Health, Wellness and Leave Benefits Help Employees with Coronavirus

What to tell employees who may have COVID-19

Stephen Miller, CEBS By Stephen Miller, CEBS March 30, 2020
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Originally posted on March 20, 2020; updated on March 30.

HR staff should make sure that employees are using their health, wellness and leave benefits to stay healthy or recover from the new coronavirus, which causes the disease known as COVID-19. But benefit programs may need tweaking if the virus becomes common in the workplace.

Benefit specialists advise employers to:

  • Follow guidelines posted by the Centers for Disease Control and Prevention (CDC).
  • Encourage workers to use telehealth services, if available, unless their symptoms are severe.
  • Use wellness programs to instruct workers about hygiene and disease prevention.
  • Tell employees to stay home if they have a fever and cough and to seek care for severe respiratory distress.

If employees need to be off work for a long time, try to be lenient about the use of leave under the Family and Medical Leave Act (FMLA).

These recommendations are discussed in more detail below.

No Doctor's Note Required

The CDC recommends that people who are experiencing respiratory illness stay home until they are free of fever and other symptoms, such as frequent and severe coughing, for at least 24 hours without the use of medicines (e.g., aspirin and cough suppressants).

"Do not require a health care provider's note for employees who are sick with acute respiratory illness to validate their illness or to return to work, as health care provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way," the CDC advised.

"We're following the CDC guidelines," said Jennifer Ho, vice president of human resources at Ascentis, a human capital management software firm based in Minneapolis. "We're telling employees if they are experiencing symptoms, to work from home if they're able, or to take time off—and to return to work only when they're symptom free."

"Employees need to check their symptoms—fever, cough, shortness of breath—against those of COVID-19 and consider if they have been in an affected area or exposed to someone who is infected," said Bobbi Kloss, director of human capital management services at Benefit Advisors Network (BAN), a consortium of independent benefit advisory and consulting firms. "Illness could occur from 2 to 14 days after exposure."

Employers, however, "should be cautious about providing medical advice to sick employees," advised Danielle Capilla, director of compliance and employee benefits at Alera Group, an employee benefits and financial services firm. "Guiding employees to speak with their physician, their local health department, and to use telemedicine as appropriate is the best course of action."

Be Lenient with Sick Leave

The CDC advises employers to "ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies."

Employers can require employees who exhibit coronavirus symptoms to stay home until they are symptom free, said Mark Neuberger, a litigation attorney in the Miami office of law firm Foley & Lardner LLP. The same is true if an employee is returning from a country designated by the CDC and the World Health Organization (WHO) as having high risk for COVID-19 transmission, or has been exposed to someone ill with the virus. Employers can require that these workers wait the maximum incubation period of the virus—thought to be approximately 14 days—before returning to the workplace.

Be cautious, though, and think about modifying your attendance policies. Requiring these quarantines could encourage hourly workers who have no remaining paid sick days or other paid time off (PTO) not to reveal that they may pose a risk to others.

"If employers force someone to stay home for two weeks without pay or make them use precious PTO, they may push people to hide where they have been or what symptoms they are experiencing, which will defeat planning to ensure that management is taking all reasonable steps to prevent the illness from spreading through the workplace," Neuberger said.

While recognizing there is a possibility for abuse by employees who would like to stay home for two weeks, Ho noted that "it really is up to employers to have best practices and training for managers on how to handle situations like this." Managers, she advised, "should work with their HR teams, who are familiar with signs that they need to dive in a little deeper" to ensure that leave isn't being abused.

"Employees who come to work with a contagious disease will spread that disease," Kloss said. "Consider providing paid leave for those employees who have no paid leave available and who are confirmed with COVID-19. In the long run it may save more dollars than it costs."

Last year, 73 percent of private industry workers in the U.S. had paid sick leave benefits available from their employers, the U.S. Bureau of Labor Statistics reported.

There's another sick leave complication employers may face: If public health officials order employees or their family members quarantined for up to two weeks because they have been exposed to someone with COVID-19 or visited a high-risk area, those being quarantined—if they show no symptoms—may not be covered by their employer's sick or disability leave policy. 

For quarantined employees who can't telework or otherwise perform their jobs remotely, employers should consider their response and may choose to extend paid leave benefits to cover this situation.

