Resources COVID-19

Home    |   Resources COVID-19

A message from Pinnacle’s President

 

Dear Valued Member,
These are unprecedented times for us all. As we face new and daily challenges brought on by the Coronavirus (COVID-19) pandemic, I wanted to personally reach out and let you know that Pinnacle is here for you. Our business and services are considered essential, so we will continue to be fully operational and work tirelessly to address any questions or concerns during this time.

Like many businesses, Pinnacle has transitioned most of its employees to remote work accommodations. The health and safety of our members, employees, and communities are at the forefront of our efforts to ensure a seamless transition while providing exceptional service.

Our members should expect the same level of excellence from PCMI. Our customer service team is on hand and ready to assist you, Monday through Friday, 7 a.m. to 5:30 p.m. P.T. at 800.649.9121. If you are unable to call during business hours, our automated system is available 24 hours a day, seven days a week and offers quick and convenient access to frequently requested information.

In the coming days and weeks, we will continue to actively monitor this pandemic to ensure our team is prepared and ready to support you in any way possible. I’ve never been more proud of the hard work and dedication shown by our team. We at Pinnacle consider it a privilege to be able to continue our operations, without interruption, through this trying time.

I wanted to thank everyone who has reached out in the spirit of helping others. We will get through this together, and I appreciate the strength of our members, employees and communities more than ever.

Sincerely,

David Zanze,
President, Pinnacle Claims Management Inc.

COBRA Benefit Extensions and Premium Subsidy

Two recent governmental changes were announced that will affect the availability and administration of COBRA benefits in 2021. This letter summarizes these changes and what they mean for your employees and your company.

EBSA Disaster Relief Notice 2021-01

In March of 2020, the Department of Labor (DOL), Department of Treasury (Treasury), and Internal Revenue Service (IRS) extended certain benefits-related deadlines for HIPAA special enrollment, COBRA elections, appeals, external reviews, and ERISA notices and disclosures. The relief was provided pursuant to ERISA §518 and Internal Revenue Code §7508A, which allow certain compliance deadlines to be disregarded for a period of up to one year in the event of a public health emergency. Although the 2020 notice provided relief through the end of the outbreak period (60 days following the end of the National Emergency, which is ongoing), the one-year limit specified in §518 and §7508A expired on February 28, 2021.

On March 1, 2021, EBSA Disaster Relief Notice 2021-01 (Notice) was issued by the DOL and approved by IRS and Treasury. The notice clarified that the one-year extension period allowed under §518 and §7508A would be applied on a case-by-case basis, meaning that each individual’s deadline will be disregarded until the earlier of:

  • One year from the date that the individual was first eligible for relief, or
  • The end of the outbreak period (60 days after the National Emergency ends).

For example, if an individual’s initial COBRA election period would have expired on March 15, 2021, the individual will have until the earlier of March 14, 2022 or the end of the outbreak period to make an election. In no case will the delay exceed one year.

The Notice encourages plan administrators and fiduciaries to

  • notify participants who are nearing the end of the relief period and are at risk of losing rights under the plan, and
  • make participants aware of other coverage options that may be available to them, including the opportunity to obtain coverage through the Health Insurance Marketplace.

American Rescue Plan Act

In a separate action, Congress passed the American Rescue Plan Act (“ARPA”), which provides a 100% subsidy on COBRA medical, dental, and vision premiums for “assistance eligible individuals” for the period beginning April 1, 2021 and ending September 30, 2021. 

How is the subsidy funded?

