The Impact of Covid-19 / Coronavirus:  Are you covered?

How does your health insurance cover Covid-19/Coronavirus testing and treatment?

Each company has come out with their own version of what is covered, how it is covered, and terms and conditions to the coverage.  Coverage may vary within each company depending on the type of plan or policy that you have.  For example, an Affordable Care Act policy may have different coverage than a Short-Term Medical Plan or an Employer Group Sponsored Plan.  I have posted below helpful information and links to various insurance companies and their policies on this matter. However, check with your insurance company directly to be certain of coverage for your specific policy (you can go to your insurance company’s website below or call Member Services via the toll free number on the back of your insurance card).

It is important to consider the following:

Variations that may occur between insurance companies:

  • You may be required to meet medical determinations to be eligible for screening. A doctor's order may be required.

  • Most companies are waiving copays, deductibles or coinsurance for the screening test certified by the CDC. It is not clear if they will cover third-company screening tests.

  • Some companies are only waiving costs for the screening test itself. Office visit charges and associated outpatient costs such as radiology may be subject to your deductible and coinsurance, although some companies are waiving those costs as well.

  • Most companies are requiring that you get the test and screening done IN-NETWORK. This is especially important if you are on an ACA/Obamacare individual plan, so be sure you verify your provider for the testing is in-network.

Disclaimer:  This information is subject to change and is being updated frequently.  This information is not medical advice, it is strictly informational.  Contact your medical professional for direction on what to do if you feel you may need testing.

01/

Healthcare.gov (Health Insurance Marketplace)

Be sure to check with your specific insurance company for details on provider network, specific coverage limitations and requirements.  Below is a link for more information on the Marketplace's impact on coverage for your Individual or Family ACA Plan

https://www.healthcare.gov/blog/coronavirus-marketplace-coverage/

04/

Children's Commnunity Health Plan (CCHP)

Together with CCHP will cover and waive all member cost-sharing, including copays, coinsurance, and deductibles, for COVID-19 diagnostic testing to establish the diagnosis of COVID-19 when performed at in-network provider locations or laboratories.

Given that the test is new and specific billing codes were only recently designated, members should report any concerns about a claim payment to our Customer Services staff.
 

Additionally, CCHP offers its members a no-cost, on-call nurse triage line called CCHP on Call. Members can speak directly to knowledgeable registered nurses who are available 24/7 by calling 1-877-257-586.
 

05/

Common Ground Healthcare Cooperative

Common Ground announced: "We will cover laboratory and radiology testing related to coronavirus without member cost-sharing. That includes copays, deductibles, or coinsurance associated with recommended testing, screening, and in-network provider and urgent care visits when related to testing for coronavirus.  During a public health emergency, out-of-pocket costs should never be a barrier to our members receiving necessary care. If members develop symptoms associated with coronavirus, we encourage you to contact your primary care provider, virtually or by phone, to discuss further action and appropriate testing.  If you do not have a primary care provider, please use our provider directory to find an in-network provider near you: CGCares.org/find-a-doctor/
 
Members may also take advantage of our online clinic, Virtuwell. Our online clinic may be a reasonable first option for members who think they could have coronavirus. Several of our network partners offer virtual visits as well.  Licensed clinicians can help you determine your risk factors and direct you to the right place for testing, if they think it is necessary. "

06/

Dean / Prevea360

Dean and Prevea360 are waiving in-network cost-sharing, including copayments, coinsurance and deductibles, for COVID-19 diagnostic testing during this public health emergency. We will cover the test and doctor visit at no cost to members when the basis for the visit is related to testing for COVID-19.

 

As a community health plan we’re committed to taking the necessary steps to limit the spread of this virus and promote access to screening and testing.

 

This policy applies to our members in all lines of business, including commercial, Medicare, Medicaid and ASO products.

 

Members are also encouraged to use telehealth services and/or Dean on Call/Prevea Care After Hours when possible for COVID-19 screening.

07/

Humana

Humana's highest priority remains the care of our members – your employees. Therefore, Humana will waive out-of-pocket costs, where allowed within state and federal law, associated with testing for COVID-19 for patients who meet CDC guidelines at approved laboratory locations.  