The nation's private largest employer, Walmart, announced on March 10 that it will provide up to two weeks' pay for workers who are quarantined or if one of its locations falls under a mandatory quarantine. If a Walmart worker is diagnosed with coronavirus, the company will offer two weeks' pay and additional pay replacement for up to 26 weeks.

Darden Restaurants, parent company for Olive Garden, also announced it will begin offering its 170,000 workers paid sick leave amid coronavirus concerns. The company was already developing the policy but it's rolling it out sooner following a report that workers were coming in sick because they couldn't afford to take time off.

Update: On March 18, President Donald Trump signed the Families First Coronavirus Response Act (FFCRA). As summarized by HR and payroll software firm Paychex, the various bills consolidated in the new act include the following:

  • Emergency Family Medical Leave (FML) Expansion Act: Temporarily expands the provisions under the Federal Family and Medical Leave Act specifically to address COVID-19-related absences.
    • Eligible employees, who have worked for their employer for 30 days, who qualify for leave under the expanded reasons for leave, would be paid by their employer after the first 10 days of leave at a rate of no less than two-thirds of their current rate of pay.
    • There is cap of $200 per day, up to a maximum $10,000, for up to 12 weeks in the benefit year.
    • Employees are permitted to take but employers cannot require the use of any other paid time off during their leave.
    • Employees covered under a multi-employer bargaining agreement are addressed separately in the legislation.
    • Some exemptions apply for employers of health care workers. 
  • Payroll Credit for Required Paid Family Leave: This refundable tax credit is designed to reimburse 100 percent of wages paid by the employer under the new Emergency FML expansion for each calendar quarter.
    • The tax credit is allowed against the employer portion of the tax-imposed Social Security rate of 6.2 percent and the Medicare rate of 1.45 percent.
    • The amount is capped for each employee at $200 per day and $10,000 for all calendar quarters.
    • If the credit exceeds the employer's total liability of the employer portion of Social Security and Medicare in any calendar quarter, the excess credit is refundable to the employer.
    • Specific rules apply that prevent a double tax benefit. 
  • Emergency Paid Sick Leave (PSL) Act: Employers are required to provide paid sick time, available for immediate use, to each employee requiring such time for specific reasons associated with the COVID-19 pandemic, including quarantines, currently seeking a diagnosis due to symptoms, or caring for an individual who is under quarantine or for a child whose school/care is closed due to COVID-19.
    • Provide up to 80 hours of paid sick leave to eligible full-time employees and pro-rate part-time employee paid sick time based on the average number of hours regularly scheduled in a two-week period.
    • The calculation and caps for compensation vary dependent on the reason for leave with a maximum of $511 per day if the employee is the individual directly impacted and up to $200 per day if it is for care of someone else. Aggregate caps exist as well.
    • Employees may not be required to use other available paid time off before using paid sick time under this Act.
    • Employees covered under a multi-employer bargaining agreement are addressed separately in the legislation.
    • Some exemptions apply for employers of health care workers.
    • Employers will be required to post a notice of employee rights; the U.S. Secretary of Labor will provide a model notice within seven days of enactment.
    • Paid sick time provided under this Act is not preempted by other federal, state, or local law. 
  • Payroll Credit for Required Paid Sick Leave: This refundable tax credit is designed to reimburse 100 percent of wages paid by the employer under the new Emergency PSL for each calendar quarter.
    • The tax credit is allowed against the employer portion of the tax imposed Social Security rate of 6.2 percent and the Medicare rate of 1.45 percent.
    • The amount is capped at the maximums of $511 or $200 per day, depending on the reason.
    • If the credit exceeds the employer's total liability of the employer portion of Social Security and Medicare in any calendar quarter, the excess credit is refundable to the employer.
    • Specific rules apply that prevent a double tax benefit.

In general, the emergency paid-leave provisions in the legislation apply to businesses with fewer than 500 employees, but there may be some exceptions available for small businesses and companies that employ health care workers. These provisions take effect April 1 and expire on Dec. 31.

"It is important to stay alert for updates and guidance, which is expected primarily to come from the U.S. Department of Labor over the next two weeks," noted Jason Reisman, an attorney with Blank Rome in Philadelphia.

