Complete Coverage: Texas Health Insurance Providers Respond to Coronavirus
March 10, 2020
The Texas Association of Health Plans, its member companies, and our employees are heavily invested in the health of the Texas communities in which we live and serve, and we are fully committed to meeting this challenge. Texas health plans are working to help contain the virus, ensure people have coverage for and access to needed testing, and help patients who are infected receive the care and treatment they need. Here are some ways Texas health plans are taking action:
- Aetna-CVS announced several steps to support its members in response to the COVID-19 outbreak including waiving co-pays for all diagnostic testing related to COVID-19, offering zero co-pay telemedicine visits for any reason over the next 90 days, giving members diagnosed with COVID-19 a care package including over-the-counter medications to help relieve symptoms, and proactively reaching out to members most at-risk for COVID-19. Aetna also announced additional steps, including waiving charges for home delivery of CVS Pharmacy prescription medications and offering 90-day maintenance medication prescriptions for insured and Medicare members. Aetna is working with state governments to make the same option available to Medicaid members where allowable, and self-funded plan sponsors will also have the ability to offer this option. In addition, Aetna will waive early refill limits on 30-day prescription maintenance medications for all members with pharmacy benefits administered through CVS Caremark. Aetna will waive member cost-sharing for inpatient admissions at all in-network facilities for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured commercial plan sponsors and is effective immediately for any such admission through June 1, 2020. Resources For Living® (RFL), Aetna’s employee assistance program, is offering support and resources to individuals and organizations who have been impacted by COVID-19 whether or not they have RFL included as part of their benefits. Individuals and organizations who don’t have RFL can contact the service at 1-833-327-AETNA (1-833-327-2386).
- Blue Cross and Blue Shield of Texas will not require preauthorization and will not apply members’ copays or deductibles for testing to diagnose COVID-19 when medically necessary and consistent with CDC guidelines.
- Centene (WellCare Health Plan of Texas) announced it is covering COVID-19 testing and screening services for Medicaid, Medicare and Marketplace members and is waiving all associated member cost share amounts for COVID-19 testing and screening. Centene will not require prior authorization, prior certification, prior notification or step therapy protocols for these services.
- Cigna is waiving customer cost-sharing for all COVID-19 treatment through May 31, 2020. The treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations.This policy applies to customers in the United States who are covered under Cigna’s employer/union sponsored insured group health plans, insured plans for US based globally mobile individuals, Medicare Advantage and Individual and Family Plans (IFP). Cigna will also administer the waiver to self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option. Cigna will deploy hundreds of on-staff clinicians, including physicians and nurse practitioners, to join the team of health care professionals at MDLIVE, a leading telehealth company and Cigna network partner. Cigna behavioral health experts are also staffing a free COVID-19 support line (1.866.912.1687) available 24/7 to the general public to help assist people in managing feelings of stress, fear, and anxiety while building resiliency. Cigna is also partnering with Buoy Health, an artificial-intelligence powered navigation platform to provide a free, web-based interactive triage tool that assesses COVID-19 risk. Through this early-intervention tool, US domestic customers can quickly receive information regarding the severity of their symptoms and recommendations on next steps for care. The symptom checker will be available this week on www.Cigna.com, www.MyCigna.com and related myCigna mobile applications. For its customers in the United States who are covered under Cigna’s employer/union sponsored insured group health plans, insured plans for globally mobile individuals, Medicare Advantage, Medicaid, and the Individual and Family insurance plans (self-insured group health plans administered by Cigna have an opportunity to opt out of these benefits), Cigna is committed to the following actions through May 31, 2020: waiving cost-sharing for the COVID-19 diagnostic test when recommended by a health care professional, waiving cost-sharing for office visits related to COVID-19 testing, and waiving cost-sharing for telehealth screenings for COVID-19. Cigna is also offering free standard shipping of up to 90-day supplies for prescription maintenance medications and 24/7 access to pharmacists through May 31, 2020.
- Community Health Choice announced it is optimizing access and removing potential barriers to member screening and diagnostic testing for COVID-19 by providing access to testing without prior authorization and waiving copays and member cost-sharing on FDA-approved testing for COVID-19. The plan is also increasing access to outpatient services for COVID-19 by encouraging the use of telemedicine services, ensuring its members are aware of telemedicine benefits Community’s nurse advice line, and waiving copay and member cost-share for telemedicine services of any modality for any reason for 90 days, including for Marketplace and DSNP members (continue zero cost telemedicine services); for Marketplace, DSNP, and CHIP members (waive member copay/cost-share for telemedicine services provided by network providers); and for STAR members (access to and coverage of telemedicine services provided by network providers). Community is also increasing accessibility to maintenance medications and waiving early medication refill limits on maintenance medications.
- Humana: For its Medicare Advantage, Medicaid, and commercial employer-sponsored plans, including self-insured plans, Humana is waiving the out-of-pocket costs (copays, coinsurance and deductibles) associated with COVID-19 testing, including related visit costs in a range of clinical settings such as a physician’s office, urgent care center, or emergency department. The plan is also allowing early prescription refills so members can prepare for extended supply needs—an extra 30- or 90-day supply as appropriate. Humana is also waiving member cost share for all telehealth services delivered by participating/in-network providers, including telehealth services delivered through MDLive to Medicare Advantage members and to commercial members in Puerto Rico, as well as all telehealth services delivered through Doctor on Demand to commercial members. Humana is also facilitating telehealth visits for its members and will temporarily reimburse for telehealth visits with participating/in-network providers at the same rate as in-office visits. To qualify for reimbursement, telehealth visits must meet medical necessity criteria, as well as all applicable coverage guidelines. For health care providers or members who don’t have access to secure video systems, Humana will temporarily accept audio-only telephone visits, which can be submitted and reimbursed as telehealth visits. Both participating/in-network primary care and specialty providers can deliver care using telehealth services, provided that CMS and state-specific guidelines are followed. This includes behavioral health services. For telehealth visits with a specialist, members are encouraged to work with their primary care physician to facilitate care coordination. Humana is providing a member support line with specially trained call center employees to help support members with specific coronavirus questions and concerns, including live assistance with telehealth. Members should call the normal customer support line to be connecting with this service.
