National Accounts Key Accounts Public Sector COVID19 Standards
National Accounts, Key Accounts, Public Sector COVID-19 Standards Guide 2021 COVID-19 DIAGNOSTIC TESTING and TESTING-RELATED VISITS Standard applies to Fully Insured and Self Funded plans: Federal regulations require waiver of member cost-sharing (copayments, coinsurance, deductibles) for approved and authorized COVID-19 testing and testing-related visits at physician offices, urgent care centers and emergency departments for members enrolled in comprehensive medical plans, and Medicare managed care plans. Testing must be provided at approved locations in accordance with U. S. Centers for Disease Control and Prevention (CDC) guidelines. United. Healthcare will only cover testing for employment, education, public health or surveillance purposes when required by applicable law. • Waiver of cost share applies in-network and out-of-network and relies upon accurate COVID-19 coding • Coverage is effective for dates of service February 4, 2020 through April 20, 2021 COVID-19 ANTIBODY TESTING Standard applies to Fully Insured and Self Funded plans: During the national public health emergency period, United. Healthcare will cover FDA-authorized COVID-19 antibody tests ordered by a physician or appropriately licensed health care professional without cost sharing (copayment, coinsurance, deductible) in-network and out-of-network. An antibody test may determine if a person has been exposed to COVID-19, while a COVID-19 diagnostic test determines if a person is currently infected. FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. According to the FDA, an antibody test should not be used to diagnose a current infection. United. Healthcare strongly supports the need for reliable testing and encourages health care providers to use reliable FDA-approved tests. United. Healthcare will only cover testing for employment, education, public health or surveillance purposes when required by applicable law. • Coverage is effective for dates of service April 10, 2020 (first date coding available) through April 20, 2021 COVID-19 TREATMENT Standard applies to Fully Insured plans 2021 Standard: United. Healthcare is waiving cost-sharing (copayment, coinsurance, deductible) for inpatient in-network treatment related medical expenses for covered services with dates of service 1/1/2021 through 1/31/2021. If a member receives treatment under a COVID-19 admission or diagnosis code, we will waive cost-sharing (copayments, coinsurance, deductibles) for the following: Emergency Department Visits and Observation Stays resulting in an admission to a network facility, Inpatient Hospital Episodes and Medical Ground Ambulance Transportation resulting in an inpatient stay. 2020 Standard: United. Healthcare waived cost-sharing (copayment, coinsurance, deductible) for inpatient and outpatient treatment-related medical expenses for covered services with dates of service in-network through 12/31/2020 and out-of-network through 10/22/2020 when associated with a COVID-19 diagnosis. If a member received treatment under a COVID-19 admission or diagnosis code, we will waive cost-sharing (copayments, coinsurance, deductibles) for the following: Office Visits/Telehealth, Urgent Care Visits, Emergency Department Visits, Observations Stays, Inpatient Hospital Episodes, Acute Inpatient Rehabilitation, Long-Term Acute Care, Medical Ground Ambulance Transportation and Skilled Nursing Facilities. We will also waive cost-share for COVID related FDA approved medications administered in these locations. UNITEDHEALTHCARE PROPRIETARY AND CONFIDENTIAL United. Healthcare’s materials are intended to provide general information and assistance during this national emergency and do not constitute medical, legal or tax advice. Please contact your medical, legal and tax advisors on how to respond to this situation. The materials and discussion topics do not constitute a binding obligation of United. Healthcare with respect to any matter discussed herein. Please note, in addition to federal law, states may have additional or differing requirements. Some of our products and networks have different features and as a result different guidelines and protocols are 1 applicable to them. 1/29/2021
National Accounts, Key Accounts, Public Sector COVID-19 Standards Guide COVID-19 VACCINE Standard applies to Fully Insured and Self Funded plans: Federal regulations require waiver of cost-share (copayments, coinsurance, deductibles) in and out of network for COVID-19 Vaccine Administration incurred through April 20, 2021. • The COVID-19 vaccine serum will initially be paid by the government • Office visits will be subject to plan benefits MONOCLONAL ANTIBODIES Standards applies to Fully Insured plans: Federal regulations require coverage of the administration of monoclonal antibodies when delivered by a network provider in an outpatient setting. Fully Insured plans will waive cost share (copayments, coinsurance, deductibles) for administration of monoclonal antibodies when delivered by a network provider in an outpatient setting for claims incurred through February 28, 2021. • The monoclonal antibodies will initially be paid by the government COVID-19 VIRTUAL VISITS & TELEMEDICINE through Am. Well, Doctor on Demand or Teladoc Standard applies to Fully Insured and Self Funded plans: United. Healthcare will waive cost-share (copayments, coinsurance, deductibles) for COVID Virtual Visits incurred through September 30, 2020* *All Virtual Visit claims apply cost share starting October 1, 2020 • COVID Claims will be reprocessed to reimburse the member cost share through April 20, 2021 • The member will be reimbursed by the provider through the original payment method Non-COVID-19 VIRTUAL VISITS & TELEMEDICINE through Am. Well, Doctor on Demand or Teladoc Standard applies to Fully Insured and Self Funded plans: United. Healthcare waived cost-share (copayments, coinsurance, deductibles) for non-COVID Virtual Visits incurred through September 30, 2020. *All Virtual Visit claims apply cost share starting October 1, 2020 TELEHEALTH – COVID-19 TESTING & RELATED VISITS Standard applies to Fully Insured and Self Funded plans: Federal regulations require waiver of member cost-share for COVID-19 testing related visits. Eligible in-network and out-of-network medical providers who have the ability and want to connect with their patient through live video-conferencing or audio-only (telephonic) may do so. Coverage is effective for dates of service February 4, 2020 through April 20, 2021 TELEHEALTH – Non-COVID-19 RELATED VISITS Standard applies to Fully Insured plans: United. Healthcare previously waived cost-share (copayments, coinsurance, deductibles) associated with in-network telehealth visits for all medical and Physical, Speech and Occupational Therapies. This change applied to network providers who have the ability and want to connect with their patient through live video-conferencing or audio-only. • In-network waiver of cost share applied to dates of service March 31, 2020 and ended September 30, 2020, and services began to pay at plan benefits • Out-of-network claim payment for expanded telehealth services ended July 24, 2020 2
National Accounts, Key Accounts, Public Sector COVID-19 Standards Guide BEHAVIORAL TELEHEALTH Part 1 - Standard applies to Fully Insured and Self Funded plans: All eligible in-network and out-of-network behavioral health care providers who have the ability and want to connect with their patient through live videoconferencing or audio-only (telephonic), may do so to support the behavioral health (mental health and substance use disorder) needs of the individual member. • Physical office visits will pay according to plan benefits • Please note, Teladoc is unable to provide behavioral health Virtual Visits at this time Part 2 - Standard applies to Fully Insured plans: Member cost-share waiver for all in-network virtual visits and telehealth outpatient behavioral health visits, including ABA services applied March 31, 2020 and ended September 30, 2020 and will now pay at plan benefits. 3
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