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Carrier Updates


Below is a compilation of the major carriers’ responses to coverage of testing for COVID-19.  Please let me know if you have any questions.  All information below is current as of  3/12/20.

Aetna – Fully Insured CVS Health announced several steps to support Aetna members in response to the COVID-19 outbreak, including coverage changes. You can access the full press release here for details.   Effective immediately, Aetna members will have access to the following resources: 

  • Aetna will waive co-pays for all diagnostic testing related to COVID-19. This policy will cover the test kit for patients who meet CDC guidelines for testing, which can be done in any approved laboratory location. Aetna will waive the member costs associated with diagnostic testing at any authorized location for all Commercial, Medicare and Medicaid lines of business. 
  • For the next 90 days, Aetna will offer zero co-pay telemedicine visits for any reason. Aetna members should use telemedicine as their first line of defense in order to limit potential exposure in physician offices. Cost sharing will be waived for all video visits through the CVS MinuteClinic app, Aetna-covered Teladoc offerings and in-network providers delivering synchronous virtual care (live videoconferencing) for all Commercial plan designs. 
  • Through Aetna’s Healing Better program, members who are diagnosed with COVID-19 will receive a care package containing CVS over-the-counter medications to help relieve symptoms. The package will also include personal and household cleaning supplies to help keep others in the home protected from potential exposure. 
  • Through existing care management programs, Aetna will proactively reach out to members most at-risk for COVID-19. Care managers will walk members through what they can do to protect themselves, where to get information on the virus, and where to go to get tested. 
  • Aetna is extending its Medicare Advantage virtual evaluation and monitoring visit benefit to all Aetna Commercial members as a fully-covered benefit. This offering will empower members with other conditions that need follow-up care to engage with providers without the concern of sitting in a physician’s office and risking potential exposure to COVID-19. CVS Health is taking additional steps across the company to address the COVID-19 outbreak and protect patient access to medication. More information about the latest enhancements is available here:    
  • Beginning immediately, CVS Pharmacy will waive charges for home delivery of prescription medications. With the Centers for Disease Control and Prevention encouraging people at higher risk for COVID-19 complications to stay at home as much as possible, this is a convenient option to avoid coming to the pharmacy for refills or new prescriptions. 
  • Aetna will now offer 90-day maintenance medication prescriptions for Commercial and Medicare members and is working with state governments to make the same option available to Medicaid members where allowable. 
  • In addition, Aetna will waive early refill limits on 30-day prescription maintenance medications for all members with pharmacy benefits administered through CVS Caremark.

Please contact your Aetna representative with any questions.

CVS Health Press Releases: https://cvshealth.com/newsroom/press-releases/cvs-health-announces-covid-19-resources-aetnamembers

https://cvshealth.com/newsroom/press-releases/cvs-health-announces-additional-covid-19-resourcesfocused-patient-access


FetchMD

  • Current service area of Austin & San Antonio
  • On-demand “house call” services that include care for ear, nose & throat, common sickness, minor injuries, skin issues, stomach problems and well checks
  • Costs:
    • Urgent Care Copay on Copay Plans
    • $145 Contracted Rate on HDHP
    • $49 Televisit Follow Up Appointments
  • Mobile Platform (App Based) and Bilingual
  • More info: https://www.fetchmd.com/
  • Hours of operation:
    • M-F: 8-8
    • Sat: 9-6
    • Sun: 10-4


BCBS – Fully Insured & Self-Funded

COVID-19 Coverage Information for Employers and Members

We are closely monitoring the 2019 Novel Coronavirus (COVID-19) outbreak. We are committed to helping our employer customers and members stay informed and educated about COVID-19 and assisting those who might be affected.  

With regard to treatment for COVID-19, our plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of the member’s benefit plan. Members should always call the number on their ID card for answers to their specific benefit questions.  

For diagnostic testing for COVID-19, please note the following coverage information.