We are also announcing the following resources for members:

  • Telemedicine costs waived for all urgent care needs for next 90 days – To help reduce the risk of infection and spread of disease, Humana is encouraging members to use telemedicine (e.g., video chat) as a first line of defense for all urgent care needs. The company will waive costs for telemedicine visits for urgent care needs for the next 90 days. This is limited to in-network providers delivering synchronous virtual care (live video-conferencing). Self-insured plan sponsors will be able to opt-out of the program at their discretion.

  • Early prescription refills allowed for next 30 days – Humana is allowing early refills on prescription medicines so members can prepare for extended supply needs - an extra 30- or 90-day supply as appropriate.

  • Member support line available – Humana has trained a specialized group of call center associates to help support members with specific coronavirus questions and concerns, including live assistance with telemedicine. Members can call Humana’s toll-free customer support line, which can be found on the back of their member I.D. card, to be connected to this dedicated team of professionals.

  • On Monday March 30, 2020, Humana announced it will be waiving all deductible, copays and cost sharing for Covid-19 related testing AND treatment.

08/

IHC Loomis

The IHC Group Takes Action Regarding COVID-19 and its Short-Term Medical Plans


We announced today that in an effort to provide protection and peace of mind to our insureds during the COVID-19 outbreak we will, effective immediately, waive certain cost sharing provisions on Independence American Insurance Company's (IAIC) Short-Term Medical plans (STM) in order to remove financial barriers to COVID-19 testing. 

As a part of this effort, all IAIC STM plans will:

  • Waive all insured cost sharing, including deductibles, copays and coinsurance, for:

    • The COVID-19 diagnostic test; and

    • The COVID-19 diagnostic related services, including the related office, emergency or urgent care visit.

  • Waive any preauthorization requirements related to COVID-19 testing     


David Kettig, the President of IAIC, stated, "STM is a potential solution for many people who cannot purchase insurance through the Affordable Care Act market. Right now, if someone is uninsured and doesn't have a Special Enrollment Period, STM may be their only option for coverage at a time when health insurance is more important than ever."
 
This will apply to all IAIC STM Plans for any covered testing performed on or after March 11, 2020 through April 30, 2020. IAIC will continue to evaluate other ways in which to assist its insureds during this emergent situation.       

It is important to remember that this ONLY applies to COVID-19 testing and costs related to covered testing. In addition:

  • The pre-existing condition will continue to apply, as will underwriting. It is important to sell STM to people who are eligible and understand the plan's limits.

  • Depending on the plan and provider, the insured may still have amounts to pay for claims in excess of the usual, reasonable and customary amount.

  • This waiver does not apply to treatment for the COVID-19 virus; however, the plan will pay for covered claims as it would any other claim.

09/

IMG (International Medical Group)

11/

MediShare

Coronavirus (COVID-19) Update

Summary

Testing and treatment for Coronavirus (COVID-19) are eligible for sharing, like costs for any testing or treatment of a confirmed illness, based on the Medi-Share Guidelines. Provider fees still apply, as does the requirement that the member’s Annual Household Portion (AHP) is met before bills are eligible for sharing. Members should access free telehealth as a first route of care, and if further treatment is recommended, utilize PHCS providers when appropriate.

What Should Members Do?

If members are feeling sick with fever >100.4 and cough, they should be utilize free MDLive telehealth service to help determine the necessary next steps regarding testing and treatment.

  • “As part of your Medi-Share membership, you have free access to 24/7 Telehealth. You can speak to a Board certified physician from the comfort of your home to review symptoms and get advice regarding any further steps, testing or treatment, if needed.”

    • If the member has not yet registered or set up their account for MDLive, please prompt them to do so now, before they need care.

Will Their Coronavirus Bills Be Shared?

Medical bills related to the Coronavirus are eligible for sharing similar to any upper respiratory illness, in accordance with the Medi-Share Guidelines.

  • Provider fees for office/hospital visits will remain $35

  • Provider fees for ER visits are $200

What About Coronavirus Testing?

Testing for COVID-19 will be increasing over the next several weeks and will be eligible for sharing consistent with the Medi-Share Guidelines.

  • Costs for these tests will typically be billed as a part of a medical or ER visit.

