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LACERA-ADMINISTERED HEALTHCARE PLANS

The Families First Coronavirus Response Act requires group health plans and health insurance issuers offering group or individual health insurance coverage (including grandfathered plans) to cover COVID-19 diagnostic testing and certain COVID-19 testing related items and services without cost sharing (deductibles, copayments and coinsurance), prior authorization, or other medical management requirements. A testing related visit may occur in a health care provider’s office, an urgent care center, an emergency department or through a telehealth visit.

Below is how LACERA’s group health insurance providers are fulfilling their obligation to our members, the Families First Coronavirus Response Act, and adapting to the ongoing situation.

Anthem

Anthem will cover the cost of coronavirus testing with no out-of-pocket cost for COVID-19 treatment and they are recommending the use of telehealth whenever possible to help prevent the spread of the virus. In addition, they are also encouraging its members to talk to their doctor about whether it is appropriate for them to change from a 30-day supply of their regular medications to a 90-day supply.

Anthem is suspending prior authorization requirements for patients as well as for the use of medical equipment critical to COVID-19 treatment. The expansion covers the waiver of cost sharing for COVID-19 treatment received through May 31, 2020.

Anthem is increasing physician availability through its telemedicine service, including encouraging in-network doctors to join the platform, given the surge in demand. This is a safe and helpful way to use Anthem benefits to see a doctor and receive health guidance related to COVID-19, without leaving one’s home or work.

Cigna

Cigna has announced it will waive customers’ out-of-pocket costs for COVID-19 testing-related visits with in-network providers, whether at a doctor’s office, urgent care clinic, emergency room, or via telehealth through May 31, 2020. This includes customers in the United States who are covered under Cigna employer/union sponsored group insurance plans, Medicare Advantage, Medicaid, and the Individual and Family plans.

Cigna is making it easier for customers with immunosuppression, chronic conditions, or who are experiencing transportation challenges to be treated virtually by in-network physicians with those capabilities, through May 31, 2020. Cigna’s Express Scripts Pharmacy offers free home delivery of up to 90-day supplies of prescription maintenance medications.

Cigna is waiving prior authorizations for the transfer of its non-COVID-19 customers from acute inpatient hospitals to in-network long term acute care hospitals to help manage the demands of increasingly high volumes of COVID-19 patients.

Cigna and Express Scripts are working to provide an early intervention screening tool to help customers and members understand their personal risks for COVID-19. The digital tool immediately triages symptoms and recommends next steps for care, while also relieving demand on an over-burdened health care system.

Kaiser Permanente

Kaiser Permanente is not requiring members to pay any costs related to COVID-19 screening or testing when referred by a Kaiser Permanente doctor. They will waive all member out-of-pocket costs for inpatient and outpatient services related to the treatment of COVID-19. This waiver will apply for all dates of service from April 1 through May 31, 2020, unless superseded by government action or extended by Kaiser Permanente.

Kaiser Permanente and Dignity Health will partner with California and Los Angeles County to open the Los Angeles Surge Hospital, a temporary facility in Los Angeles that will expand access to additional beds and expand ICU capacity for patients who contract COVID-19. The facility will be located on the campus of the former St. Vincent Medical Center in central Los Angeles.

SCAN

SCAN has implemented a series of temporary changes to ensure members are able to get needed care should their assigned provider not be available. These include:

  • Accessing medically necessary services from any available Medicare-certified provider or facility without obtaining prior authorization
  • Paying the same amount for care from out-of-network Medicare-certified providers and facilities as they do for in-network care
  • Getting medications when needed: using out-of-network pharmacies if they don’t have reasonable access to a network pharmacy and getting refills early
  • Telehealth – MDLIVE (ongoing)

If a member gets tested and is found to be positive, they should follow their physician’s recommendations. In some instances, based on the member’s risk and clinical condition, this would involve getting hospitalized, in other cases it may include symptomatic care and follow up.

SCAN is adapting many of their community services from in-person to telephonic, including clinical programs for seniors and caregivers and many volunteer efforts.

They have launched an employee "all hands" effort, which entails proactively calling members to make sure they have what they need to stay healthy at home, focusing first on those who are:

  • High-risk, such as those on oxygen or who are homebound
  • Socially isolated, because they live alone or don’t have a support system

SCAN Health Plan is committing to addressing a variety of needs for vulnerable seniors and others at risk due to the effects of the COVID-19 pandemic.

The emergency funding will address:

  • Delivery of additional services to seniors in need of nutritious meals and other essential supplies;
  • Additional financial support to non-profit, senior-focused organizations and provider groups
  • Assistance for SCAN employees most impacted by current circumstances.

UHC

UnitedHealthcare is waiving member cost sharing for the treatment of COVID-19 through May 31, 2020 for its fully insured commercial (pre-65), Medicare Advantage, and Medicaid plans. In addition, starting March 31, 2020 until June 18, 2020, UnitedHealth will also waive cost sharing for in-network, non-COVID-19 telehealth visits for its Medicare Advantage, Medicaid, and fully insured individual and group market health plans. These waivers are whether the care is received in a physician’s office, an urgent care center, or an emergency department.

UnitedHealthcare is also suspending prior authorization requirements in a post-acute care setting through May 31 and suspending them when a member transfers to a new provider through May 31.

4/29/20

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