  • Coverage for fully insured members: Effective immediately for all fully insured members, for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance:
  • No prior authorization needed
  • No member copays or deductibles

The same coverage above applies to HSA qualified high-deductible health plans, pursuant to the IRS notice on COVID-19 Leaving site icon issued March 11, 2020.

Coverage for self-insured and split-funded* members: Self-insured and split-funded employers must opt in to offer their employees the testing to diagnose COVID-19 when medically necessary and consistent with CDC guidance with:

  • No prior authorization needed
  • No member copays or deductibles

Action needed: Self-insured and split-funded groups must communicate their agreement to opt in by emailing their account executive or broker to activate this coverage. These groups must opt in by March 31, 2020.

 

Member communications: We have developed a member flier PDF about COVID-19 to share with your customers.

For employers: The CDC has an entire section on its website Leaving site icon focused on how coronavirus can impact employers.

Key sections of the site include:

Recommended strategies for employers to use now

What employers should do if an employee reports exposure to someone with COVID-19 (including the steps they should follow to conduct a risk assessment of their potential exposure)

Recommendations for an infectious disease outbreak response plan 

 UHC – Fully Insured

https://www.unitedhealthgroup.com/newsroom/2020/2020-03-09-covid-19-support-resources.html

UnitedHealth Group Reinforces Actions Taken to Provide Members and Patients with COVID-19 Support and Resources

  • UnitedHealthcare has waived all diagnostic test cost-sharing for insured members
  • OptumCare clinicians are trained, well-prepared and addressing patients’ needs
  • Optum’s Emotional-Support Help Line is free of charge to help anyone dealing with stress and anxiety

UnitedHealthcare and Optum are taking action to ensure health plan members and patients affected by COVID-19 have the support and resources they need. “Our top priority is the health and well-being of our members and patients – and the safety of those who deliver care,” said Dr. Richard Migliori, chief medical officer, UnitedHealth Group. “While the situation is dynamic, we are committed to adapting and supporting those we serve.” 

Actions to Support Members, Patients and the Community

Individuals who feel like they may have been exposed to COVID-19 should immediately contact their primary care provider for guidance. Advance telephone calls are highly recommended to ensure safe and proper patient handling.

UnitedHealthcare has waived all member cost sharing, including copays, coinsurance and deductibles, for COVID-19 diagnostic testing provided at approved locations in accordance with CDC guidelines for all commercial insured, Medicaid and Medicare members. UnitedHealthcare is also supporting self-insured customers choosing to implement similar actions.

Optum’s Emotional-Support Help Line is available to support anyone who may be experiencing anxiety or stress following the recent developments around COVID-19. The free service can be reached at (866) 342-6892, 24 hours a day, seven days a week and is open to all.  In addition, emotional-support resources and information are available online at www.liveandworkwell.com.

OptumCare clinicians across the country are well-prepared and providing compassionate care to COVID-19 patients of the more than 18 million people we serve through our primary care practices, urgent care centers, and in-patient homes and nursing homes.

To limit the spread of COVID-19, OptumCare clinicians have been trained on the CDC safety and clinical care protocols enabling patients to get the appropriate care, ensure the safety and well-being of the team, and protect others from exposure.  

Eligible UnitedHealthcare and OptumRx members needing help obtaining an early prescription refill can call the customer care number located on the back of their medical ID card for assistance or contact OptumRx customer service (800) 788-4863.

Health plan members are encouraged to use UnitedHealthcare’s Virtual Visit* capability, available through the UnitedHealthcare app, to help answer any general questions or concerns they might have.

UnitedHealth Group is utilizing its advanced analytics capabilities to enhance situational awareness and continuously adapt and evolve support services for members, patients and employees. 

For the Latest Information

Because this situation continues to evolve, we encourage people to stay informed by visiting the CDC website.

If individuals have travel plans, be sure to check out the CDC’s travel advisories, including the recently released CDC travel guidance for older Americans, people with underlying health concerns and all travelers planning cruise ship travel.   

