New Executive Order for Health Insurance Special Enrollment Period

On January 28, 2021, President Biden signed an Executive Order directing the Department of Health and Human Services (HHS) to open healthcare.gov for a three month special enrollment period (SEP).

Usually, the Open Enrollment Period for new health insurance or changes to a current plan is from November 15-December 15 of every year for the following year’s coverage. In the past, if you needed new coverage or changes made outside of that time frame, you would have to qualify by having a life event such as marriage, divorce, birth, adoption, loss of employer-provided coverage, etc.

This Period for 2021 is from February 15-May 15 to provide an additional opportunity for uninsured and underinsured Americans to enroll in coverage in the face of the COVID-19 pandemic. Coverage would be available as soon as the 1st of the following month. This applies to both subsidized plans (with premium assistance based on income qualifications) in the Marketplace and non-subsidized plans that are considered Off-Marketplace.

According to Florida Blue, here are a few tips if you are in the market for new health insurance or to make changes to what you currently have:

  • Starting February 15, consumers seeking to take advantage of this SEP can find out if they are eligible by visiting healthcare.gov or speak with an agent. The application process and plan selection can either be done online or through an agent as well.
  • Consumers who are eligible and enroll under this SEP will be able to select a plan with coverage that starts prospectively the first of the month after plan selection. Consumers will have 30 days after they submit their application to choose a plan.
  • Current enrollees will be able to change to any available plan in their area without restriction to the same level of coverage as their current plan. In order to use this SEP, current enrollees will need to go through their application and make any changes if needed to their current information and submit their application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment.
  • Consumers won’t need to provide any documentation of a qualifying event (e.g., loss of a job or birth of a child), which is typically required for SEP eligibility.

HHS has published a fact sheet here: https://www.hhs.gov/about/news/2021/01/28/hhs-announces-marketplace-special-enrollment-period-for-covid-19-public-health-emergency.html providing additional details on implementing the healthcare.gov SEP as well as an CMS fact sheet here: https://www.cms.gov/newsroom/fact-sheets/2021-special-enrollment-period-response-covid-19-emergency with more technical details.

When Should a 4 Point Inspection Be Done?

A 4 point inspection covers the main 4 points of a home and assesses the updates and conditions of those aspects of the home. This is an effort for the homeowner and insurance company to better understand the status of the home and likelihood of avoiding damage or injury.

Those main 4 areas that this inspection reviews are the roof, heating and air conditioning, electrical and plumbing. The inspection would look at the current condition, when any updates were done and if they are up to acceptable building codes, as well as how much life is left before needing repair or replacement.

Often times when it comes to homeowners insurance, this type of inspection can help determine the insurability of the home and whether or not it meets certain insurance company’s underwriting guidelines. This is extremely important on homes that are 25 years old or more.

So what can be done when it comes to a 4 point inspection early in the process? How can you avoid any hiccups that could delay closing or cause insurance issues after the fact? 

  • If working with a buyer, help them understand the condition and age of those 4 main points of the house and the importance in updates or being up to code
  • If working with a seller, help get quotes to update those 4 main points as that can be a deal breaker for buyers or the re-insurability of the home

When should a wind mitigation inspection be done on a home?

A wind mitigation inspection is completed by a licensed contractor. On a standard homeowners insurance policy, a home may qualify for a hurricane/wind premium discount. A wind mitigation inspection would be required for homes built prior to 2002, since that is when building codes changed.

Homes built in 2002 or after were required to meet roofing regulations by building code, and therefore automatically receive wind mitigation credits. This inspection typically costs between $85 and $150 and the premium discount applied by the insurance company will remain for the life of the home policy.

Wind resistive construction features that are considered when a property is being inspected for wind mitigation credits include:
• Secure roof shingles and roof coverings that meet the Florida Building Code requirements
• Roof decking secured with larger nails or screws closer together
• Hurricane clips/straps that secure the roof to the supporting walls
• Window protection (i.e. shutters, impact resistant glazing, etc.)
• Additional water resistant barriers to prevent leakage in the event that the top layer of roofing is damaged
• Roof geometry or shape of roof

This information may be helpful when questioning whether or not a wind mitigation inspections should be done:

2002 or newer: No wind mitigation needed, credits automatically apply
1990-2001: Very likely to receive credits, especially if roof has been replaced since 2002
1980-1989: Likely to receive credits, especially if roof has been replaced since 2002
1970-1979: Not likely to receive credits, but possible if roof has been replaced since 2002
Older than 1970: Unlikely to receive credits
Flat roof (any age): Unlikely to receive credits

Have you thought about what HR really looks like after COVID?

