The new Families First Coronavirus Response Act requires all group health
plans, including self-funded plans, to provide coverage for diagnostic testing,
including U.S. Food and Drug Administration (FDA)-approved COVID-19 diagnostic
testing products and items and services related to testing furnished during an office,
telehealth, urgent care center or emergency room visit. We have removed the
group waivers that were previously in place to comply with this mandate.
Premera follows state and federal mandates related to end dates for these
services. See the COVID-19 Key Dates section in this FAQ for current dates.
Commercial and Medicare Supplement members: We’re
waiving in-network cost shares (coinsurance, copays, and deductibles) for
members requiring FDA-authorized diagnostic COVID-19 and influenza testing. All
other treatments and services including hospitalization not related to a
COVID-19 diagnosis will be subject to the usual benefits and cost shares.
Pre-authorization isn’t required for medically necessary and
FDA-authorized COVID-19 testing. If a member requires COVID-19 testing and
treatment and there isn’t an in-network provider within a reasonable distance,
the claims will be paid as in-network.
What cost shares are waived and who do they apply to?
We know
these are difficult times for many, and the worry about medical bills,
especially as they relate to COVID-19, is great. To ease some of the burden for
our members, effective today Premera will be waiving cost shares
including copays, deductible and coinsurance for all COVID-19 related treatment
(both inpatient and outpatient).
See the COVID-19 Key Dates section in this document for current
dates.
Who is
eligible for the treatment cost share waivers?
This benefit
will apply to members of insured group, individual, grandfathered,
non-grandfathered, and association enrollees. Self-funded
group plans have the option to participate. This includes qualified high
deductible plan participants. This will
not apply to Shared Admin, FEP, and self-funded plans that opt-out.
What’s being
waived for treatment?
Premera
will waive member cost shares including copays, deductible and coinsurance for
treatment of COVID-19 or health complications associated with COVID-19,
including hospitalizations and medical transportation when needed, FDA-approved
medications delivered inpatient for both in and out of network providers.
How do you
know if a treatment or hospitalization is related to COVID-19?
Our
providers are using specific claim and diagnosis codes that have been provided
by various regulatory agencies. We’ll use those codes to determine if
a claim is related to COVID-19.
How is do I
find out if my group is participating?
Self-funded
groups, including OptiFlex, have until noon PST on April 16, 2020 to
determine if they want to opt out of the cost share wavier for COVID-19
treatment. We’ll have information about self-funded group
participation by April 16, 2020.
Note: HHS announced that the COVID-19 public health emergency (PHE) will
likely remain in place for the entirety of 2021. However, a PHE declaration is
limited by law to a 90-day period that can be terminated early or extended.
Premera will extend federally mandated benefits every 90 days upon official
renewal of the PHE by HHS Secretary. The HHS will provide 60-day notice if it
decides to terminate PHE or allow it to expire.
For groups, including self-insured and OptiFlex: The IRS issued
guidance allowing COVID-19 testing and treatment cost-share waivers for high deductible health plan and non-high deductible health plan members.