The COVID-19 (Coronavirus) outbreak has caused a lot of changes in the insurance world. We’ve put this Carrier Enhancements COVID-19 FAQ to highlight updates carriers have made to their plans including Telemedicine, free COVID-19 Testing, waived copay & cost-sharing, RX information, and links to their Resource Centers. Please note that the content of this piece is the most up to date information that we have received directly from the carrier, therefore it is subject to change at any time. For the most up to date information, please visit the Resource Link for each carrier below as things are changing daily. This is to be used as a guide only. We recommend checking directly with your carrier if you have a specific issue.
COVID testing Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. The test can be done by any authorized testing facility. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The policy also aligns with new Families First legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. The requirement also applies to self-insured plans. Per guidance from the Centers for Medicare & Medicaid Services (CMS), the Department of Labor and the Department of the Treasury, all Commercial, Medicaid and Medicare plans must cover certain serological (antibody) testing with no cost-sharing.
Waiver of Copays/Cost Sharing for COVID Related Illnesses Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. The test can be done by any authorized testing facility. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The policy aligns with new Families First legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. The requirement also applies to self-insured plans. Per guidance from the Centers for Medicare & Medicaid Services (CMS), the Department of Labor and the Department of the Treasury, all Commercial, Medicaid and Medicare plans must cover certain serological (antibody) testing with no cost-sharing.
CVS Health and Aetna are here to support you during the COVID-19 pandemic. We want you to know that New York has extended the emergency rules that waive patient cost share for certain services. The extensions last until December 29, 2021.
When COVID-19 escalated in the United States, Aetna®, a CVS Health® company, implemented a series of cost-sharing waivers to support individuals seeking COVID-19 care. While some of those waivers have expired, Aetna is extending others as noted below.
COVID Vaccines Aetna is waiving member cost-sharing related to COVID-19 vaccination for Commercial and Medicaid members. For Medicare, CMS has indicated it will cover the full cost of the vaccine for all Medicare beneficiaries, including those in a Medicare Advantage plan, in 2020 and 2021.
What about the booster shot? The booster is available at no cost to any eligible member either through insurance or a federal program for the uninsured (As of 11/19/2021)
Informational Links: https://www.aetna.com/employers-organizations/resources/covid19.html
Aetna Resource Center Link: https://www.aetna.com/individuals-families/member-rights-resources/covid19.html
Telemedicine Talk to a doctor from anywhere. Telemedicine services from your doctor for a non-COVID diagnosis are available for same cost as an office visit, based on your health plan. You can also schedule a same- day appointment with a doctor 24/7 with MDLIVE at no cost, depending on your plan. MDLIVE doctors can assess your symptoms and help with next steps. Register or login at mdlive.amerihealth.com.
Covers telemedicine appointments for specialists; nutrition counseling; urgent care; video only visits for physical and occupational therapy; and audio or video for speech therapy for in network services, unless the benefit design provides otherwise or is permitted by AmeriHealth New Jersey due to a network adequacy or access determination.
Behavioral Health – Covers in network, out-of-area, and out-of- network telebehavioral health visits at no cost.
Primary care telemedicine visits will be covered at $0 member costshare; this will continue until 90 days after the end of both the state of emergency and public health emergency declared by the State of New Jersey in response to COVID-19.
COVID testing AmeriHealth New Jersey will cover COVID-19 testing for diagnostic and antibody tests in accordance with federal and state guidelines and the company’s medical policy until 90 days after the end of both the public health emergency and state of emergency, whichever is later.* For complete details, please review the policy News Article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for AmeriHealth New Jersey Members (Updated October 6, 2021). Testing is covered. AmeriHealth covers the cost for medically appropriate diagnostic and antibody testing ordered by a physician or authorized by a health care professional at no cost to the member. This coverage is in accordance with all federal mandates through the end of the public health emergency². AmeriHealth does not cover tests that are needed for return to work, a condition of employment, return to school, or travel.