The COBRA subsidy is paid by the federal government. But ARPA requires employers to front the full cost of premiums owed to a plan administrator. This means that:

  • The employer pays the COBRA premiums during the subsidy period, but is made whole by claiming a tax credit against the employer’s 1.45% Medicare Hospital Insurance (“HI”) tax, reduced by any credits allowed under other COVID-19 relief legislation, such as the CARES Act or the Families First Coronavirus Response Act (“FFCRA”). In your case, this means that subsidy eligible individuals will no longer submit a COBRA premium payment during the subsidy period. You as the self-funded employer will simply cover the cost of claims like any other eligible enrollee. 
  • Subsidy payments that exceed the allowable tax credit in any quarter are treated as a tax overpayment and employers will become eligible for a direct refund. The technical aspects of the tax credit, such as the timing of the credit and the mechanics for claiming it, have yet to be explained.                    

Who is eligible for the subsidy?

An assistance eligible individual is any individual (including a covered dependent) who loses coverage as the result of a reduction in hours or involuntary termination (for reasons other than gross misconduct) and is not eligible for other group health coverage or Medicare. The class includes those:

  • who are currently enrolled in COBRA or become eligible during the subsidy period;
  • who did not elect COBRA during their initial election period, but are still within the 18-month coverage period; and
  • who elected COBRA during their initial election period but let the coverage lapse, and are still within the coverage period.

A dependent child who loses coverage because of age (i.e., reaches age 26) is not eligible for the subsidy.

How do participants receive the COBRA subsidy?

Participants eligible for the subsidy who are already enrolled in COBRA as of April 1, 2021 are not required to take any action; they will automatically receive the subsidy. Current enrollees must be notified of the subsidy, and individuals who have already paid premiums for any portion of the April-September subsidy period must be reimbursed for the amount previously paid. Employers may apply for a payroll tax credit for the reimbursed amounts, as described above.

ARPA requires that a new election period be offered to assistance eligible individuals who declined COBRA coverage or who previously elected, then discontinued, COBRA coverage before April 1, 2021. Coverage for these assistance eligible individuals will be effective on April 1; no premiums will be required for any period prior to that date. Affected individuals may only take advantage of the subsidy if they are still within their 18-month COBRA coverage period. For example, an individual who did not elect COBRA coverage and whose coverage period would have ended on May 31, 2021 may be eligible for the subsidy for the months of April and May, but the individual’s COBRA coverage will expire on May 31. ARPA does not extend the COBRA eligibility period.

Election notices describing the premium subsidy must be delivered to assistance eligible individuals prior to May 31, 2021. Plans must send a new election form or add a disclosure form to existing election forms; the new forms must include:

  • forms necessary to establish eligibility for premium assistance,
  • contact information for the plan administrator or other persons maintaining information related to premium assistance,
  • a description of the extended election period, and (iv) a description of the individual’s obligation to notify the plan of the existence of other group health plan coverage.

The DOL will release sample model notices and model election forms on or before April 11, 2021.

Assistance eligible individuals must elect coverage within 90 days of the date of the election notice; the enrollment extensions provided under EBSA Disaster Relief Notice 2021-01 (described above) are not recognized. An employer may allow enrollees to elect a plan that is different from the plan in which he or she was enrolled prior to the qualifying event if: (i)  the premium for the alternate coverage is not more than the coverage in which the employee is currently enrolled and the alternate plan is offered to similarly situated employees; (ii) the coverage is not an excepted benefit, such as dental and vision only; and (iii) the group health plan is not an FSA or HSA.

When does the subsidy end?

The premium subsidy will end on the earlier of the first day the individual becomes eligible under another group health plan, the first day the individual becomes eligible for Medicare, the date the individual’s 18-month COBRA coverage period expires, or September 30, 2021.

How do these rules affect employers not subject to COBRA?

Very small employers (under 20 employees) are not subject to COBRA; however, many states, including California and Arizona, offer “mini COBRA” programs that apply to these small employers. Although ARPA expressly includes “mini-COBRA” plans offered at the state level in its definition of COBRA continuation coverage, it does not explain how the subsidy will be administered for state plans. Additional guidance is expected in the coming weeks.  

What are the next steps?

