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.
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