COVID-19 – Guidance for employers

Quick links:

• Hospital update
• COVID-19 Benefits Survey Report – UK
• Furloughing your employees
• Group risk, healthcare and international health & risk insurances
• Impact on private sector healthcare
• Voluntary travel insurance

COVID-19 Employer updates

6th January 2021 Hospital Update

The following information was last validated on 6 January 2021.

The % of private hospitals classed as “fully open for all services” has dropped from 86% on 18^th December to 59% in early 2021.

This has been driven by the following updates from major hospitals which are now classed as “open for some non-urgent services”:

• HCA – non urgent services are available but surgeons have been asked to consider pausing non-urgent treatment where appropriate. HCA have also confirmed that they will be offering support to local NHS Trusts but this will not affect the availability of services to private patients – a formal communication is to be issued later in the week.
• Spire have confirmed that surgery under general anaesthetic is temporarily paused at 6 sites (Wellesley, Sussex, Alexandra, Thames Valley, Clare Park, Gatwick) due to the suspension of ITU transfer arrangements with local NHS Trusts.
• Aspen have advised that they will be introducing a screening programme to identify high risk patients given the limited availability of critical care support at local NHS Trusts. There is currently no impact to the availability of services but this is likely to change in the coming days.
• Cromwell Hospital has advised that they will be offering their free theatre slots to NHS Trusts but private services will not be affected.
• Royal Marsden, London Clinic, Schoen Clinic, Nuffield, Ramsay and BMI have also confirmed that there is currently no further impact to the availability of services to private patients.
• Private providers in Wales and NI have also confirmed no change in the availability of services.
• Private hospitals in Scotland remain available with the exception of the Edinburgh Clinic which had closed before Christmas.
• 15 hospitals have been issued with NHS surge notifications*
• In total 7 hospitals have suspended surgery under general anaesthetic following the suspension of NHS ITU transfer arrangements (the six Spire hospitals mentioned above plus Nuffield Tunbridge Wells as previously reported).

*Surge notifications are issued by NHS trusts to put private hospitals on notice that their services may be requisitioned for NHS patients.

12 May 2020 – Furloughing your employees

Update from HM Treasury on 12 May 2020:

• The Coronavirus Job Retention Scheme will be extended to 31 October 2020.
• From the start of August, furloughed workers will be able to return to work part-time with employers being asked to pay a percentage towards the salaries of their furloughed staff – detail around the application and implementation of this will be published by the Government at the end of May.

Clearly we are not legal advisers, but listed below are employer considerations we have seen and heard in the market in relation to furloughed workers and these may be points you wish to consult your legal team on:

• The Coronavirus Job Retention Scheme is open to all UK employers with a PAYE scheme and a UK bank account to support employers and their employees who would have otherwise potentially been laid off, made redundant and lost their jobs.
• Employees, who have been asked to stop working, but who are kept on the employers payroll, will be able to benefit from the Government’s Scheme and receive 80% of their pay up to £2,500 per month (this is pay only and will not cover bonus or commission or other such variables). Employers will also be able to claim for their National Insurance Contributions and auto-enrolment pension contributions based on the furloughed pay from the Government.
• The HMRC guidance states that reference salary should not include the cost of non-monetary benefits provided to employees, including taxable Benefits in Kind and the guidance states that benefits should be in addition to the wages that must be paid under the terms of the Job Retention Scheme. Elsewhere the guidance states the cost of benefits or salary sacrifice schemes cannot be taken from the government grant that is received to cover an employee’s subsidised furlough pay. This clearly needs further consideration as regards the provision of salary sacrificed and other employee funded benefits provided through flexible benefit arrangements.
• It will be for employees on PAYE as at 28th February and be effective from 1st March initially for a period of three months – this isn’t law yet, and is currently based on HMRC guidance, but this will be law in the near future.
• It is important to note that employees can’t work while furloughed by their employer (they can take part in training), but all other employment rights continue.
• Employees who may have initially been made redundant as a result of the pandemic could be re-hired and benefit from this Scheme, as could those on unpaid leave, but any employee who has had their contract changed already to reduce pay would need to have this re-visited to benefit fully from the Scheme, we understand.
• There is the need for employers to consider a ‘furlough agreement’ with their employees so that the reduction in pay will not be considered ‘an unlawful deduction from pay’ and so all parties clearly understand what is and what is not being provided, for example, this could include details around an employer topping up the Government amount to full pay.
• While an employee is furloughed it will be possible to take part in volunteering or to work for another entity (if allowed within their contract of employment), it may also be possible to rotate furlough periods, for example, full pay and work for a period of time followed by a period of furlough and no work. The minimum period for furlough is three weeks.

This information is for general interest and guidance. Action should not be taken on the basis of any of the above information without seeking specific advice.

12 June 2020 – Group risk, healthcare and international health & risk insurances

The following information was last validated on 12 June 2020.

In terms of your employee group risk, healthcare and international health and risk insurances, the insurance providers have been extremely quick to react, updating and amending their terms, ways of working and standard approach to help with the challenges we face with COVID-19.

The insurances, in most scenarios, remain broadly unaffected; however, it should be noted that some insurances, such as, dental, critical illness and travel would either not feature in this situation or have an exclusion as part of the standard terms. Please check your policy terms, and your specific insurer’s website here, for their latest updates on COVID-19.