COVID Vaccines & Booster Reimbursement rules for approved COVID-19 vaccines, boosters, and their administration: The vaccine and booster will be distributed by the U.S. Government at no charge and will not be eligible for reimbursement by AmeriHealth. AmeriHealth will cover the administration of approved COVID-19 vaccines and boosters as a preventive service with $0 cost-share (i.e., copayment, deductible, and coinsurance). We will reimburse the vaccine and booster administration cost as a preventive service.November 11, 2021. AmeriHealth covers the cost of administering the Pfizer and Moderna booster shots for certain immunocompromised individuals (e.g., organ transplant recipients). AmeriHealth will also cover booster shots for the broader population once formal authorization from the FDA is received.
RX Member cost share is waived for in-network, acute in-patient treatment of COVID-19 through December 31, 2021. Cost sharing will continue to be applied to all post-acute care (e.g. skilled nursing, rehabilitation and long term acute care facilities), outpatient treatment, prescription drugs, ambulance transportation to a post-acute setting, and out of network care.
Waiver of copays/cost sharing for COVID related illnesses AmeriHealth New Jersey is waiving member cost-sharing (i.e., copayment, deductible, and coinsurance) for the following services:
Telemedicine/Telehealth. AmeriHealth New Jersey will waive member cost-sharing for all in-network telemedicine/telehealth visits, as well as out-of-network COVID-19 related services. Non-COVID-19 out-of-network services are not covered unless included in the applicable benefit design or permitted by AmeriHealth New Jersey due to network adequacy or access limitations. In such cases, member cost-sharing for out-of-network telemedicine/telehealth services is waived. MDLive® cost-sharing is waived for all MDLive telemedicine visits.
AmeriHealth New Jersey will waive member cost-sharing for in-network, inpatient, acute care treatment of members diagnosed with COVID-19.
AmeriHealth New Jersey will waive member cost-sharing for emergency room/department (ED) visits associated with admissions for in-network, inpatient, acute care treatment of COVID-19 whether for medical or behavioral health.
For services not related to COVID-19, we will continue to apply the appropriate member cost-sharing.
Resource Center Link – AmeriHealth COVID-19 Resource page: https://www.amerihealth.com/htdocs/custom/covid-19/index.html
COVID Vaccines Cigna covers the cost of administering FDA-approved and FDA-authorized COVID-19 vaccines at 100% without any out-of-pocket costs when performed by an in-network or out-of-network provider.
COVID Booster Just as with the first doses of the COVID-19 vaccine, booster shots will be provided without cost-sharing or out-of-pocket costs. In the event a Cigna customer receives a surprise bill for their booster shot, they should call the number on the back of their insurance card for immediate support and guidance.
Covid Testing On October 15, 2021, the Secretary of Health and Human Services (HHS) renewed the national public health emergency (PHE) period for COVID-19 through January 15, 2022. Consistent with the new end of the PHE period, Cigna is extending cost-share waivers for COVID-19 diagnostic testing and related office visits through January 15, 2022. We also continue to make additional key accommodations related to credentialing and virtual care
RX 90-day supplies with free delivery directly to their home, and have access to our pharmacists 24/7 through our Express Scripts Pharmacy.
Resource Center Link Members can log into MyCigna.com or Corona Virus Resource Center https://www.cigna.com/coronavirus/
COVID Vaccines The FDA has approved two vaccines for COVID-19, and more may be approved in the coming months. FDA-approved COVID-19 vaccines will be covered under member plans. In some situations, the government may cover the vaccine cost. Members will pay $0 out-of-pocket for both doses of the vaccine they receive. This applies whether they visit health care providers in or out of our network.
Will there be any cost-sharing or copays for members receiving the vaccine? No. Members will pay $0 out-of-pocket for both doses of the vaccine. This applies for vaccination visits to health care providers in or out of our network.
Are Boosters Covered? If you are eligible under FDA rules to receive a booster, you will pay $0 out-of-pocket. This means no copays, deductibles or coinsurance will apply.
RX For members who are under quarantine or want to avoid visiting pharmacies during the outbreak: EmblemHealth covers 90-day supplies of long-term medications (or maintenance drugs) through Express Scripts mail order so members can get their medications delivered right to their home. Express Scripts also gives members access to pharmacists 24 hours a day, seven days a week, in case they have questions about their medications.
Telemedicine Our Temporary Telehealth Policy, with allowable procedure codes, and Frequently Asked Questions provides guidance on these services for our members. Telehealth services include visits by phone, virtual check-in, or virtual visit via Skype, FaceTime, or other video exchange.