- Magellan Healthcare is taking a number of actions to respond to coronavirus. The Behavioral and Specialty Health reporting unit of Magellan Healthcare is making resources available to all individuals, especially those who might be feeling stress or anxiety during these unfamiliar times, including free access to RESTORE® (a digital cognitive behavioral therapy app) for individuals experiencing sleep difficulty and insomnia related to COVID-19. The managed care reporting unit of Magellan Healthcare, Magellan Complete Care (MCC), is working hand-in-hand with federal and state customers, providers and community organizations to implement emergency measures and provide access to care for COVID-19 and other medical, behavioral and social needs. This includes adoption of state and federal guidance around waiving of testing copays, prior authorizations, pharmacy, and telehealth requirements to address immediate needs for care for members. MCC is also reaching out to members, especially those that are most vulnerable, to help ensure they have support and continuity of care. Magellan’s pharmacy segment, Magellan Rx Management (MRx), has enacted key strategies to address the needs of specific customer segments to minimize disruption of member access to needed medications. In accordance with applicable federal, state, or local regulatory requirements, or upon plan sponsor approval, MRx is modifying prescription refill restrictions should members request additional medication supplies. MRx is also working closely with its prescription drug supply chain partners to monitor for any potential disruptions.
- Memorial Hermann Health Plan is waiving all co-pays and cost shares related to requested COVID-19 diagnostic screening and has created a dedicated clinical triage nurse line to help direct care. The plan is also lifting up refill-to-soon edits to chronic medications and allowing a 90-day supply temporarily.
- Molina announced it is waiving all member costs associated with testing for COVID-19. Refill timing will be relaxed to allow refills at least up to 7 days early, and Molina will allow 90-day prescription volumes when filled at CVS pharmacies. Molina has also created the Coronavirus Chatbot, an enhanced digital tool available to members looking for current insight, risk factors, live help, and appropriate action to take if symptoms are present. The tool can be found on Molina’s website, its member portal, and mobile app.
- Oscar is waiving cost-sharing for diagnostic testing for COVID-19 when recommended by a doctor and is offering $0 telemedicine services on most plans. The plan has also launched a coronavirus risk assessment survey and testing center locator, both accessible by the general public.
- Scott & White Health Plan is waiving all member out-of-pocket copays and cost-sharing for telemedicine eVisits and tests for the diagnosis of COVID-19 and is committed to providing its members with access to all their prescription medication needs. This applies to fully insured Commercial Group and Individual policies, as well as Medicare plan members. Self-insured or administrative services only (ASO) employer groups will be permitted to opt out of this additional preventive coverage at their discretion. Members of self-insured groups should contact their Human Resources Department for information.
- Superior HealthPlan is covering COVID-19 testing and screening services for STAR, STAR+PLUS, STAR Health, STAR Kids (Medicaid), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP), Allwell from Superior HealthPlan (Medicare), and Ambetter from Superior HealthPlan (Marketplace) members and is waiving all associated member cost-share amounts for COVID-19 testing and screening. Superior will not require prior authorization, prior certification, prior notification, or step therapy protocols for these services. Additionally, telehealth visits with a doctor in Superior’s network are available at no cost or cost sharing for most members.
- UnitedHealthcare has waived all member cost-sharing, including copays, coinsurance, and deductibles, for COVID-19 diagnostic testing provided at approved locations in accordance with CDC guidelines for all commercial insured, Medicaid, and Medicare members. The plan is also waiving copays, coinsurance, and deductibles for visits associated with COVID-19 testing at physicians’ offices, urgent care centers, and emergency departments for those members. UnitedHealthcare is also expanding Telehealth access for their members by allowing them to access their existing telehealth benefit offered through one of UnitedHealthcare’s designated partners for free and by waiving member cost-sharing for COVID-19 testing-related Telehealth visits for all eligible in-network medical providers connecting with members through synchronous virtual care (live video-conferencing). UnitedHealthcare is rapidly expanding access to its personalized digital care platform for those who need it most, including highest-risk members. This interactive platform helps members receive up-to-date information, schedule an in person or a telehealth visit with their provider, talk to a nurse, refill or schedule home delivery for prescriptions, and access emotional support 24 hours a day. The plan is also adding a symptom checker that can guide members to the appropriate services and deploying a new home-based care management platform for high-risk members. UnitedHealthcare has established a navigation support program—which provides members with a dedicated customer service professional to help coordinate access to medications, supplies, food, and appropriate care—for members under home isolation due to COVID-19 diagnosis or exposure. Members can access the program by calling the customer care number located on the back of their ID card and indicating that their provider has prescribed self-isolation. Eligible UnitedHealthcare and OptumRx members needing help obtaining an early prescription refill can call the customer care number located on the back of their medical ID card for assistance or contact OptumRx customer service (800) 788-4863. Optum’s Emotional-Support Help Line is available to support anyone who may be experiencing anxiety or stress following the recent developments around COVID-19. The free service can be reached at (866) 342-6892, 24 hours a day, seven days a week and is open to all.
We will continue working closely with health care providers, government agencies, community leaders, and our other partners to ensure all stakeholders are operating effectively to keep Texans as safe and healthy as possible.
For more information, please click here to see TAHP’s statement, which includes a link to our legislative testimony on coronavirus preparedness.
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