Although the COVID pandemic may not be quite over yet, there are several considerations all business owners and anyone in HR should be thinking about. In addition to new processes, this is also a great opportunity to revisit current procedures to ensure things are operating as they should. Here are a few steps you can take to cover your HR bases today and in the future of our new “normal”.

Be sure you have a plan in place for things such as:

o Remote work and technology
o Policies on employee termination, furlough vs layoff, pay cuts, time off
o Return to work (after injury or exposure) protocol
o Safety measures and screenings
o Office closure in the event it is mandated
o Handling an exposure within the workplace
o Mental health support
o Communication methods with both staff and clients

You should also have a structured plan for how you will stay current with resources like:

o Families First Coronavirus Response Act
o Coronavirus Aid, Relief, and Economic Security Act
o Centers for Disease Control, local and state government guidelines

This is extremely important in an effort to remain compliant at all times. Something like COVID is a very fluid and ambiguous situation with requirements as little as a poster you’re instructed to have up at your business’s front entrance so you want to be sure you’re adhering to all instructions given.

2020 may have felt like a bit of an HR roller coaster… or even a nightmare. However, let’s look ahead to 2021 and beyond. There is no better chance to prove your care and consideration for your staff than the way you react to a crisis. Your employees are watching. Your efforts and actions when they need you most will leave a lasting impression and be an invaluable reason they remain loyal to you.

What is your protocol for employees returning to work after an injury?

It may sound alarming but it’s reality that almost all employees of a company will, at some point in their career, either be injured or contract an illness of some kind. The way their employer reacts to and handles that leave of absence, as well as their return to work, will speak volumes. Studies have shown that employees feel more valued and want to work harder when they know their leader is in their corner and wants them back as soon as possible.

Establishing a solid, realistic and fair return-to-work program is extremely important for business owners. First and foremost, there are some legal considerations to comply with. The Family and Medical Leave Act (FMLA) as well as the Americans with Disabilities Act (ADA) have guidelines in place to protect employees from losing their job if they are unable to perform, given their disability or injury. These, along with state non-discrimination laws, require that employers provide reasonable accommodations for employees returning to work but unable to perform at the same level they did prior to their injury or illness. Two important things for business owners to consider here are:

1. An employer cannot refuse the employee’s return to work unless they pose as a “direct threat”.
2. The fact that an injury or illness occurred does not necessarily mean they can no longer do their job, assuming they are not a “’direct threat”.

Deeming an employee able to return to work, either in their pre-injury/illness capacity or a different position, may fall on the employer’s own discretion, which can be very difficult. The most commonly advised strategy for business owners in this position is to consult with the physician releasing the employee to work, get legal guidance if it’s questionable, and have a plan in writing that is agreed upon with the employee. The goal is to bring the employee back in to the work force safely and in a way that is productive for themselves, the rest of the team and the company as a whole.
Developing a return-to-work program that will apply to any position is the key here. It will keep things organized, efficient and consistent. Here are a few tips in creating a return-to-work plan:

• Define which employees or positions this program applies to
• Document the job duties of each position in the company
• Reporting process — to whom, frequency of reporting, and if advance notification is needed
• Medical evaluation documentation and use of a medical provider process
• How physical limitations will be assessed for reasonable accommodations
• Process for limited duty or transitional assignments to bring employees back sooner than later
• Consequences if an employee refuses to participate in the return-to-work program

Good and open communication throughout will undoubtedly make this program a success. Don’t forget the details though… it’s more than just checking in:

• Date of injury/initial clinic visit
• Physician status reports and follow-up visits
• Contact between employee and manager or HR (phone calls, emails, etc.)
• Interactive process to determine potential reasonable accommodations
• Written transitional duty offer letter
• Acceptance/refusal of or modified transitional duty agreement

A great way to keep all of this together and organized is in a return-to-work kit or section of your employee handbook. Nothing shows more support from an employer than being there for your team in their time of need and helping them get back on their feet to be an asset to the company.