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Coronavirus COVID-19 Benefits Announcement

March 18, 2020

Yesterday, March 17, the State Group Insurance Program received approval from the state, local education and local government insurance committees to waive member cost-sharing for in-network COVID-19 testing and in-network outpatient visits associated with this test.
 
This includes testing and visits in a provider’s office, urgent care, Telehealth and emergency room when the visit leads to a COVID-19 test, as well as any services performed at the visit during which the COVID-19 test is performed. For Telehealth visits, a COVID-19 test must occur within 48 hours from when the Telehealth visit occurs for the cost of the Telehealth visit to be waived. This waiver of cost-sharing applies to members in all plans, Premier PPO, Standard PPO, Limited PPO, CDHP/HSA and Local CDHP/HSA.
 
The benefit does not include waiving member cost-sharing for subsequent treatment associated with COVID-19, which would fall under the current cost-sharing based on the plan members are enrolled in.
 
Benefits Administration (BA) is working with our medical carriers to implement this benefit as soon as possible. There are coding and systems issues that must be addressed for claims to automatically process as intended. While every effort will be made to pay claims accurately, the complexity and short timeframe in which to make the needed changes may lead to some members receiving a bill or an Explanation of Benefits (EOB) showing member cost for a service where cost-sharing should be waived. BA and the medical carriers will work with any member who feels their claims have processed incorrectly to correct the issue as appropriate. 

If members pay upfront, once they receive their EOB and it shows no member cost share, members will then have to ask for a refund from their provider.

If members feel their claim has been processed incorrectly, once they receive their EOBs showing they owe more than expected, the members should call BlueCross BlueShield or Cigna member services at the phone number listed on the back of their insurance ID cards.
 
What this means for our members?

  • Cost-sharing (copays, coinsurance and meeting a deductible) will not apply to in-network COVID-19 testing and in-network outpatient visits leading to COVID-19 testing for ALL members in any plan (Premier, Standard, Limited, CDHP) with either carrier (BCBST, Cigna).
  • Benefit will take effect immediately and could also include claims prior to 3/17/20 which meet these requirements.
  • Regular cost-sharing will apply for any treatment associated with COVID-19 under the current cost-sharing based on the plan members are enrolled in.
  • If you use Telehealth you will be charged at the time of service. If you have a COVID-19 test within 48 hours you will receive a refund after all claims are processed. Refunds may take a few weeks after you receive your EOB. Call BCBST or Cigna if you have questions.
  • Because we are implementing this change quickly, we are still working with our medical carriers on coding and system changes for COVID-19 coverage. Some members may still receive a bill or Explanation of Benefits (EOB) showing a member cost when it should be waived. BA and our medical carriers will work with members to correct this if it occurs.

If a member believes they have a claim issue, here is what they can do:

  • If members paid upfront, once they receive their EOB, they can contact the provider or hospital and ask for a refund.
  • If members believe their claims were processed incorrectly, once they receive their EOB, members should call their carrier, BlueCross BlueShield or Cigna member services for a correction.  

Members who have questions should call BCBS and Cigna member services:

Pharmacy Benefits
Make the most of your CVS/Caremark Pharmacy Benefit. You can prepare ahead and avoid crowds by setting up mail order prescription fills, refilling prescriptions before you run out, and filling your 30-day or 90-day supplies on most of your prescriptions (excluding controlled substances, like opioids, and specialty medications).  
 
If you have concerns about picking up your prescription in person you may want to call your pharmacy and ask about shipping and delivery options. Some pharmacies are offering to mail or deliver prescriptions at no additional cost.
 
Here is some additional information about your CVS/Caremark pharmacy benefit. You may take advantage of:
 
Relaxed refill restrictions. We are temporarily waiving early refill limits on 30-day and 90-day prescriptions for maintenance medications (such as high blood pressure, high cholesterol, coronary artery disease, congestive heart failure, depression, and asthma/chronic obstructive pulmonary disease (COPD) at any in-network pharmacy. You can now fill maintenance medication prescriptions ahead of schedule. 
 
If you have any trouble, tell your pharmacy staff to check for messaging in their system from CVS/Caremark and that your plan sponsor is temporarily allowing early refill overrides. If they have trouble with the override, they should contact the CVS/Caremark pharmacy help desk (your pharmacy has the phone number).
 
For more help with your CVS/Caremark pharmacy benefits, visit info.caremark.com/stateoftn or call 877.522.TNRX (8679).

May 26, 2022