Phase 2 Highlights: Reopening Plan for Massachusetts
Residents can now begin to receive routine in-office medical care, according to guidance from the Massachusetts Executive Office of Health and Human Services (EOHHS). On June 8, EOHHS announced that health care providers may resume in-person elective, non-urgent procedures and services, this includes routine office visits. However, providers must remain in compliance with current public health and safety standards. While EOHHS recommends that patients no longer defer necessary care, the emphasis remains on telehealth as the preferred means of providing that care. For the full Phase 2 Reopening Plan, visit here. Health New England updates are below on: “Do you need to talk to a doctor” section.

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


Last Updated 6/15/2020


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. Our self-funded employer groups have also opted in to cover COVID-19 testing.
  • Waiving out-of-pocket costs for medically necessary emergency department, inpatient and in-network outpatient services, including professional, diagnostic and laboratory services, related to COVID-19. In addition, copays will be waived for out-of-network outpatient COVID-19 treatment. We are working with our self-funded employer groups to implement the same measures or those of their choosing.
  • 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.
  • Health New England members can access telehealth services from all in-network providers that are offering these services. Health New England members who have access to telehealth services through Teladoc, Health New England’s telehealth platform, can also use that service. Health New England is waiving all member cost-sharing for COVID-19 and non-COVID-19 related medically necessary telehealth services.* The waiver of member cost sharing has been extended until the end of 2020 for most plan members.** Our 24/7 Nurse Advice Line is also available for free at (866) 389-7613. To lessen the spread of the virus and limit potential exposure in physician offices, we encourage you to use telehealth services.
  • 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. (Applies to members who have prescription coverage through Health New England.)

*Some self-funded employer groups do not participate in Health New England’s Teladoc benefit, and/or have decided to not waive member cost sharing for telehealth services. Please check your plan materials for additional information.

**Health New England’s Medicare Advantage Members may be limited to cost share waivers only throughout the declared state of emergency based on guidance from CMS.


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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