[SHRM members-only HR Q&A: How Does the Families First Coronavirus Response Act (H.R. 6201) Impact Employers?]

Encourage Workers to Use Telehealth

The CDC encourages employees to use telehealth services, rather than visiting a doctor's office or clinic, to limit the spread of the virus.

"It is important for employers to keep employees advised as to the benefits that they have available that can assist them with making health decisions," Kloss said. "Telehealth programs can assist by providing clarity to the situation and aid the employee with determining their next steps."

"If telehealth is an option for your employees, advise them to make use of it," said Kim Buckey, vice president of client services at DirectPath, a benefits education, enrollment and health care transparency firm based in Burlington, Mass. "The doctor will be able to assess whether the employee needs to come in for testing or can be treated at home. This minimizes the risk of infecting others in the office waiting room or getting infected themselves" if it turns out that they have a cold or the flu.

For employees without a telehealth plan, "the best course of action is to call their health provider if they have one, their local urgent care clinic, or—in a pinch— the local ER and describe their symptoms. Tests are limited at this point and will be reserved for those who are severely ill, recently traveled to affected countries or have interacted with those who have," Buckey pointed out.

Noted Kathleen Ann O'Driscoll, vice president of the nonprofit Business Group on Health, an employers' education and advocacy group in Washington, D.C., "Telehealth has been a growing focus for employers and has a prime role to play in health care overall. The coronavirus has highlighted its benefits."

Mary Kay O'Neill, a partner at HR consultancy Mercer, called telehealth "an important first step to managing the virus," but advised "it's important to ensure your vendor doesn't over-promise and under-deliver and to make sure they have the proper protocol for handling a virus like this." However, "If you are confident in the vendor/carrier system, there will never be a better time to communicate its availability to your employees."

Don't overlook telehealth for treating emotional health issues, she advised, "especially if people are quarantined for weeks on end. Epidemics like this can increase anxiety and depression among people, resulting in a greater need for these services."


Health Insurance Covers the Coronavirus Test

Lab tests for COVID-19 will be covered by private insurance, as well as by Medicare and Medicaid, Vice President Mike Pence said on March 4. The Department of Health and Human Services "has already denominated a test for the coronavirus to be an essential health benefit," Pence said. Under the Affordable Care Act, health insurance plans must cover essential health benefits, although enrollees may still be required to share the costs by paying deductibles and co-payments.

Several states have now directed insurance carriers to waive all health plan cost-sharing associated with COVID-19 testing—including California, New York, Georgia, Oregon, Maryland and Washington. For fully insured health plans in these states, employees and family members will have COVID-19 testing covered in full by the plan without being subject to any deductibles, co-pays or co-insurance.

Self-insured health plans are not subject to state insurance mandates, which means the state cost-sharing directives for COVID-19 will not apply. Self-insured employers that desire to waive COVID-19 cost-sharing should consult with their third-party administrator and stop-loss provider to determine whether such measures are an option for the plan.

Health insurer Cigna said it has signed up all of its self-insured employer clients to eliminate cost-sharing for coronavirus tests. Cigna sent letters on March 9 and 10 to these "administrative services only" clients giving them 10 business days to opt out of the program.

Generally, health savings account (HSA) holders can only make or receive contributions to an HSA that is linked to a high-deductible health plans (HDHP) with no disqualifying, pre-deductible coverage. On March 11, the IRS issued Notice 2020-159, stating that health plans that otherwise qualify as HDHPs will not lose that status merely because they cover the cost of testing for or treatment of COVID-19 before plan deductibles have been met, and that individuals covered by the HDHP will not lose their eligibility to make tax-favored contributions to an HSA.

Update: HSA coverage was further expanded by passage of the Coronavirus Aid, Relief and Economic Security (CARES) Act on March 27. The CARES Act allows HDHPs linked with HSAs to cover telehealth services prior to a patient spending up to the plan deductible. Normal cost sharing can still be imposed for telehealth visits, such as co-pays that the plan may require after the deductible is paid. This provision is temporary, and will sunset Dec. 31, 2020 unless Congress takes future action to extend it or make it permanent.