Pinnacle will work with you to identify individuals who may be affected by ARPA and the EBSA Disaster Relief Notice 2021-01. As your COBRA administrator, we will:

  • manage COBRA enrollment deadlines on an individual basis;
  • update COBRA enrollment materials to include information about the subsidy;
  • provide notice of the subsidy to current COBRA enrollees and to assistance eligible individuals who have received enrollment notices but have not yet enrolled;
  • provide a second enrollment period for assistance eligible individuals who did not elect (or elected and later discontinued) COBRA coverage but are still within the COBRA coverage period;
  • refund, within 60 days of the date payment was made, COBRA premiums paid for the subsidy period;
  • notify COBRA-eligible individuals who are nearing the end of the extended enrollment period of other coverage options, including coverage through Covered California and the Marketplace; and
  • notify assistance eligible individuals when their ARPA subsidy will expire. Notice will be given at least 15, but no more than 45 days before expiration.

We recognize the challenges that come with these new policy changes, and we want to assure you that we remain dedicated to serving our members. As always, we’re here to help with any questions regarding these new requirements. Please contact your Account Manager with any questions or concerns.

David Zanze

President, Pinnacle Claims Management, Inc.

COVID-19 Mandate Extensions and Optional FSA Changes

June 2, 2020

Dear Valued Clients,

In response to the COVID-19 outbreak and resulting National Emergency declaration, the Departments of Labor (DOL), Health and Human Services, and Internal Revenue Service (the “Departments”) issued rules and guidance that mandate extensions of certain timeframes for participants covered under group health plans and allow plans to ease restrictions on some FSA plan regulations, as explained in the following paragraphs.

As always, Pinnacle is here for you. If you have questions, please call our customer service team at 800.649.9121, or visit Pinnacle’s COVID-19 resources page here: https://www.pinnacletpa.com/Resources-COVID-19. Please use this as a resource as needed.

 

Extension of Group Health Benefit Plan Timeframes

The Departments recognize that plan participants may encounter problems, such as exercising rights to COBRA continuation coverage or difficulty filing or perfecting claims, and extend timeframes for certain activities. This is accomplished by excluding the “Outbreak Period” when calculating plan deadlines for the specified activities. The Outbreak Period is identified as the period beginning with the declaration of National Emergency (March 1, 2020) and ending 60 days after the National Emergency ends.

The new rules extend timelines under eight scenarios for employees, as explained below. The examples that follow each scenario assume that the National Emergency ended on April 30 and the Outbreak Period will end on July 29, 2020. The DOL and IRS have stated that the Outbreak Period may be revised based on the impact of the virus in different parts of the country.

 

1. HIPAA Special Enrollment Period. Under HIPAA, employees have 30 days to request enrollment in a plan following (i) the loss of other group coverage, or (i) acquisition of a new dependent. The enrollment period is extended to 60 days for employees who lose or gain eligibility under Medicaid or CHIP. The new rules extend the enrollment period by disregarding the Outbreak Period.

Example: Mary previously declined to participate in her employer-sponsored health plan. On April 1, 2020, Mary gave birth and would like to enroll herself and her child into her employer’s plan. Under the new rules, Mary may enroll as early as the child’s date of birth, but the enrollment period will extend through July 29, 2020, the 30th day after the end of the Outbreak Period.

 

2. COBRA Election Period. The 60-day election period for COBRA Continuation Coverage is disregarded during the Outbreak Period.

Example: Paul is laid off from his job and loses his employer-sponsored health coverage. He receives his COBRA election notice on April 1, 2020. Under the extension rules, the Outbreak Period is disregarded in the calculation of Paul’s election period, and the last day of the election period will be 60 days after June 29, 2020.

3. COBRA Payment Period. Under COBRA, a qualified beneficiary has 45 days from the date of his COBRA election to make his first premium payment. After the initial payment, premiums must be paid by the end of the 30-day grace period that begins on the first day of each month. The rules extend the payment deadlines by disregarding the Outbreak Period.

