COVID-19 Coverage Information for Employers and Members

March 13, 2020

We are closely monitoring the 2019 Novel Coronavirus (COVID-19) outbreak. We are committed to helping our employer customers and members stay informed and educated about COVID-19 and assisting those who might be affected.

With regard to treatment for COVID-19, our plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of the member’s benefit plan. Members should always call the number on their ID card for answers to their specific benefit questions.

For diagnostic testing for COVID-19, please note the following coverage information.
 
Coverage for fully insured members: Effective immediately for all fully insured members, for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance:

  • No prior authorization needed
  • No member copays or deductibles

The same coverage above applies to HSA qualified high-deductible health plans, pursuant to the IRS notice on COVID-19 issued March 11, 2020.
 
Coverage for self-insured and split-funded* members: Self-insured and split-funded employers must opt in to offer their employees the testing to diagnose COVID-19 when medically necessary and consistent with CDC guidance with:

  • No prior authorization needed
  • No member copays or deductibles

Action needed: Self-insured and split-funded groups must communicate their agreement to opt in by emailing their account executive or broker to activate this coverage. These groups must opt in by March 31, 2020.

What is the risk of COVID-19?
According to recent reports from the CDC, the immediate health risk from COVID-19 is low at this time for most of the population. However, older adults and individuals with chronic medical conditions like heart disease, diabetes and lung disease are at higher risk to get very sick.

We are ready to assist doctors, hospitals and public health organizations in serving our members and the community in understanding, preventing and potentially treating people who have been affected by the COVID-19.

More information: Because this is a rapidly evolving situation, continue to use Centers for Disease Control guidance on COVID-19, as the CDC has the most up-to-date information and recommendations.

Member communications: We’ve developed a member flier about COVID-19 to share with your employees. Check with your account representative for the latest flier.

For employers: The CDC has an entire section on its website focused on how coronavirus can impact employers. Key sections of the site include:

  • Recommended strategies for employers to use now
  • What employers should do if an employee reports exposure to someone with COVID-19 (including the steps they should follow to conduct a risk assessment of their potential exposure)
  • Recommendations for an infectious disease outbreak response plan

*A split-funded group self-insures a portion of their benefits and a portion is premium.