COVID Testing All Empire plans cover medically necessary COVID-19 testing and the care visit where the test takes place with no out-of-pocket costs. Find a COVID-19 testing location near you by using this tool. Please talk to a doctor first to be certain you need a COVID-19 test. A doctor must order a COVID-19 test for you.
Waiver of copays/cost sharing for COVID related illnesses Empire is waiving cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits associated with the COVID-19 test, including visits to determine if testing is needed.
COVID Vaccines Empire members will receive the COVID-19 vaccination at no cost. Empire will cover the cost of the COVID-19 vaccine. Empire members won’t have out-of-pocket costs for the vaccination during this national public health emergency.
RX Empire has relaxed early prescription refill limits, where permitted, for members who have Empire pharmacy benefits and wish to refill a 30- day supply of most maintenance medications early.
Resource Center Link – Member FAQ & Broker Guidance https://www.empireblue.com/coronavirus/
Telemedicine Cost-sharing (your copay) is waived for all services delivered via telemedicine by in-network providers or via Teladoc. You won’t be charged for a telemedicine visit even if the visit is for something unrelated to COVID-19.
COVID testing If your primary care provider (PCP) or an in-network provider orders a COVID-19 test, your Healthfirst health plan will cover the cost for the test and the in-network provider visit related to the evaluation. You will not be subject to any cost sharing for the test or the in-network provider visit.
RX Members can continue their current mail order arrangements and request a one-time refill for a 30-day supply of medication for a chronic condition while the state of emergency is in effect in New York. This includes diabetic medication. This excludes controlled substances, injectable, and intravenous infusions
Resource Center Link- Healthfirst Frequently Asked Questions or Healthfirst Resource Center https://healthfirst.org/coronavirus-covid-19/
HealthPass (Please see specific carrier’s coverages) – EmblemHealth, Healthfirst, Oscar, Oxford
Resource Center Link https://healthpass.com/covid-19
Telemedicine EFFECTIVE IMMEDIATELY through at least 90 days after the end of the public health emergency and State of Emergency declared by the Governor, in an effort to connect members with their providers, Horizon BCBSNJ shall expand the use of telemedicine services, for providers, during the current public health emergency, COVID-19. Horizon BCBSNJ shall reimburse the following services in addition to those allowed under the existing Telemedicine Services reimbursement policy.
COVID testing When ordered by your doctor, testing, diagnosis and treatment for COVID-19 are available to Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) members with zero out-of-pocket costs. Members will pay no deductible, copay or coinsurance for services ranging from doctor’s visits to hospital stays when their testing or treatment is related to COVID-19.
Waiver of copays/cost sharing for COVID related illnesses Horizon BCBS will end the cost share waiver for members’ out-of pocket costs (copays, deductibles and coinsurance) for claims for inpatient and outpatient treatment of COVID-19 after June 30, 2021. At that time, our COVID-19 treatment cost share waiver will have been in place for almost 18 months. Other major health insurance carriers in New Jersey ended their waivers earlier this year, or never waived these costs at all
COVID Vaccines Horizon BCBSNJ is committed to doing our part to combat the COVID-19 public health emergency. That’s why, our members can get COVID-19 vaccines that are authorized through an Emergency Use Authorization (EUA) and recommended by the Advisory Committee on Immunization Practices (ACIP) at no cost. During the COVID-19 public health emergency, the COVID-19 vaccines will be covered 100% through in- and out-of-network doctors, hospitals, pharmacies and other health care professionals, as well as through vaccine administration sites.
COVID Vaccines Nippon Life Benefits will be covering, without cost-sharing, a covered member’s and dependent’s COVID-19 vaccination(s) regardless of in or out of network provider or pharmacy.
Vaccine Booster COVID-19 booster vaccine recommendations and eligibility continue to be considered and reviewed by the FDA and CDC. We are regularly monitoring for updates regarding this topic. Please be aware that COVID-19 booster vaccines will be covered without cost sharing for all covered members who meet the requirements as they are established and authorized by the FDA and/or CDC, regardless of in or out of network provider or pharmacy.