UHC – All Savers

All Savers is following the above stated UHC guidance. They are also allowing early Rx refills through the end of March.

Humana – Fully Insured

Please see the attached agent email from Humana.


Humana – Self Funded

Test must be ordered by a physician and done at an approved lab.

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. Self-insured plan sponsors will be able to opt-out of the program at their discretion.


 

IRS Guidance for COVID-19 Testing & Coverage + HDHP/HSAs

HIGH DEDUCTIBLE HEALTH PLANS AND EXPENSES RELATED TO COVID-19 Notice 2020-15

PURPOSE

To facilitate the nation’s response to the 2019 Novel Coronavirus (COVID-19),

this notice provides that, until further guidance is issued, a health plan that otherwise satisfies the requirements to be a high deductible health plan (HDHP) under

section 223(c)(2)(A) of the Internal Revenue Code (Code) will not fail to be an HDHP under section 223(c)(2)(A) merely because the health plan provides health benefits associated with testing for and treatment of COVID-19 without a deductible, or with a deductible below the minimum deductible (self only or family) for an HDHP. Therefore,

an individual covered by the HDHP will not be disqualified from being an eligible individual under section 223(c)(1) who may make tax-favored contributions to a health savings account (HSA).

Part of the response to COVID-19 is removing barriers to testing for and treatment of COVID-19. Due to the nature of this public health emergency, and to avoid administrative delays or financial disincentives that might otherwise impede testing for and treatment of COVID-19 for participants in HDHPs, this notice provides that all medical care services received and items purchased associated with testing for and treatment of COVID-19 that are provided by a health plan without a deductible, or with a deductible below the minimum annual deductible otherwise required under

section 223(c)(2)(A) for an HDHP, will be disregarded for purposes of determining the status of the plan as an HDHP.

BACKGROUND

Section 223 of the Code permits eligible individuals to deduct contributions to HSAs.1 Among the requirements for an individual to qualify as an eligible individual under section 223(c)(1) is that the individual be covered under an HDHP and have no disqualifying health coverage. As defined in section 223(c)(2), an HDHP is a health plan that satisfies certain requirements, including requirements with respect to minimum deductibles and maximum out-of-pocket expenses.

RELIEF

Due to the unprecedented public health emergency posed by COVID-19, and the need to eliminate potential administrative and financial barriers to testing for and treatment of COVID-19, a health plan that otherwise satisfies the requirements to be an HDHP under section 223(c)(2)(A) will not fail to be an HDHP merely because the health plan provides medical care services and items purchased related to testing for and treatment of COVID-19 prior to the satisfaction of the applicable minimum deductible.

As a result, the individuals covered by such a plan will not fail to be eligible individuals under section 223(c)(1) merely because of the provision of those health benefits for testing and treatment of COVID-19.

1 Tax-favored contributions may also be made on behalf of eligible individuals by their employers. See

Q&A 19 of Notice 2004-2 (2004-2 I.R.B. 269)

This guidance does not modify previous guidance with respect to the requirements to be an HDHP in any manner other than with respect to the relief for testing for and treatment of COVID-19. Vaccinations continue to be considered preventive care under section 223(c)(2)(C) for purposes of determining whether a health plan is an HDHP.

This notice provides flexibility to HDHPs to provide health benefits for testing and treatment of COVID-19 without application of a deductible or cost sharing. Individuals participating in HDHPs or any other type of health plan should consult their particular health plan regarding the health benefits for testing and treatment of COVID-19 provided by the plan, including the potential application of any deductible or cost sharing.

DRAFTING INFORMATION

The principal author of this notice is Jennifer Solomon of the Office of Associate Chief Counsel (Employee Benefits, Exempt Organizations, and Employment Taxes), though other Treasury Department and IRS officials participated in its development.

For further information on the provisions of this notice, contact Jennifer Solomon at (202)

317-5500 (not a toll-free number)

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