Example: Juan elected COBRA continuation coverage on February 1; his initial payment was due March 17, and his first monthly payment due on April 1. Juan missed both payments. Under the rules, the Outbreak Period is disregarded in the calculation of payment due dates, and the initial payment, as well as payments for April, May, and June are considered timely if received by July 29, 2020, 30 days after the end of the Outbreak Period.

4. COBRA Notice of Qualifying Event. COBRA requires that a participant notify the plan within 60 days of a qualifying event (such as a divorce) that would cause a dependent to lose eligibility, or a disability that would extend the maximum COBRA extension period. The rules extend the 60-day notification period by disregarding the Outbreak Period.

Example: Ella and her husband are covered under her employer’s group health plan. Their divorce was finalized on March 1 and, as a result, her husband lost eligibility for coverage under her health plan. Ella and/or her former husband have until 60 days after the end of the Outbreak Period (August 28) to notify the plan of the divorce, allowing the former husband to continue coverage under COBRA.

5. Deadline for filing medical claims. The rules extend the period in which a medical claim must be filed by disregarding the Outbreak Period.

Example: Eric receives medical treatment on April 1, 2020. His medical plan requires that claims be received within 90 days of the date the expense is incurred. Under the rules, the deadline for filing Eric’s claim is extended to 90 days after the end of the Outbreak Period, or September 27, 2020.

6. Deadline for appealing an adverse benefit determination. ERISA imposes strict deadlines in which a participant may appeal an adverse benefit determination. The new extension rules extend the period in which an appeal may be filed by disregarding the Outbreak Period.

Example: Arlene receives a denial of a medical claim on February 1, 2020 and has 180 days to appeal the determination. Twenty-eight days passed between the date of the denial and the start of the Outbreak Period, so Arlene must file her appeal within 152 days (180-28 days following February 1 to March 1) after the end of the Outbreak Period.

7. Deadline for requesting external review. Under ERISA, a participant has four months after receipt of an adverse benefit determination or notice of rescission of coverage to request an independent medical review. The rules extend this period by disregarding the Outbreak Period.

Example: Richard receives the denial of a medical claim on medical necessity grounds on April 1, 2020, and has four months to request an external review. Under the new rules, Richard must request the external review within four months of the end of the Outbreak Period.

8. Deadline to perfect request for external review. A plan participant who submits an incomplete request for external review may perfect the request within the initial four-month filing period. The rules disregard the Outbreak Period in the calculation of this date.

Example: Richard receives the denial of a medical claim on April 1 and requests an external review on April 15.  On April 20, he receives notification that his external review request is incomplete. Richard may perfect his request within the initial four-month filing period. Under the rules, the filing period ends 180 days after the end of the Outbreak Period.

 

The rules also offer relief to group health plans by disregarding the Outbreak Period when determining the deadline for providing a COBRA election notice. Under COBRA, an employer must notify the plan administrator of a qualified beneficiary’s COBRA eligibility within 30 days of loss of coverage, and the plan administrator must then deliver the election notice within 14 days.

Example: Howard’s employer notifies the plan administrator on March 15 that Howard is a qualified beneficiary under COBRA. Under the extension rules, the plan administrator has until July 13 – 14 days after the end of the Outbreak Period – to provide the COBRA election notice to Howard.

 

Relaxation of Certain FSA and Cafeteria Plan Rules

The IRS recognizes that the COVID-19 crisis will likely interrupt scheduled medical procedures and appointments and, as a result, employees are more likely to have unused balances in their FSA accounts at the end of the 2020 plan year or grace period. As a result, new IRS guidelines offer employers the discretion to amend their FSA plans to temporarily extend the applicable grace period for using FSA funds. Additionally, the agency has provided employees and employers increased flexibility with respect to mid-year elections under cafeteria plans. Employers who sponsor a Section 125 plan have the option to amend their plans to take advantage of these new rules but are not required to do so.  Finally, the list of FSA-eligible expenses has been expanded to include certain over-the-counter medications and products.

