Home > Internal
A Message on COVID-19
We understand that staying on top of the evolving, substantial volume of COVID-19/Coronavirus information released from multiple sources both within and outside the benefits industry may be overwhelming as companies determine applicability for use in the development of its own responses to the pandemic. Therefore, we felt it beneficial to aggregate the pertinent, current benefit plan-related information in one source for your current and future reference. As you read the below summary, you may be directed to an attached document or website.
With the increasing spread and associated media coverage of the Coronavirus, healthcare coverage has become increasingly more visible and important. Employees are asking questions on what coverage there is for testing and treatment for the Coronavirus and, just as important, what financial support is available if they cannot work due to sickness or company shut down due to quarantine or government mandate.
Most insurance carriers, Pharmacy Benefit Managers, TPAs and EAPs have released guidance on their response to the pandemic. Although testing is not currently available at most medical offices or retail convenience clinics at this time, it has been designated as an Essential Health Benefit under the ACA and must be covered by fully insured plans. Self-funded health plans may decide whether to cover the test and can also opt to apply or waive cost share. Health plans with Qualified High-Deductible Health Plans will not be negatively affected by covering this test as a first-dollar benefit (refer to “IRS HDHP COVID- 19”).
Below are brief summaries of the steps being taken by carriers, including links to their specific press releases and/or resources. In all cases for medical plans, self-funded groups will have the option to opt-out of waiving member cost-sharing for COVID-19/Coronavirus testing. If your company wants to opt-out you must notify your ASO vendor immediately. All other services and care, even if resulting from the COVID-19 virus, will continue to be covered under your plan as usual. Given the fluid nature of this situation, the below is reflective of a current point in time and may evolve as necessary. We will continue to update clients if/when changes occur.
Aetna will waive co-pays for all diagnostic testing related to COVID-19, offer $0 co-pay telemedicine visits for any reason for 90 days (from March 6, 2020), provide care packages containing OTC medications and cleaning supplies to any member diagnosed with COVID-19, and proactively reach out to high-risk members through existing care management programs.
Anthem will waive the member’s out-of-pocket cost (copay, coinsurance, deductibles, and prior authorizations) for the focused diagnostic test for COVID-19.
CIGNA will cover COVID-19 testing as a preventative benefit, waiving co-pays, deductibles and co- insurance. Cigna has also opened a 24-hour telephone helpline (866-912-1687) for members wanting to speak with qualified clinicians about COVID-19 related issues.
CVS is waiving early refill limits on 30-day prescriptions for maintenance medications at any in- network pharmacy, encouraging members to refill their maintenance medications, and waiving charges for home delivery of all prescription medications.
Express Scripts standard refill policies, which allow a refill or renewal of a prescription medication when 25%-35% of the current prescription remains. If a participant currently fills a 30-day supply of a medication at a local pharmacy and would like a longer-term supply, ask his/her physician to write your prescription for a 90-day supply and fill it at Express Scripts Home Delivery. Our pharmacists can help you get started: just call the number on the back of your pharmacy card.
Kaiser Permanente will not charge member cost-sharing for all medically necessary screening and testing for COVID-19. This applies to the cost of the visit, associated lab tests, radiology services, emergency department, urgent care, and provider locations where the purpose of the visit is to be screened and/or tested for COVID-19.
Medical Mutual is covering all diagnostic testing for COVID-19 if it is ordered by a medical provider, and waiving all member cost-sharing (copays, coinsurance, and deductibles) for these tests.
UnitedHealthcare / UMR will waive all member cost-sharing for COVID-19 diagnostic testing provided at approved locations in accordance with CDC guidelines. Optum’s Emotional-Support Help Line is free of charge to any member (866-342-6892). Members needing an early refill on medications should call the customer service number on the back of their ID cards for assistance or OptumRx customer service at 800-788-4863.
SummaCare is covering all diagnostic testing for COVID-19 if it is ordered by a medical provider, and waiving all member cost-sharing (copays, coinsurance, and deductibles) for these tests. Call the Summa Health Coronavirus hotline at 234.867.6314, available 24/7.
Disability Coverage COVID-19 should be covered under Short Term Disability if the medical records and diagnosis substantiate the need for a disability benefit. The quarantine period would count towards the elimination period if it is documented by a treating doctor, with a subsequent confirmed diagnosis. Each claim is decided based on the specific facts presented at time of claim, but if an employee is under quarantine and not ill, the employee would likely not meet the definition of disability.
Employee Leave Requirements Please refer to the attached document titled “Coronavirus in the Workplace - Compliance Considerations for Employers”.
An employee may be considered eligible for a leave (paid or unpaid) under his/her company leave program dependent upon the terms of the employer’s company paid leave policy as well as at the employer’s discretion. It is within an employer's discretion to continue to pay employees if an employee is required to stay out of the workplace. Employees may be entitled to paid time off under certain state laws if they (or a family member) contract the illness.
Under the Family Medical Leave Act (FMLA), if an employer ceases operation at a location or employees are not expected to report to work for one or more weeks, the days the employee cannot report to work are not counted against the employee’s leave entitlement. As a result, if an employer shuts a location due to the Coronavirus or another virus, any employees who are out on a qualifying FMLA leave (unrelated to company shutdown) cannot have the time the location is closed counted against their leave entitlement.
Additional resources/references on COVID-19/Coronavirus are available (see below). In addition, do not forget to make use of your company’s EAP program and its resources. We have also attached a business guide from the CDC (“CDC Coronavirus Guide”) and a sample employee communication letter (“Coronavirus Employee Letter”) for your use in communicating with your employees regarding the virus and any courses of action you may plan to take.
We will communicate new information to you as soon as reasonably possible. Should you have any questions, concerns or need any assistance during this time, please reach out to your DS Benefits Group consultant and/or Account Manager.