. Most short-term disability plans have relatively short waiting periods for benefits eligibility, e.g. 7-days for sickness and 0-days for injuries.

I heard that “pandemic insurance is available” can I get it?

Probably not. Specific “pandemic insurance” for business interruption is generally rare. RKT is aware of a London-based specialty market that may offer insurance protection for future pandemics, but this insurance cannot be purchased during an ongoing viral outbreak/pandemic. RKT is also aware of a Canadian insurer that offers an optional business interruption insurance rider for pandemics as part of its business insurance policy. Although we do not know many specifics about this product or its limitations and exclusions, we know that it is not available in the U.S.

Where can I find additional R.K. Tongue insurance and risk management discussion about COVID-19?

Virginia Dental Association / R.K. Tongue webinar – April 3rd, 2020

Walk Carefully! How to Navigate a COVID-19 Liability Minefield by Dental Bites with Dental Zorro and The Smiling Lawyer • A podcast on Anchor – April 8th, 2020

DC Dental Society / R.K. Tongue webinar – April 9th, 2020

Virginia Academy of General Dentistry / R.K. Tongue webinar – May 1st, 2020

When in doubt, file a claim. The foregoing Q&A is for general informational purposes. Only your insurance company can make a coverage determination based on your specific claim circumstances.

*Guidelines vary by jurisdiction and carrier and are subject to change at any time.