 

1. Expansion of FSA Grace Period. Employers may amend their cafeteria plans to permit employees to apply unused funds remaining in a health or dependent care FSA as of the end of a grace period ending in 2020 or plan year ending in 2020 to pay or reimburse expenses incurred through December 31, 2020. The extension of time for incurring claims is available to both cafeteria plans that have a grace period, and those that allow a carryover (prior to the new ruling, health FSAs could either adopt a grace period or provide for a carryover amount but cannot have both).

Example A: ABC Company’s 2019 plan year runs from July 1, 2019 to June 30, 2020. The company provides a health FSA with a 90-day grace period; as a result, employees may use 2019 contributions to pay for services incurred through September 30. Bob, an employee of ABC, was scheduled to have elective surgery in May, 2020; however, his surgery was postponed until October 15 and he had $1,500 remaining in his health FSA at the end of the grace period. If the company elects to amend the plan and extend the grace period, Bob may use his 2019 FSA balance to pay for his surgery, as well as any other eligible expenses incurred prior to December 31.

Example B: Acme Company provides a health FSA with a $500 carryover policy but no grace period. Its plan year runs from July 1, 2019 to June 30, 2020. Jill has a remaining balance in her health FSA for the 2019 plan year of $2,000. In October she undergoes surgery that had been postponed due to the COVID-19 crisis; her total costs are $1,900. Even though the company did not previously offer a grace period, the new rules permit Jill to be reimbursed from the health FSA for $1,900 from the $2,000 remaining in her FSA at the end of the 2019 plan year, leaving $100 unused from the 2019 plan year. Under her plan’s carryover rules, Jill is allowed to use the remaining $100 until June 30, 2021.

 

2. Changes to Mid-Year Elections. An employer, in its discretion, may amend one or more of its cafeteria plans to allow an employee who is otherwise eligible to make prospective election changes (including an initial election) during calendar year 2020. Plans may be amended to allow employees to prospectively:

  • a. make a new election for coverage, if the employee initially declined to elect employer-sponsored coverage;
  • b. revoke an existing election and make a new election to enroll in different plans offered by the same employer, or change from individual coverage to family coverage;
  • c. cancel coverage under an employer-sponsored plan, provided that the employee attests in writing the he or she is enrolled in, or immediately will enroll, in other coverage;
  • d. revoke or change a health FSA election, or make a new election; or
  • e. revoke or change a dependent care election, or make a new election.

The employer has discretion to determine the extent to which election changes are permitted.

Example: Scott is a full-time telecommuter with two small children in daycare. Scott’s company amends its dependent care FSA to allow mid-year changes to dependent care elections. Due to the COVID-19 pandemic, the child care center closes and Scott is caring for his children while he works from home and as a result, he is contributing more to his dependent care FSA than he will be able to use during the plan year. Under the new regulations, Scott may reduce his dependent care election, even though he has not experienced a change in status under IRS or plan regulations.

 

3. Expansion of FSA Eligible Expenses. Effective January 1, 2020, over-the-counter medicines and products have been returned to the list of expenses that are eligible for reimbursement under participants’ flexible spending accounts. Eligible over-the-counter expenses include:

  • a. Pain relief medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs);
  • b. Cold and flu products;
  • c. Allergy products such as antihistamines and decongestants;
  • d. Heartburn medications; and
  • e. Menstrual products.
CARES Act Overview

April 2, 2020

Dear Valued Clients,

There were a number of federal legislative and regulatory changes last week that address the financial impact of COVID-19 on employers. These changes led to a $2.2 trillion economic stimulus package, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The Internal Revenue Service (IRS) and Department of Labor (DOL) also released guidance to assist employers in implementing certain benefit-related provisions under the Families First Coronavirus Response Act (FFCRA). We have compiled all the relevant information for you and will take you through how this can potentially impact your business as well as your employees. Please use this as a resource as needed.

