Supporting Covered Members Access to Care During COVID-19
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 BENEFITS RELATED TO COVID-19
Federal Deadline Extension - The Internal Revenue Service (IRS) and the Department of Labor (DOL) issued a joint rule on May 4 mandating the extension of certain plan deadlines due to the COVID-19 crisis (see link for more information). The following deadlines have been extended:
- Enrollment in connection with a HIPAA special enrollment event, such as due to birth, adoption, placement for adoption, marriage, or loss of other coverage
- Filing a claim for benefits
- Filing an appeal with respect to a denied benefit claim
- Filing a request for, and providing the information needed to obtain, an independent external review
- Submitting claims for Flexible Spending Account (FSA)
The “Outbreak Period” began on March 1, 2020 and will end 60 days after the announced end of the COVID-19 National Emergency (unless another date is specified by the IRS/DOL).
An example of the deadline extension would be if a deadline for one of the items above occurred on March 15, 2020, then the new deadline will be 15 days following the end of the Outbreak Period.
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.
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. For more information please go to Telehealth. You can also connect with an AmWell provider by calling 1-844-733-3627.
Aetna has added an indicator within their provider lookup tool to identify/filter searches based on providers offering telemedicine. Aetna is working quickly to identify providers with telemedicine availability but it may take time to update their systems.
Buoy Health for You – Symptom Checker for COVID-19 – Are you having symptoms, but not sure what they mean? Let Buoy assist you. Buoy Health is an interactive symptom checker. This tool could serve as an early intervention for COVID-19, helping you understand the symptoms you may be experiencing and what your next steps should be based on your risk level.
Visit Buoy Health, your health, wellness, and peace of mind are our primary concerns during this time.
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 and to update your prescriptions to home delivery, please visit the Prescription Management page.
Member Responsibility $0 – Your out-of-pocket expenses will be $0 when receiving testing for COVID-19 as well as vaccination for COVID-19.
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.