Read More

Carriers Relax Requirements & Open COVID-19 Special Enrollment Periods

On March 21, 2020, The Wall Street Journal reported that, in response to the coronavirus, the Trump administration is considering opening a special enrollment period on healthcare.gov, and now some carrier are following suit.

As COVID-19 continues to test our economy, many employers are being forced to make the difficult decision to lay off employees and institute furloughs or other temporary leaves of absence that cause employees to lose access to their employer-sponsored health coverage.

While the federal government continues to weigh its options regarding an Exchange special enrollment period, a number of states who operate their own Exchanges, including Colorado, Connecticut, Maryland, Massachusetts, Nevada, New York, Rhode Island, and Washington, have already announced COVID-19 related special enrollment periods. Importantly, these special enrollment periods only apply to state and federally sponsored Exchanges.

Employer-sponsored plans are subject to carrier approval and regulated by Section 125 rules that determine when employees can make mid-year election changes. While some carriers have announced special enrollment periods in response to COVID-19, the Section 125 rules have not yet been revised to allow for cafeteria plan election changes because of COVID-19. Accordingly, any mid-year enrollments permitted from a carrier special enrollment period would be provided on a post-tax basis outside of the employer’s cafeteria plan.

Additionally, before implementing these relief efforts, employers should consider whether:

Here are some of the carrier relief plans that have been announced to date. For the most up-to-date information on carrier relief, visit the carrier’s COVID-19 website.

Aetna

  • $0 copays for COVID-19 related diagnostic testing and doctor visits.
  • Free home delivery on CVS Pharmacy prescriptions.
  • Waived all cost-sharing for any covered telemedicine visit (regardless of diagnosis) until June 4, 2020.
  • Waived early prescription refill limits on 30-day prescription maintenance medications.

Anthem

  • Individuals with Anthem pharmacy benefits may refill a 30-day supply of most maintenance medications early.
  • COVID-19 testing is covered with no out-of-pocket costs and requires no preauthorization.
  • Effective March 19, 2020, for 90 days, cost sharing is waived for in-network telephonic visits and telehealth services through Anthem’s authorized telemedicine service, LiveHealth Online.

Blue Shield of California

  • Waived copays, deductibles, or coinsurance for testing to diagnose COVID-19 and related visits.
  • Lifted restrictions on early prescription refills.

BlueCross BlueShield (Various States)

  • Waived copays, deductibles, or coinsurance for testing to diagnose COVID-19 and related visits.
  • Lifted restrictions on early prescription refills.

CareFirst

  • Waived copays, coinsurance, and deductible during the public health emergency for COVID-19 testing and treatment.

Cigna

  • Out-of-pocket costs for COVID-19 testing will be waived through May 31, 2020.

Highmark

  • When recommended by a medical professional, Highmark will cover 100% of the cost of COVID-19 testing on most Medicare Advantage, ACA, and select employer plans.

Humana

  • No testing out-of-pocket costs for patients who meet CDC guidelines at approved COVID-19 laboratory locations.
  • Waived out-of-pocket costs for urgent care telemedicine visits for the next 90 days.
  • Early prescription refills allowed for the next 30 days.

Independence Blue Cross

  • Waived cost sharing for COVID-19 testing and primary care telemedicine visits through June 4, 2020.
  • Lifted “refill too soon” prescription restrictions.

Premera

  • Extended the 30-day grace period to 60 days for insured groups, effective March 17.
  • Waived cost-sharing requirement for COVID-19 testing on all plans.
  • Permitting early prescription refills during the public health emergency.

United Healthcare

  • Special enrollment period available March 23, 2020 – April 6, 2020, for individuals who are not enrolled in the Plan, or who previously elected self-only coverage and desires to add eligible dependents.
  • Individuals with OptumRx pharmacy benefits may request an early refill of medications.
  • Cost-sharing is waived for COVID-19 testing for Medicare Advantage, Medicaid, and employer-sponsored plans.

For more information on evolving carrier offerings in the wake of the COVID-19 pandemic, visit our 
OneDigital Coronavirus Advisory Hub, or reach out to your local OneDigital advisory team. 

Share

Leave a Reply

Your email address will not be published. Required fields are marked *

Related News & Updates

Illinois Cannabis Compliance Seminar

Connect With a OneDigital Team Near You

Stay In The Know

Sign up for OneDigital's email newsletters!

Top