As the landscape changes with the coronavirus pandemic, we want to keep you up to date on legislation and recommendations to keep you and your family safe. Following are important notes on two topics: (1) COVID-19 mandatory coverage; and (2) expanded coverage of telehealth visits.
COVID-19 Legislation Update
What you should know
While early recommendations focused on the coverage for testing at $0 out of pocket to health plan members, the final legislation requires private health plans to provide coverage for COVID-19 diagnostic testing, including the cost of a provider, urgent care center, and emergency room visits in order to receive testing. Coverage must be provided at no cost to the covered member. Treatment for COVID-19 will continue to be covered as it otherwise would be under the terms of your plan for similar illnesses.
What you should do
There’s nothing you need to do other than follow the COVID-19 safety guidelines established by the CDC and your state public health officials. As your health plan administrator, Healthcare Highways already updated its systems to support this new coverage related to a COVID-19 diagnosis or suspected case.
CMS guidelines for expanded coverage of telehealth visits
What you should know
Healthcare Highways Health Plan follows the general guidelines of the Centers for Medicare & Medicaid Services (CMS). Recently, CMS broadened access to telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. So, what does this mean to you?
- You receive the same benefit coverage and pay the same amount for a physician visit delivered in office or via telehealth.
- Primary care providers and other practitioners, such as certified clinical psychologists, nutrition professionals, etc. can offer telehealth visits. Importantly, telehealth vendors like MDLive or HealthiestYou that may already be included in health plan benefits will continue to apply normal member benefits and cost sharing to their specific services, (i.e., telehealth vendor visit copays still apply).
- You pay your standard copays for a telehealth visit to a PCP, specialist, etc., or other providers if it’s not related to COVID-19.
- Telehealth visits to a PCP, specialist, etc., or other providers for COVID-19-related cases are covered at $0 out of pocket to members.
What you should do
Call your PCP for guidance. Your primary care physician is your best resource for getting answers to your questions or concerns about coronavirus. They can determine if you are a candidate for testing, and provide you with the right authorization and information to obtain the test. Call first, as many are now providing telephonic office visits in lieu of or in place of physical office visits.
To help the healthcare provider’s office take steps to keep other people from getting infected or exposed, you should wear a facemask in public and especially before you enter a healthcare provider’s office.
If you need assistance finding a local provider, accessing your information, or have a question on COVID-19 or your coverage, our Customer Experience Team is here to provide extra support 844-869-5640, 8 AM to 5 PM, Monday through Friday.