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Guide to COVID-19 Coverage

HPI is monitoring the coronavirus (COVID-19) outbreak and what it means for our members, clients, business partners and communities.

The Centers for Disease Control and Prevention (CDC) website is the best source for up-to-date information. The outbreak is evolving quickly, and the CDC and health departments in each state are working on public health policies to help prevent the spread of the illness.

Stay safe. If you need to see a doctor, call first. Many providers that you have always seen in person are now offering appointments over the phone. If your doctor or urgent care facility doesn’t offer phone or video visits, you have access to telemedicine through other providers.

Try the CDC’s symptom checker to help you make decisions about seeking appropriate care.

Starting January 15, 2022, health benefit plans must cover FDA-approved at-home over-the-counter COVID-19 tests without any cost-sharing or prior authorization requirements. Coverage is provided for up to eight (8) tests per eligible member, per 30-day period. To meet this federal requirement, most Plans’ pharmacy benefit managers (PBM) will provide direct coverage of the test. Members can present their pharmacy identification card to any network pharmacy and receive the test with no upfront out-of-pocket cost. Please note that this does not ensure a network pharmacy has tests available or that the pharmacy has implemented operations to support claims submission. As such, if you purchase an at-home test at an out of network pharmacy or online, you can submit to the PBM for reimbursement, which will be limited to the lesser of the cost of the test or $12. Please do not submit to HPI for reimbursement since coverage is only reimbursable under the PBM benefit.

To find out how to get coverage for your FDA-approved at-home over-the-counter COVID-19 test kit, please contact the PBM listed on your membership identification card. Below is a list of some common PBMs and how to obtain more information for at-home test kit coverage.

In addition, starting January 19, 2022, U.S. households can order four (4) free COVID-19 test kits from www.covidtests.gov. To learn more about this federal program, please visit: www.whitehouse.gov/briefing-room/statements-releases/2022/01/14/fact-sheet-the-biden-administration-to-begin-distributing-at-home-rapid-covid-19-tests-to-americans-for-free

HPI has implemented the following coverage for medically necessary COVID-19-related services at in-network doctor’s offices, urgent care centers, telemedicine providers or emergency rooms:

  • Testing*: covered in full, no member cost-sharing
  • Treatment: covered in accordance with member's plan and applicable member cost-sharing
  • Telehealth services: covered in full, no member cost-sharing
  • Prior authorizations: not required for COVID-19 testing
  • Vaccine**: covered in full, no member cost-sharing

*Cost-sharing for testing received from out-of-network providers also will be waived should the urgent services be unavailable from in-network providers.

**A vaccine will be covered after it has received an A or B recommendation from the United States Preventive Services Task Force (USPSTF) or a recommendation from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention.

HPI will continue to review coverage and cost-sharing policies to ensure that members can receive the appropriate COVID-19 testing and treatment without difficulties.

 

HPI Case Management is here to help

Assistance is available to eligible members who are having difficulty managing their current medical needs during this pandemic. Case Managers can help to obtain currently approved medications, medical equipment or accessing and coordinating needed medical care. Please contact your case manager directly or send an email to casemanagement@healthplansinc.com. Please include your name, contact information and best day/time, and our case manager will attempt to contact you.

If you have health concerns, check in with your health care provider to see if they offer virtual visits from home (via smartphone, tablet or computer). If your provider doesn't offer virtual visits, providers such as Doctor On Demand are covered under all plans. Members can also receive outpatient behavioral health care through virtual visits.

PDF icon Download instructions for registering for Doctor On Demand

Telehealth visits may help limit the spread of the disease and provide crucial behavioral health care to those in need. It may also be an option for individuals in self-imposed quarantine to check in with a health care provider.

HPI is taking steps to ensure all plans provide coverage for telehealth services as follows:

  • All plans, including Qualified High Deductible Health Plans (QHDHPs), will cover COVID-19-related testing, treatment and counseling via telemedicine providers with no member cost-share.
  • All plans, excluding QHDHPs, will cover all other services received via telehealth providers with no member cost-share*.
  • All QHDHPs will continue to cover non-COVID-19 related telehealth services with applicable member cost-sharing, as the IRS has not changed the regulations governing these plans to date.

*This may vary by client. Please refer to the client’s Plan Document to confirm how these services are covered.