As always, Pinnacle is here for you. If you have questions, please call our customer service team at 800.649.9121, or visit Pinnacle’s COVID-19 resources page here: https://www.pinnacletpa.com/Resources-COVID-19.

On March 13, 2020, President Trump declared a national emergency in response to the health crisis caused by COVID-19. On March 18, 2020, the President invoked the Defense Production Act to expand the nation’s ability to produce medical supplies, including ventilators and personal protective equipment. While the situation is dire, the federal and state governments are taking this matter seriously in an effort to turn the tide and flatten the curve. Below is brief summary of the government response so far. We have also included:

  • A description of the new COVID-19 mandates applicable to health benefit plans;
  • New employer leave law requirements, including links to federal FAQs that are being routinely updated;
  • Guidance for covering furloughed employees;
  • Information and resources for employers who are interested in applying for monetary relief;
  • A brief description of the new laws’ business tax provisions;
  • Best practices for employers to help slow the spread of COVID-19; and
  • Additional federal and state resources for employers

To date, three federal laws have been passed to address the crisis and provide relief to Americans:

  • The Coronavirus Preparedness and Response Supplemental Appropriations (CPRSA) Act (Phase 1)
  • The Families First Coronavirus Response Act (FFCRA) (Phase 2)
  • The Coronavirus Aid, Relief, and Economic Security (CARES) Act (Phase 3)

On March 6th President Trump signed the CPRSA that included $8.3 billion in emergency supplemental funds for essential federal agencies responding to the coronavirus crisis. On March 18th, the FFCRA became law and was designed to mitigate the impact on individuals by providing low income food and nutrition assistance, unemployment insurance, emergency leave, and employer tax credits to partially offset the costs of required leave. The CARES Act, signed into law by the President on March 27th, is a $2.2 trillion-dollar relief package that includes:

  • $500 billion in financial assistance for large distressed businesses;
  • $350 billion in low-interest loans to small businesses;
  • $100 billion in financial assistance to hospitals;
  • $1,200 in financial assistance for the lowest income taxpayers;
  • An additional 13 weeks of unemployment compensation benefits; and
  • An employee extension credit

Right now, Congressional democrats are preparing a fourth bill (Phase 4) to address the pandemic. This Phase 4 package could include more direct payments to Americans, spending on infrastructure and may be even larger than the $2.2 trillion dollar CARES Act. House Speaker Nancy Pelosi stated that she would like to see the next bill feature more money for state and local governments, increased worker protections, more assistance to hospitals, and more opportunity for family and medical leave.

We’ll go through how the new legislation will impact employees.

1. EMPLOYEE BENEFITS IMPACT

A. No Cost Screening and Testing for COVID-19

The FFCRA and CARES Act impose cost sharing restrictions on insured and self-insured group health benefit plans (including grandfathered plans) for the testing and screening of COVID-19 and the associated office visit. Insurance carriers and self-insured group health plans (even grandfathered plans) must cover the testing, screening, and associated office visit in and out-of-network.

The FFCRA requires the coverage of FDA-approved COVID-19 diagnostic testing products, including items and services furnished during a provider visit (office, telehealth, urgent care, and emergency room) to the extent those items and services relate to the furnishing or administration of the testing product or the evaluation of the individual’s need for the testing product. The mandated coverage must be provided without any cost sharing (including deductibles, copayments, and coinsurance) requirements or prior authorization or other medical management requirements.