Update:
The FFCRA's health care provisions require employee group health plans maintained by any employer, regardless of size, to provide coverage without any cost-sharing requirements, such as deductibles, co-payments and co-insurance, or prior authorization or other medical management requirements, for:

  • The costs of a test to detect or diagnose the virus that causes COVID-19; or
  • Health care provider visits, including telehealth visits, urgent care and emergency room visits, that result in an order for or administration of a test to detect or diagnose the virus that causes COVID-19.

These requirements took effect on March 18 and will continue on a temporary basis for at least 90 days unless extended by the Department Health and Human Services. Federal funding will be provided for uninsured individuals to receive reimbursement for COVID-19 testing and related services.

Update: The CARES Act extends no cost sharing to any services or items provided during a medical visit that results in coronavirus testing or screening —including an in-person or telehealth visit to a doctor's office, an urgent care center or an emergency room. This coverage requirement remains in effect only while there is a declared public health emergency as defined under federal law.

Deploy Wellness Programs

Show employees how to use good hygiene and take responsible precautions through lunch 'n learn sessions, posters, e-mail campaigns and other channels. "This is back to basics—take care of yourself by getting enough sleep, exercise and eating healthy," Buckey said. Advise employees to wash their hands vigorously throughout the day, for at least 20 seconds using warm water and soap, to use hand sanitizers and disinfect hard surfaces, and—especially—to stay home if they are sick.

This is good advice regardless of COVID-19, Neuberger pointed out. "As statistics demonstrate, seasonal flu poses a far greater and more immediate threat to your employees' health than does the coronavirus."

Jeff Levin-Scherz, M.D., Boston-based co-leader of the health management practice at consultancy Willis Towers Watson, said wellness education should emphasize changing the way we great one another. "Don't shake people's hands, it's just silly," he noted. "Encourage people to use a fist bump" or wave hello, instead.

As part of your wellness initiatives, "make sure that employees understand the resources available to them," Levin-Scherz said. These could include an employee assistance program for those experiencing severe stress or mental health issues triggered by virus fears.

O'Driscoll noted that onsite clinics, for those employers that provide them, are also a great resource for educating employees. "For employees who may start to feel unwell while at the office, they have ready access to a medical professional for guidance."

[SHRM members-only toolkit: Designing and Managing Wellness Programs]

Temperature Checks Not Advised

Levin-Scherz does not recommend that employers scan workers for increased body temperature. "While a handful of employers are doing thermal scanning to estimate employees' temperature, there are many false negatives and false positives. Employees could have a fever for some other reason," he explained.

Checking employees' temperatures could also run afoul of U.S. and EU law.

Update:  The U.S. Equal Employment Opportunity Commission (EEOC) gave employers the green light to take employees' temperatures to try and ward off the spread of the coronavirus in guidance updated March 18, but some question whether taking temperatures is worthwhile.


When to Use FMLA

For long-term absence, most employees dealing with their own or a family member's serious illness can take up to 12 weeks of unpaid leave under the federal Family Medical Leave Act.

"If it turns out to be coronavirus, the employee will likely be out for two weeks or more, so short-term disability and FMLA may come into play," Buckey said.

"An eligible employee of a covered employer could request FMLA leave in order to recuperate from coronavirus or care for a sick family member if the illness was a 'serious health condition,' which would be dependent on a variety of factors," Capilla noted.

Ho advised employers to "follow whatever FMLA guidelines you typically use, working with your employment attorneys."

While generally a doctor's certification is needed for FMLA leave, "if an employer understands the employee has a serious health condition within the meaning of the FMLA, the employer is free to waive the requirement to provide documentation," said Neuberger. "That can be a management decision."

At the same time, he noted, employers may have legitimate concerns about people who try to "milk the system and take 12 weeks off, claiming they have something they don't," he said. "It's a balancing act. But under these circumstances, being flexible is the better way to go."

Attorney Carrie B. Cherveny, senior vice president for strategic client solutions and compliance at Hub International, a global insurance brokerage, and Mingee Kim, senior vice president and certified leave management specialist at the firm, shared a cautious view.

"An employer facing the possibility of an employee or family member being diagnosed with the coronavirus may be inclined to bypass the regular and ordinary FMLA steps," they wrote recently. "The FMLA rules regarding notices and documentation have not been lifted. Therefore, employers must continue to follow their regular and ordinary FMLA process including the notice of eligibility and rights and responsibilities, certifications, designation notice, and most important, the fitness for duty."

