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Pending Federal Regulations on COVID-19 (Coronavirus) Member Cost Share

The coronavirus COVID-19 pandemic is disrupting life for everyone as our communities battle this deadly virus.  The number of confirmed coronavirus cases continues to grow in New York state and across the country.

New York state is requiring all insured health coverage to waive the member cost share for COVID-19 testing and the site visit where the testing takes place. We expect that federal legislation will be enacted soon to mandate that the same coverage be provided for self-funded employer groups.

To assure that everyone has access to testing and diagnosis for this serious virus, Univera Healthcare is implementing these benefits now for all employer groups, including self-funded groups. Should the federal mandate not become effective, the Health Plan will give self-funded groups the ability to opt out of the cost-share waiver and the benefit changes noted below.

Effective immediately, Univera Healthcare will implement the following benefit changes:

  • Prior authorizations will be waived for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19.
     
  • Coverage of medically necessary diagnostic tests that are consistent with CDC guidance related to COVID-19 at no cost share to the member. 
     
  • During the duration of the state of emergency all telemedicine visits will be covered in full. Members will have no cost share while this is in effect.
     
  • Members 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 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).

For all our members, we are making dedicated clinical staff available to address inquiries related to medical services, ensuring timeliness of responses related to COVID-19. 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. 

These are uncertain times and we appreciate your understanding. As always, if you have a specific question, please contact your account representative.

 
 
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