Each applicable policy of insurance must be reviewed to determine the extent, if any, of coverage for COVID-19.  Coverage may vary depending on the jurisdiction and circumstances. For global client programs it is critical to consider all local operations and how policies may or may not include COVID-19 coverage.

19 June 2020 – Impact on private sector healthcare

The following information was last validated on 19 June 2020.

Private hospital update

(This applies to England as we do not have information from Scotland, Wales and Northern Ireland.)

Original situation

• All proposed treatments, whether funded privately or by the NHS, were assessed by an NHS England multi-disciplinary team and a priority level assigned.
• The treatments were categorised as follows:
  • Priority level 1a Emergency operation needed within 24 hours/ immediate
  • Priority level 1b Urgent operation needed with 72 hours / urgent-expedited
  • Priority level 2 Surgery that can be deferred for up to 4 weeks / semi-acute
  • Priority level 3 Surgery that can be delayed for up to 3 months*
  • Priority level 4 Surgery that can be delayed for more than 3 months*

• Treatments for levels 3 and 4 were not allowed.
• Treatment was authorised for NHS patients and privately funded patients strictly on the basis of clinical priority.
• This substantially reduced capacity for treatment.

What has changed

• The contract remains in place until 30 June and for some facilities it is expected that the contract will be extended to 31 August.
• The NHS retains the right to book NHS patients into private hospitals for elective treatment, but this is restricted to core hours of 9 to 5.
• NHS England has given independent hospitals autonomy to treat private patients providing they meet their obligations to the NHS without referring to the authorisation team.
• Treatments are still categorised according to the severity but treatment for levels 3 and 4 is now permitted.
• This gives the opportunity for independent hospitals to work through their own waiting lists.
• In practice, the independent hospitals have had plenty of spare capacity, which they have until now been unable to use for private patients, and many are taking steps to expand capacity further by running services over weekends.  This means that, although there are some capacity limitations and a backlog of patients to care for, almost all patients will now be able to access care.

What patients can expect

• Patients can expect to be admitted based on clinical priority.
• Patients will have to be COVID-19 free.
• Hospitals will implement a testing and self-isolation regime prior to admission.
• It is expected the patient will have to self-isolate for 14 days prior to treatment.
• The hospital will admit a day early so the patient can be tested and held in isolation for 24 hours before treatment.
• It is understood that medical insurers will pay for the cost of tests and additional accommodation.
• The hospitals will be taking additional measures in relation to physical distancing and the use of personal protective equipment.

Implications for medical plan claims experience

• Claim levels under most schemes have dropped significantly since late March, reflecting the suspension of the majority of elective treatments.
• However, most claims will have only been deferred through the suspension and treatments are still required.
• Therefore, claims are now likely to increase as the independent sector reopens.
• There is still significant uncertainty around exactly how claims will develop and ‘catch up’ in the coming months as there are many variables that will influence this.

3 November 2020 – Voluntary travel insurance

The following information was last validated on 3rd November 2020.

This advice relates to travel insurance as part of employer flexible benefit arrangements, and how coronavirus (COVID-19) impacts the terms offered. With many employees considering the purchase of such insurance and potentially thinking about their travel plans at this time, there are some important points to note.

Policy exclusions

The policies will typically be annual policies which are employee funded through flexible benefit programmes set up by their employers. In the flexible benefit market, the majority of employer plans will be set up through Crispin Speers & Partners (CSP) or Pen Underwriting (PEN) and insured through Lloyd’s of London. These travel insurance plans, offered by both CSP and Pen, will have an exclusion relating to pandemics in respect of cancellation cover. This is relevant because coronavirus (COVID-19) was officially classed as a pandemic by the WHO on 11 March 2020.

We are aware this may differ to the approaches of some insurers in the individual retail market, as these may not have a pandemic exclusion, and this could lead to questions from your employees.

However, this is not straightforward as there are many different types of travel policy available in the individual retail market. Some insurers offer base plans with different modules to ‘buy up’ to comprehensive cover, so coverage will be dependent on what modules an individual has purchased. It is unclear at this stage how insurers will apply some of the other exclusions included in the plans. For example, some insurers have exclusions relating to the cancellation of cover in the event of ‘government action’ or ‘an order of regulation’.

Clearly the insurers are regularly reviewing their terms at this time and you may have seen in the press recently that several have updated their position in the individual market, for example, Aviva and the Post Office have both removed cover for coronavirus related claims from their consumer travel plans and LV announced they are suspending sales of travel insurance.

What to do, and further information

The general advice from at the moment is for employees to understand what cover is available through their current travel insurance provider.

For those employees who are thinking of changing their travel plans, they should contact their travel company provider or credit card company to progress any refunds through the schemes these organisations are likely to have in place. For those insured through CSP, there is a useful FAQ section on their website here: http://www.eb.cspinsurance.com/index.php/324-coronavirus-faq-update

There is also further information available from CSP here: http://www.eb.cspinsurance.com/index.php/newsmain/323-coronavirus

If you have specific queries relating to the terms of your policy which are not covered here, or any other aspect regarding your employee benefits programmes, please contact us