United Behavioral Health/Optum offers a Public Crisis Line for those needing emotional support. Open 24/7, this help line is free of charge and available to anyone.
Call (866) 342-6892

SAMHSA’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters, and infectious disease outbreaks.
Call (800) 985-5990

PDF icon March 28, 2022 | Compliance eBlast - Temporary Waiver to Deductible for Telehealth Service for HSA-QHDHP

PDF icon January 21, 2022 | Compliance Alert - Over The Counter COVID Tests

PDF icon January 14, 2022 | Compliance eBlast - Over The Counter COVID Tests

PDF icon June 24, 2021 | Compliance eBlast - COVID-19 Waiver of Cost Share Update

PDF icon April 29, 2021 | Compliance FAQ - COBRA Subsidy 2021 FAQ

PDF icon April 21, 2021 |  Compliance eBlast - Personal Protective Equipment (PPE) to protect against COVID-19

PDF icon March 26, 2021 | Compliance Bulletin - 2021 American Rescue Plan Act COBRA Subsidy Deadlines for COBRA Actions under the CARES Act (updated March 31, 2021)

PDF icon January 14, 2021 | Compliance Alert - New Options for Medical Care Reimbursement and Dependent Care Reimbursement Accounts

PDF icon December 17, 2020 | Updated Frequently Asked Questions for HPI Brokers and Clients

PDF icon May 28, 2020 | Compliance Bulletin: Optional Plan Changes Permitted under Newly Issued IRS Guidance

PDF icon May 28, 2020 | Optional Plan Changes Checklist

May 28, 2020 | Sample Attestation Required for Dropping Medical Coverage

PDF icon May 11, 2020 | Compliance Alert - Pandemic-Related Deadline Extensions

PDF icon April 14, 2020 | We're here to support you | A message to our valued brokers

PDF icon April 8, 2020 | Frequently Asked Questions for HPI Brokers and Clients

PDF icon April 3, 2020 | Compliance Alert - COVID-19 Update

PDF icon March 26, 2020 | Revised Compliance Alert - The Families First Coronavirus Response Act (this replaces the Alert distributed on March 24, 2020)

PDF icon March 17, 2020 | Mandated Telehealth Coverage

PDF icon March 11, 2020 | Important Information About Coronavirus

The federal rule issued on May 4, 2020, entitled Extension of Certain Timeframes for Employee Benefit Plans, Participants and Beneficiaries Affected by the COVID-19 Outbreak, provides participants in certain employee benefit plans* additional time to:

  • Elect COBRA coverage
  • Make COBRA premium payments
  • Notify the Plan of second qualifying events under COBRA
  • File medical, dental, vision, Medical Care Reimbursement Account (MCRA )(aka health FSA), and disability claims for covered benefits/eligible expenses
  • Appeal denials of medical, dental, MCRA and disability claims
  • Make a Special Enrollment Request under HIPAA rules for medical or dental coverage

The deadlines for taking any of the actions described above that would ordinarily have been due on or after March 1, 2020, are extended to the earlier of the following dates:

  • One year from original due date shown in your Explanation of Benefits, COBRA Election Notice or response to your request for an appeal, or
  • At least 60 days after the end of the pandemic National Emergency, (the pandemic National Emergency was declared by the President to begin on March 1, 2020, and will continue until the current President ends it).

 

This message will be updated when the pandemic National Emergency has ended.

 

What’s not affected

The new rule does not apply to the deadlines related to:

  • Active employees initially enrolling in a plan
  • Change in status events, except a change in status that also qualifies under the HIPAA Special Enrollment rules (see your Plan Document for information about HIPAA Special Enrollment)

*Plans sponsored by government entities or churches are not required to extend these deadlines. If you are covered by a government or church-sponsored plan, please call the member service number on your Plan Identification Card to find out if the deadline extension applies to your plan.

*Medical, dental, vision and Medical Care Reimbursement Account plans only

Benefits and coverage questions:
Contact the phone number listed on the back of your Member ID Card, or call:

800-532-7575
Monday through Friday, 8am to 5pm (ET)

 

COVID-19 -specific questions:
877-213-5225
Monday through Friday, 8am to 5pm (ET)

If you are not feeling well, please contact your primary care provider to discuss active symptoms.

© 2022 Health Plans, Inc.

Health Plans, Inc. is a Harvard Pilgrim company

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