N.J. insurers announce coverage related to coronavirus

See below for information regarding Horizon BCBSNJ, United Healthcare and AmeriHealth NJ

By ROI-NJ Staff
New Jersey | Mar 8, 2020 at 5:00 pm

The biggest insurance companies in New Jersey announced guidelines on how they will deal with the impact of coronavirus and the growing COVID-19 outbreak.

We present them to you as they have presented them:

Horizon Blue Cross Blue Shield

Statement from Kevin Conlin, chair and CEO: “The health and well-being of our members is our top priority. These steps will help them access the care they need with coverage that reflects the unique situation created by COVID-19. We’re working closely with our customers, the state’s public health leadership, and our provider partners across New Jersey to prepare and these first steps reflect our readiness to adapt to the situation as it evolves.

“In addition to the changes we are making for our insured members, Horizon will continue to work with our self-insured customers on their specific plan designs our members and customers can rest assured that Horizon is responding to this emerging public health threat.”

Coverage information (effective immediately)

Waiver of prior authorization for diagnosis of COVID-19

  • Waiving prior authorizations for a visit to a primary care physician, urgent care center or emergency room for evaluation of upper respiratory symptoms, fever, shortness of breath or other conditions that may represent COVID-19.
  • Waiving prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19.
  • Waiving prior authorization for lab studies or diagnostic testing required during an ER evaluation or inpatient hospital stay.

Full coverage of the cost of the COVID-19 test

  • Horizon will cover, with no cost share to the member, the appropriate medically necessary diagnostic testing for COVID-19.

Increased access to prescription medications

  • Waive early medication refill limits on 30-day prescription maintenance medications (consistent with member’s benefit plan) and/or encourage members to use 90-day mail order benefit. Horizon will also ensure formulary flexibility if there are shortages or access issues and not hold patients liable for additional charges stemming from obtaining a non-preferred medication resulting from shortages or access issues.

Access to telehealth and nurse advice hotlines

  • Horizon members will have no cost, 24/7 access to licensed nurses who can assess and assist members with symptoms that are consistent with suspected COVID-19 infection. Those service are available through the company’s free “Horizon Blue” app, the HorizonBlue.com online portal, or by phone at 1-888-624-3096.  Members may also use those services to consult with a nurse about other health concerns and potentially avoid a visit to a physician office or urgent care facility.

UnitedHealthcare

Statement from company: UnitedHealthcare has a team of experts closely monitoring COVID-19, formerly known as the Novel Coronavirus or 2019-nCoV. Our top priority is the health and wellbeing of the people we serve.

As with any public health issue, UnitedHealthcare will work with and follow all guidance and protocols issued by the U.S. Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), state and local public health departments in supporting our members’ needs.

Symptoms of COVID-19 are similar to an upper respiratory infection and may include: Fever, cough and shortness of breath. It is important to know that 80 percent of COVID-19 cases are mild or without symptoms. Like the seasonal flu, COVID-19 is more severe in patients with long term, underlying health conditions and the elderly. For the most updated information about COVID-19, visit the CDC’s Share the Facts page.

Coverage information (effective immediately)

Waiving of costs

  • United Healthcare will waive member cost sharing, including copays, coinsurance and deductibles for COVID-19 diagnostic testing provided at approved locations in accordance with CDS guidelines for all commercial insured, Medicaid and Medicare members.
  • United Healthcare will also work to support self-insured customers who choose to implement similar actions.

AmeriHealth New Jersey

Statement from the company: AmeriHealth New Jersey is committed to ensuring that our members have access to the care they need, at the right time, and in the right setting. As coronavirus (COVID-19) has escalated into a serious global health threat, we are working to make sure that our members can receive appropriate testing and treatment for this virus if needed.

Coverage information (effective immediately)

Waiving of costs

  • AmeriHealth New Jersey will cover and waive cost-sharing (such as co-pays and coinsurance) for the COVID-19 test when performed at a hospital or an approved laboratory. This includes members enrolled in our fully insured plans, employer-sponsored plans and the individual and family plans available through the Affordable Care Act. Self-funded plans will be able to opt-out of this program.
  • Given that the test is new and specific billing codes for commercially available tests were only recently designated, members should report any concerns about claim payment to our customer service staff at the number on their member card. At this time, the Centers for Disease Control and Prevention (CDC) and state labs currently performing the testing are not billing for COVID-19 testing, so members should not incur costs when tested by these labs.

Treatment

  • If members have any questions about whether they should be tested, they should contact a health care professional who will work with the state public health department in the member’s state and the CDC to determine if they need to be tested for COVID-19.
  • At this time, there is no specific antiviral treatment or vaccine for COVID-19. Members should receive care from their doctor to help relieve symptoms as they would other viral respiratory infections. AmeriHealth New Jersey continues to cover medically necessary health care costs to treat infectious diseases, including COVID-19, based on the terms of the member’s insurance plan.

Telehealth

  • To help reduce potential exposure, AmeriHealth New Jersey also encourages members to utilize telemedicine services if they are available as part of a member’s plan. To encourage use of these services, AmeriHealth New Jersey will waive member cost share where applicable for telemedicine visits for the next 90 days. To access telemedicine options, members should login to our member website at amerihealthnj.com.

More guidance

  • If members would like information about specific symptoms they are experiencing or have questions about their personal health, we recommend that they contact their doctor. For reliable information about the coronavirus disease (COVID-19), we suggest visiting the CDC website at gov/coronavirus.
  • We encourage all AmeriHealth New Jersey members to visit here regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

CVS Pharmacy

Statement from CVS Health Chief Medical Officer Troyen Brennan: “Being committed to the welfare of those we serve means being responsive to evolving needs and acting swiftly,” he said. “This is particularly true in times of uncertainty. The latest steps we’re taking will help ensure patients of all ages have every option available to them when it comes to filling prescriptions.”

Measures taken (effective immediately) 

Waiving of costs

  • CVS Pharmacy is waiving all charges for home delivery of prescription medication.

Increased access, availability

  • Aetna, a CVS Health company, will now offer 90-day maintenance medication prescriptions for insured and Medicare members and is working with state governments to make the same option available to Medicaid members where allowable. (Self-funded plan sponsors will also have the ability to offer this option);
  • Aetna will waive early refill limits on 30-day prescription maintenance medications for all members with pharmacy benefits administered through CVS Caremark;
  • Caremark is working with all clients to waive early refill limits on 30-day prescription maintenance medications.
ROI-NJ Staff | editorial@roi-nj.com | @roinjnews