Last Updated 6/7/2021
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.
NEW: Cost Share For Non-COVID Telehealth Services Resumes
Effective July 1, 2021, Health New England will reinstate member cost share for non-COVID-19 related telehealth services, including care provided by telephone or video communications.
Because of last year’s COVID-19 shutdowns, Health New England temporarily waived cost share for non-COVID telehealth services to maintain member access to health care and to help prevent infection and illness. As vaccines roll out and states and businesses reopen, this waiver of cost share for non-COVID related telehealth services will end on June 30, 2021. Standard cost share for non-COVID telehealth services will apply.*
Health New England is expanding the types of services that are eligible for telehealth coverage. Details are below.
Continued member cost share waivers include:
*This update applies to fully funded commercial members, and only to employer groups that participated in the telehealth cost share waiver during the COVID State of Emergency. Please check your plan materials for additional information. Health New England’s Medicare Advantage members may be limited to cost share waivers only during the declared state of emergency based on guidance from CMS.
- COVID-19 related telehealth services
- In-person COVID-19 related services when performed in an outpatient setting
- Inpatient COVID-19 services for both fully insured and self-insured employer groups that have opted in
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 ordered by a medical professional 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.
- 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. Our 24/7 Nurse Advice Line is 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. Please check your plan materials for additional information.
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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