  • Bills related to COVID-19 will be shared in accordance with the usual process.

  • Bills will first be applied to the AHP, then will be shared with no annual or lifetime limit.

Coronavirus Testing Is Only Recommended For:

  • Fever of 100.4 and cough/shortness of breath AND

  • You have returned from international travel with the last 14 days, or

  • You have returned from a cruise within the last 14 days, or

  • You have been in close contact with someone who has returned from international travel/cruise and that person is sick.

Final Thoughts

Christian Care Ministry, like our nation, will continue to monitor the COVID-19 situation. We encourage our members to stay calm and to follow local public health recommendations regarding travel, avoiding work/school if sick, and implementing social distancing when directed in your area. Let’s remember who we serve! We put our faith and trust in God for all things and in all circumstances. We are praying for our members, for our nation, and the world as we navigate this pandemic.

Prayer & Encouragement

 We've included some powerful verses from God's Word to share, or to encourage you!

  • Dear friend, I pray that you may enjoy good health and that all may go well with you, even as your soul is getting along well. 3 John 1:2

  • Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid. John 14:27

  • For the Spirit God gave us does not make us timid, but gives us power, love and self-discipline. 2 Timothy 1:7

  • Even though I walk through the darkest valley] I will fear no evil, for you are with me; your rod and your staff, they comfort me. Psalm 23:4

  • Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own. Matthew 6:34

  • Then Jesus said to his disciples: “Therefore I tell you, do not worry about your life, what you will eat; or about your body, what you will wear. For life is more than food, and the body more than clothes. Consider the ravens: They do not sow or reap, they have no storeroom or barn; yet God feeds them. And how much more valuable you are than birds! Who of you by worrying can add a single hour to your life[a]? Since you cannot do this very little thing, why do you worry about the rest? Luke 12:22-26

13/

National General

To help limit the spread of COVID-19, National General will waive 100% of customers’ out-of-pocket costs for COVID-19 diagnostic tests and will ease access for customers seeking diagnostic testing. This waiver will extend to all National General Short Term Medical customers and will be made available to employers in the National General Benefits Solutions Program. As part of the effort regarding COVID-19 diagnostic testing, National General will:

  1. Waive all member cost sharing for COVID-19 diagnostic tests and related services, including the associated office visit, emergency room, or urgent care charges. The waiver applies any out-of-pocket costs, including deductibles, copays, and co-insurance for diagnostic testing related to COVID-19.

  2. Waive all prior authorization requirements as it relates to COVID-19 diagnostic testing.

  3. Allow early refills and up to a 90-day supply of a member’s prescription drugs in the event of hardship related to COVID-19.

Customers concerned about exposure to COVID-19 should contact their healthcare provider or state health department. National General’s customer service call center will be available to assist if customers have any questions about COVID-19 testing-related services.

15/

Pivot Health / Companion Life

Pivot Health is dedicated to helping our members maintain their health and well-being during the Coronavirus (COVID-19) outbreak. The following measures will be taken in connection with short term medical plans provided by Pivot Health:

  • Cost sharing, including copays, coinsurance, and deductibles for COVID-19 diagnostic testing will be waived when recommended by the insured's Physician

  • Pre-authorization will not be required for diagnostic services related to COVID-19 testing

  • Claims will be paid promptly for treatment in accordance with the terms of the policy

Members with a short term medical or Bridge to MedicareTM plan will soon receive an email from Pivot Health with the subject line, "An Important Notice About Coverage for Coronavirus (COVID-19)

16/

UnitedHealthcare

Expanded access to care, support and resources

We are expanding your access to care, support and resources to help you navigate through this unprecedented time. We are committed to helping you protect your health by enabling you to get access to the right care including from the comfort of your home.

Latest updates on COVID-19

UnitedHealthcare is waiving member cost-sharing for the treatment of COVID-19 through May 31, 2020 for its fully-insured Commercial, Medicare Advantage and Medicaid plans. We will also work with self-funded customers who want us to implement a similar approach on their behalf. This builds on the company’s previously announced efforts to waive cost-sharing for COVID-19 testing and testing-related visits, and the expansion of other member services.