The CARES Act expands the coverage mandated under the FFCRA and requires group health plans and health insurance issuers to cover, without cost-sharing, any qualifying coronavirus preventive service. For this purpose, a “qualifying coronavirus preventive service” means an item, service or immunization that is intended to prevent or mitigate COVID-19 and that is:

An evidence-based item or service that has in effect a rating of ‘‘A’’ or ‘‘B’’ in the current recommendations of the U.S. Preventive Services Task Force; or
An immunization that has in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved.
Under the CARES Act, a group health plan or issuer shall reimburse the provider of the diagnostic testing as follows:

At the negotiated rate, if the health plan has a negotiated rate for such service with the provider in effect before the public health emergency was declared pursuant to Section 319 of the Public Health Service Act (prior to March 13, 2020).
If there is not a negotiated rate, the cash price for such services as listed by the provider on a public website, or such plan or issuer may negotiate a rate with such provider for less than such cash price. Each provider of diagnostic testing for COVID-19 shall make available on a public website the cash price for such testing. Failure to comply with such internet posting may result in monetary penalties of up to $300 per day.

2. FFCRA PAID LEAVE

The FFCRA provides all American businesses with fewer than 500 employees funds to provide employees with paid leave, either for the employee’s own health needs or to care for family members. The legislation was passed to ensure that workers are not forced to choose between their paychecks and the public health measures needed to combat the virus while at the same time reimbursing businesses. The FFCRA mandates paid sick time and paid family medical leave to employees impacted by COVID-19. Employers with fewer than 500 employees will have to take immediate action to prepare to comply with the new law, which goes into effect on April 1, 2020.

The FFCRA has several components, including:

paid family and medical leave
paid sick time
tax credits for paid family and medical leave and paid sick time
unemployment insurance
medical plan components
several immediate public health related matters

The Wage and Hour Division of the Department of Labor has developed a series of frequently asked questions about COVID-19 and its effects on wages and hours worked under the Fair Labor Standards Act (FLSA), job-protected leave under the Family Medical Leave Act (FMLA), and paid sick leave and expanded family and medical leave under the FFCRA. You can find the Department of Labor FAQs here.

3. COVERAGE CONTINUATION DURING FURLOUGH OR MANDATED LEAVES

Most employer sponsored employee group health benefit plans contain detailed eligibility rules that condition eligibility on full-time employee status. Employers who are considering extending coverage to laid off or furloughed employees should review their benefit plans and insurance policies to determine how to treat employees or former employees who no longer qualify under the terms of the employer’s plan. Self-insured employers may have more flexibility to determine their plan’s eligibility rules; however, they should ensure that any changes to extend eligibility are agreed to by their stop loss or reinsurance carrier.

4. CARES ACT BUSINESS PROTECTION PROGRAMS

A. PAYCHECK PROTECTION PROGRAM

The CARES Act includes the Paycheck Protection Program that is a loan designed to provide a direct incentive for small businesses to keep their workers on the payroll. The Small Business Administration (SBA) will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for payroll, health benefits premiums, rent, mortgage interest, or utilities. The Paycheck Protection Program will be available through June 30, 2020.

(1) Who May Apply?

This program is for any small business with less than 500 employees (including sole proprietorships, independent contractors and self-employed persons), private non-profit organization or 501(c)(19) veterans organizations affected by coronavirus/COVID-19. Businesses in certain industries may have more than 500 employees if they meet the SBA’s size standards for those industries.

Small businesses in the hospitality and food industry with more than one location could also be eligible at the store and location level if the store employs less than 500 workers. This means each store location could be eligible.

(2) How to Apply?

Employers may apply through any existing SBA 7(a) lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating. Other regulated lenders will be available to make these loans once they are approved and enrolled in the program. Employers should consult with their local lender to determine whether it is participating in the program. Lenders may begin processing loan applications as soon as April 3, 2020. Employers may begin preparing applications and may download a sample form here to see the information that will be requested. To apply for a loan visit SBA.gov

(3) Loan Details and Forgiveness

The loan will be fully forgiven if the funds are used for payroll costs, interest on mortgages, rent, and utilities (due to likely high subscription, at least 75% of the forgiven amount must have been used for payroll). Loan payments will also be deferred for six months. No collateral or personal guarantees are required. Neither the government nor lenders will charge small businesses any fees. Forgiveness is based on the employer maintaining or quickly rehiring employees and maintaining salary levels. Forgiveness will be reduced if full-time headcount declines, or if salaries and wages decrease. Paycheck Protection Program loans may have a principal loan amount of up to $10 million (limitations apply). Loans may have a term of up to 10 years and bear interest at a rate of no more than 4% per annum (with payments to be deferred for at least 6 months and at most 1 year).

