Access to Care During Coronavirus

Coronavirus COVID-19

Supporting Covered Members Access to Care During COVID-19

To make testing and treatment for the COVID-19 virus more accessible, some changes have been made to the benefits in the Ascend to Wholeness Healthcare Plan (Plan). The Plan is waiving member deductibles and co-pays for testing and treatment of the COVID-19 virus. These changes exceed the current government requirements for healthcare plans and are available under both the Access and Accelerate plans.

IMPORTANT - YOUR PARTNERSHIP
The availability of testing and treatments for the COVID-19 virus are constantly changing. The Plan benefits administrators, claims processors, and member services are committed to providing service to each of you and we ask for your patience during this unprecedented scenario. We anticipate we will be required to make decisions quickly and there may be changes to normal processes. The Plan is committed to providing benefits as noted below; however, there may be unanticipated items that come up that may require you to pay deductibles or co-pays upfront, and then seek reimbursement through member services. We will work through these situations with you.

We anticipate that the COVID-19 virus may put a strain on the United States healthcare system. We ask, on behalf of our medical provider partners, for your patience and understanding.

IMPORTANT - FOR PROVIDERS
Please call Member Services at 888-276-4732 to confirm the Plan benefits concerning COVID-19. The Plan is waiving member deductibles and co-pays for testing and treatment of the COVID-19 virus.

Providers MUST use diagnosis code U07.1 (there may be additional codes adopted as set by public health entities) for:
  • Urgent care
  • Lab testing
  • Office Visit
  • Emergency room
  • Inpatient hospital stays

IMPORTANT - ON-SITE BIOMETRIC SCREENING CANCELLED 

Due to the continued growth and spread of the coronavirus (COVID-19) pandemic, we want to exercise the CDC’s recommendation regarding social distancing and avoiding group gatherings. Therefore, we will not be conducting on-site biometric screenings this year. 

Adventist Risk Management, Inc., on behalf of the Ascend to Wholeness Plans (Plan), will be cancelling your scheduled events with Interactive Health. Off-site biometric screenings are still available for members and covered spouses if they choose to do so. Forms are available in the Resources Library on this page. 

Please be assured that your health and safety are the Plan’s priority. If you have any questions, please contact our customer service at (888) 276-4732 or by email at healthcare@adventistrisk.org

IMPORTANT BENEFITS RELATED TO COVID-19
Telehealth (Amwell) – is a free in-network service that allows you to be treated by a licensed physician without leaving your house. Members should use telehealth as their first line of defense in order to limit potential exposure in physician offices and other areas. Amwell physicians are prepared with a pre-approved standard questionnaire for COVID-19. For more information please go to Telehealth.

UPDATE: Effective 3/1/2020, the telehealth benefit has been expanded beyond Amwell and now includes phone and email visits. This service may be offered by any of your current physicians, therapists, etc. who are in-network and it will be covered. The clinician needs to be in-network, have the appropriate technology in place and be able to bill correctly, as well as being a licensed provider type covered by the Plan. Your telehealth copay remains at $0 for both Access and Accelerate plans.

Prescriptions (Express Scripts) – refills or renewals of prescriptions can be made when 25% - 35% of your current supply is remaining. Members will also be able to have one (1) override refill per 365 days at your request. The Plan will also have protocols in place for further overrides for zip codes that are specified as needing emergency access. For more information please go to Prescription Claims

Member Responsibility $0 – your out-of-pocket expenses will be $0 when receiving testing or treatment for COVID-19 and the diagnosis code U07.1 (there may be additional codes adopted as set by public health entities) for urgent care, lab testing, office visit with diagnosis, emergency room, and in-patient hospital stays.

This page is a summary and briefly describes some of the benefits and member responsibilities of the Plan. This document does not provide coverage of any kind. Coverage will be determined based on the Summary Plan Document.