Starting March 31, 2020 until June 18, 2020, UnitedHealthcare will now also waive cost-sharing for in-network, non-COVID-19 telehealth visits for its Medicare Advantage, Medicaid and fully-insured Individual and Group market health plans. Again, we will work with self-funded customers who want us to implement a similar approach. The company previously announced we would waive cost-sharing for telehealth visits related to COVID-19 testing, in addition to waiving cost-sharing for 24/7 Virtual Visits with preferred telehealth partners.

Cost-sharing is waived for COVID-19 tests and testing related visits

If you believe you might have been exposed to COVID-19 or have symptoms such as fever, cough or difficulty breathing, call your health care provider right away. Only health care providers can order a COVID-19 test.

We are waiving cost-sharing for COVID-19 testing during this national emergency. And we are waiving cost-sharing for COVID-19 testing related visits during this same time, whether the testing related visit is received in a health care provider’s office, an urgent care center, an emergency department or through a telehealth visit. This coverage applies to Medicare Advantage, Medicaid and fully-insured Individual and Group health plans. 

Access to telehealth

Telehealth gives you access to health care providers from the comfort of your home through digital audio-visual technologies, such as FaceTime, Skype, Zoom or dedicated telehealth applications. We expanded access to telehealth to help you stay in your home and reduce exposure to the virus.

  • 24/7 Virtual Visits through designated telehealth providers: These visits are ideal for urgent care. Our preferred telehealth partners include Teledoc, American Well, Doctor On Demand and other partners. To access your benefit, sign in to your health plan account.

    Medicare Advantage and Medicaid members can continue to access their existing telehealth benefit offered through one of our preferred partners without cost-sharing. For members with a telehealth visit through their employer-sponsored plan, cost-sharing for members will be waived until June 18, 2020.

     

  • Talk to your health care provider from home: Eligible health care providers can provide a telehealth visit for many of your urgent and non-urgent health care needs. This way, you can stay at home while still receiving the care you need.

    Starting March 31, 2020 until June 18, 2020, we are waiving cost-sharing for in-network telehealth visits for Medicare Advantage, Medicaid and fully-insured Individual and Group health plans, with opt-in available for self-funded employers. Telehealth visits may include:

     

    • Urgent and routine medical care: Providers can use both interactive audio/video and audio-only.

    • Outpatient behavioral care: Providers can use both interactive audio/video and audio-only.

    • Physical, occupational and speech therapies: Providers must use interactive audio/video technology.
       

    Cost-sharing will be waived for in-network telehealth visits. Out-of-network and cost-sharing will apply, if applicable. Out-of-network telehealth services will be covered in accordance with your health plan benefits.

    COVID-19 testing related telehealth visit: For COVID-19 testing related visits, we will waive member cost-sharing for in-network and out-of-network telehealth services, including both interactive audio/video and audio only. This coverage is available from March 18, 2020 and throughout this national emergency.

Early prescription refill

If you have UnitedHealthcare prescription drug coverage or an OptumRx pharmacy benefit and need an early prescription refill, you may request one through your pharmacy. Look at your current supply of medications, as well as what you might need in the near future, to decide if you should refill early.

Pharmacy delivery is available through Optum Home Delivery by signing into your health plan account and selecting this option. Pharmacy delivery is also available through several retail pharmacies.

Additional resources for our members

  • Access your health plan account: Sign in to your health plan account to find network health care providers, understand benefits coverage, manage prescriptions and more.

  • Call a UnitedHealthcare advocate: If you have health benefits questions, need help finding a health care provider or would like to talk to a nurse, call the phone number on your UnitedHealthcare member ID card.

  • Get emotional support: In a stressful time, it can be hard to cope. Talking to someone can help.

    • Our emotional support line is here for you to call any time at 866-342-6892. This 24/7 Optum Help Line is staffed by professionally trained mental health experts. It is free of charge and open to anyone.

    • On-demand emotional support is also available to you through Sanvello, a free mobile app that can help you cope with stress, anxiety and depression during the COVID-19 pandemic.

17/

Others

Stay tuned for updates or call your insurer directly by phone using the contact information located on the back of your insurance card.

info@kladirect.com    |    (262) 536-5155

211 N. Franklin St., Suite 205

Port Washington, WI   53074

Office Hours By Appointment Only

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