B. Economic Injury Disaster Loan and Loan Advance Program

Small business owners in all U.S. states, Washington D.C., and territories are eligible to apply for an Economic Injury Disaster Loan advance of up to $10,000.

The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. The loan advance will provide economic relief to businesses that are currently experiencing a temporary loss of revenue. Funds will be made available within three days of a successful application.

To apply for a COVID-19 Economic Injury Disaster Loan, click here.

C. SBA Debt Relief

The SBA Debt Relief program will provide a reprieve to small businesses as they overcome the challenges created by the COVID-19 health crisis.

Under this program:

The SBA will also pay the principal and interest of new 7(a) loans issued prior to September 27, 2020.
The SBA will pay the principal and interest of current 7(a) loans for a period of six months.

D. SBA Express Bridge Loans

The Express Bridge Loan Pilot Program allows small businesses who currently have a business relationship with an SBA Express Lender to access up to $25,000 with less paperwork. These loans can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing and can be a term loan or be used to bridge the gap while applying for a direct SBA Economic Injury Disaster loan. If a small business has an urgent need for cash while waiting for a decision and disbursement on an Economic Injury Disaster Loan, they may qualify for an SBA Express Disaster Bridge Loan.

Terms:

Up to $25,000
Fast turnaround
Will be repaid in full or in part by proceeds from the EIDL loan
Employers can find an Express Bridge Loan Lender by connecting with their local SBA District Office.

5. BUSINESS TAX PROVISIONS

The CARES Act provides significant business tax relief including:

Employee Retention Credit
Delay of Employer Payroll Taxes
Changes to Net Operating Loss Rules
Changes to Business Loss Limitations
Modification of Credit for Prior Year Minimum Tax Liability of Corporations
Changes to Business Interest Limitations
Qualified Improvement Property
For more information on these business tax sections, please see our companion article linked here.

6. SLOW THE SPREAD OF COVID-19 GUIDANCE

The Centers for Disease Control and Prevention (CDC) has developed interim guidance for businesses and employers to respond to COVID-19 linked here. The guidance is routinely updated. Most states have issued stay at home orders, including California and Arizona (where the majority of our clients and enrollees reside). The only exceptions are for essential critical infrastructure workers. This means that most employees–to the extent possible–are working from home.

The CDC recommends the following to reduce risk of contracting COVID-19 and to slow the spread of the disease:

Avoid contact with COVID-19 infected individuals.
Practice responsible social distancing by avoiding large gatherings and maintain distance (approximately six feet) from others when possible.
Wash your hands often with soap and water for at least 20 seconds. Use hand sanitizer with at least 60% alcohol if soap and water are not available.
Avoid touching your eyes, nose, and mouth with unwashed hands.
Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues in the trash and immediately wash hands with soap and water for at least 20 seconds.
Clean and disinfect frequently touched objects and surfaces, such as workstations, keyboards, telephones, handrails, and doorknobs. Dirty surfaces can be cleaned with soap and water prior to disinfection. To disinfect, use products that meet the EPA’s criteria for use against SARs-CoV-2 (the novel coronavirus that causes the disease COVID-19).

7. OTHER HELPFUL RESOURCES

A. Federal Agencies and State Departments of Health

The U.S. government is undertaking unprecedented steps to combat the COVID-19 pandemic. For more information and additional resources, visit USA.gov/coronavirus and https://www.coronavirus.gov/.

For more information about what California is doing to combat COVID-19, visit https://www.cdph.ca.gov/ . To find out what your state is doing, visit https://www.usa.gov/state-health.

LET’S CONNECT
Brokers/Employers EmployeesProviders