General guidance regarding health benefits coverage for COVID-19 for Health Plan members

This information is subject to change at any time and is only a brief reference.

Members who are part of a self-funded employer group should check with their employer's benefits department to confirm their benefits. Group administrators for self-funded employers should contact their Health Plan sales account managers if they want to change their benefits to include the cost share and prior authorization waivers and other measures described in this statement relating to COVID-19.

For fully insured members, the Health Plan will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19. We will also make dedicated clinical staff available to address inquiries related to medical services, ensuring timeliness of responses related to COVID-19.

The Health Plan will cover medically necessary diagnostic tests that are consistent with CDC guidance related to COVID-19 at no cost share to member. Across all our fully insured health plans (Commercial, Medicaid Managed Care, HARP, Essential Plan, Child Health Plus, Medicare Part B, Medicare Advantage), this testing will be covered, with no cost share to the member, where it is not covered as part of the Public Health Service response. The Health Plan will also ensure that patient testing and any subsequently needed care are done in close coordination with federal, state and public health authorities.

  • Members who are in fully insured commercial plans will have coverage with no out-of-pocket expense to them, for in-network provider office visits, in-network urgent care visits and emergency room visits resulting in testing for COVID-19. If an in-network provider is not available, the Health Plan will cover testing at an out-of-network provider with no out-of-pocket expense to the member.
  • Members who are enrolled in Medicaid Managed Care, HARP or Child Health Plus will have the cost of coronavirus testing by an in-network provider covered with no out-of-pocket expense. If an in-network provider is not available, the Health Plan will cover testing at an out-of-network provider with no out-of-pocket expense to the member.
  • Medicare members - Medicare Part B (Medical Insurance) covers COVID-19 testing. This test is covered when your doctor or a health care provider orders it, if you get the test on or after February 4, 2020.
  • Members with high deductible health plans will not be responsible for copayments, coinsurance and deductibles for 2019 Novel Coronavirus (COVID-19)-related testing even if the deductible has not been met, under new guidance from the Internal Revenue Service. This also means that an individual with an HDHP that covers these costs may continue to contribute to a health savings account (HSA).

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