FAQ – Nippon Life COVID-19 Resource center https://www.nipponlifebenefits.com/coronavirus/
Telemedicine Oscar understands the importance of having access to medical services while many of us are staying at home to help reduce the spread of COVID-19. We continue to offer $0 telemedicine to most of our members through Oscar’s Virtual Urgent Care.
COVID testing Oscar will waive cost-sharing of diagnostic testing for COVID-19,7 including antibody (serology tests)8 and any FDA-approved at-home COVID-19 diagnostic tests, through the duration of the Public Health Emergency (PHE) period. Oscar members will pay $0 cost-share for COVID-19 testing, including the cost of the visit associated with the test and the test itself, whenever a test is recommended by a physician. Oscar does not cover testing for surveillance and back to work purposes.
Waiver of copays/cost sharing for COVID related illnesses Your Oscar plan will cover treatment associated with COVID-19 under your plan’s normal cost-sharing rate. There are also some exceptions based on federal and local regulations, such as for COVID-19 treatment delivered via telemedicine as outlined in the FAQ.
Login to your Oscar account online or through the Oscar app to review your plan details and message your Care Team about any questions you may have. Oscar will continue to assess our policies to make sure they are best serving the needs of our members as the pandemic continues to evolve. Please visit this page for the latest updates.
COVID Vaccines Now that the U.S. has recommended COVID-19 vaccines, we are working to help our members get immunized as quickly as possible. Oscar will cover the COVID-19 vaccine at $0 co-pay wherever it is available, such as at your local pharmacy like CVS. Our $0 cost-share COVID-19 vaccine policy covers COVID-19 immunizations that have been approved by the federal government and national public health institutes like the CDC.2 This is a quickly evolving situation and Oscar will keep you updated as more information is shared. You can find the latest news on COVID-19 vaccines and related regulations on the CDC’s website.
Resource Center – Oscar COVID-19 Resource Center https://www.hioscar.com/covid19
Oxford / UnitedHealthcare
Telemedicine COVID-19 Testing/Test-related Visits – Diagnostic and Antibody: UnitedHealthcare will cover medically appropriate COVID-19 testing and test-related visits in- and out-of-network during the national public health emergency period through January, 15th, 2022, at no cost-share, when ordered by a physician or appropriately licensed health care professional for purposes of the diagnosis or treatment of an individual member.
Coverages vary by state. Some are still in effect and some have expired. https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2020/covid19/telehealth-provisions-northeast.pdf
COVID Vaccines COVID-19 vaccines are an important step in protecting your health and your loved ones, and we encourage you to talk to your doctor about the right time to get your vaccine. We are committed to providing helpful vaccine information and resources to support you, including $0 cost-share on COVID-19 vaccinations through the national public health emergency period. For those who are moderately to severely immunocompromised as defined by the CDC, a third COVID-19 vaccination dose is covered at $0 cost-share. https://www.uhc.com/health-and-wellness/health-topics/covid-19/vaccine
COVID Testing Medically-appropriate COVID-19 tests have $0 cost-share during the national public health emergency period, currently scheduled to end Jan. 15 2022. Medically-appropriate COVID-19 tests must be FDA-authorized or approved, and be ordered or reviewed by a health care professional to either 1) diagnose if the virus is present in a person due to symptoms or potential exposure, or 2) help in the treatment of the virus for a person. This coverage applies to in-network and out-of-of-network tests for Medicare Advantage, Exchange, Individual and Employer-sponsored health plans. For individuals enrolled in UnitedHealthcare Community Plans, state variations and regulations may apply during this time. UnitedHealthcare health plans generally do not cover COVID-19 surveillance testing, which is testing used for public health or social purposes such as employment (return to workplace), education, travel, or entertainment.
Cost Sharing covid Related treatment If you get sick with COVID-19, your health care provider may prescribe treatments. For COVID-19 treatment, cost-sharing will be according to the member’s benefit plan. You will be responsible for any copay, coinsurance, deductible or out-of-network costs. This coverage applies to Medicare Advantage, Exchange, Individual and Employer-sponsored health plans. For members enrolled in UnitedHealthcare Community Plans, state provisions and regulations may apply during this time.
Resource Center Link https://www.uhc.com/broker-consultant/covid-19-faqs?cid=ei_eng|uhc|co|em|multi|null|null|cta3getFAQs|2021_12_13|CTA3&sfmcid=1597667167
Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.