COVERAGE AND COST SHARING FOR TESTING AND TREATMENT OF CORONAVIRUS (COVID-19)


Last Updated 3/26/2020


Coronavirus (COVID-19) information is rapidly changing. Health New England is monitoring the situation closely and we are working hard to make sure we are prepared to continue supporting all of our members in the most effective way with no disruption of service.

As such, we are making policy changes that focus on the health and safety of our community, our members and our staff in light of the coronavirus. Below is what we are doing, which is consistent with policies at other institutions across the state and country.


Cost Sharing and Access for Members

Per recent mandates from the Massachusetts Division of Insurance, Health New England will be:

  • Covering the cost of diagnostic tests for COVID-19 for our fully insured and Connector members (including high deductible health plan members), and Medicare members. These members will pay no copay, co-insurance or deductible for these tests. We will be working with our self-funded employer groups to implement the same measures or those of their choosing.
  • Waiving copays for medically necessary COVID-19 treatment at doctors’ offices, emergency rooms and urgent care centers, consistent with the guidance issued by the Massachusetts Division of Insurance.
  • Covering the cost of vaccination when a COVID-19 vaccine is available.
  • Removing any administrative barriers, such as prior authorizations, for members receiving medically appropriate care for COVID-19.
  • Consistent with Health New England’s policies, referrals will remain unnecessary.
  • Waiving and reimbursing copays for COVID-19 services for members with access to Teladoc®, our telehealth platform, and telehealth services with local providers as they become available. Our 24/7 Nurse Advice Line at (866) 389-7613 remains available for free to all members.
  • Health New England is expanding access to telehealth services for all conditions. Members should use telemedicine as their first line of defense in order to limit potential exposure in physician offices. Cost sharing for telehealth services not related to COVD-19 will incur normal cost sharing responsibility. 
  • Ensuring access to prescription medications by allowing early refills consistent with guidance from federal, state and local governments. In addition, Health New England has a 90-day maintenance medication benefit available to members for both retail and mail-order. We will have formulary flexibility if there are shortages or access issues, or if new treatment options become available.


At Health New England, we are prepared to continue to operate amid the coronavirus outbreak. We have measures in place and technologies available to allow our associates to work from home, if necessary, so we can effectively provide you with the service you expect from Health New England.

 

Should you have questions or concerns about the coronavirus, testing or treatment coverage, please contact Member Services at (800) 310-2835.


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