Taking Steps to Protect Employees

Many North American companies are responding to the coronavirus by launching employee communications campaigns, restricting travel and expanding the number of employees working remotely, a mid-February survey of 158 U.S. and multinational employers by consultancy Willis Towers Watson shows. Among the findings, companies:

  • Canceled planned international trips (63 percent).
  • Are encouraging virtual meetings (55 percent).
  • Canceled planned conferences in selected countries (47 percent).
  • Now require screening for visitors or employees who have recently traveled to countries deemed to be high risk (30 percent).
  • Are clarifying pay policy if worksites are closed or employees are furloughed (28 percent).

Caution vs. Panic

"There are going to be employee responses across the spectrum, from lack of concern to fearful and overly cautious," Kloss said.

At some workplaces, Neuberger observed, "employees are afraid to touch shipments from China." Management, he said, "has to deal with irrational fears in a rational way, by providing good information and staying on top of rapidly changing advice posted by the CDC and WHO, and assigning someone to monitor those websites every day," he advised.

"It's important to be cautious, to be up to date and to stay informed," Ho said. "It's equally important to deploy common sense," and to encourage employees to do the same.

Employers should "continually inform employees about what's included in their benefit plans in case they were to get sick," said Nancy Reardon, chief strategy and product officer at Maestro Health, an employee-benefits services firm. "One contributing factor to employees' fear is that they wouldn't know what to do if they became infected or how much it would cost to begin treatment. It shouldn't take something like coronavirus for companies to proactively communicate and engage their employees' in their overall health and benefits."

Educate employees year-round to make sure they understand which care options are covered in their benefits plan, "not just during times of crisis," Reardon advised. To prevent frustration and fear, employees should know where to go to get the best care at a fair price; what primary care doctors exist in their network; when they should use a retail clinic or urgent care center; what services their benefits cover; and how to use telehealth and counseling options. 

"By offering a variety of health care options and pointing workers in the right direction, employers can help their employees feel prepared, rather than panicked," she noted.

A final thought: Some employees, including recent hires or part-time workers, may not be covered by health benefits. "Employer notifications should be responsive to this group as well," Kloss said. "Employers should communicate with their local health departments to assist them with a responsiveness plan."


SHRM Advocates for Employer-Based Health Care System

"Rightfully, COVID-19 is spurring precautionary measures by the general public and raising greater awareness of the importance of health insurance in the U.S.," said Chatrane Birbal, director of policy engagement at the Society for Human Resource Management (SHRM). Due to the high costs associated with the virus, public health officials are increasingly worried that medical bills will discourage low-income, uninsured and underinsured individuals from getting medical care, she noted. "This is at the backdrop of the presidential election campaign where candidates have varying views on future health care reform, including implications for employer-sponsored health insurance."

Birbal called employer-based health care "the foundation of health insurance in the U.S., which provides health benefits to more than 181 million Americans and their families," and noted that employer-sponsored plans frequently include benefits such as telehealth and wellness, "which are valuable tools and resources for employees throughout the year, but especially important when responding to a health crisis. That's why SHRM continues to advocate that any approach to health care reform in the U.S. must preserve the option for employers to provide employer-sponsored health insurance and lower costs for employers and employees. In addition, SHRM supports adoption of employer wellness programs to encourage healthy behavior and to lower costs for employers and employees."



Related SHRM Articles:

Valuing Health Plan Costs for Payroll Tax Credits, SHRM Online, April 2020

IRS and DOL Explain Employer Tax Credits for Coronavirus-Related Leaves, SHRM Online, April 2020

How the CARES Act Changes Health, Retirement and Student Loan BenefitsSHRM Online, March 2020

DOL Issues Workplace Posters on Employees' Right to Paid Coronavirus Leave, SHRM Online, March 2020

IRS Relaxes High-Deductible Terms for COVID Testing and Treatment, SHRM Online, March 2020

Some Employers Forgo FMLA Certifications During COVID-19 Crisis, SHRM Online, March 2020

Hourly Workers Lose Pay Due to Coronavirus, SHRM Online, March 2020

Protect the Privacy of Employees with Coronavirus, SHRM Online, March 2020

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