HealthChoice extended many of its temporary benefits put in place as a response to the pandemic. This information is effective March 6, 2020, through dates of service as indicated below:
Telehealth
- Through July 31, 2022, HealthChoice is continuing to waive cost share for all network and non-network office visits that result in COVID-19 diagnostic testing (at a provider’s office, via telehealth, urgent care or emergency department). Non-network services are subject to balance billing charges.
- Through Dec. 31, 2021, HealthChoice HDHP members can access telemedicine services through SwiftMD at no cost. HealthChoice members and covered dependents are eligible for free consults with SwiftMD doctors by phone and videoconference. Federal regulations usually require that participants meet their annual deductible before a health plan can waive costs for any medical services other than preventive. However, during the COVID-19 pandemic, there will be no HDHP fee applied for SwiftMD services, regardless of whether or not the visit is related to COVID-19.
- Through Dec. 31, 2021, HealthChoice is expanding its telehealth coverage for both network and non-network providers to include all services that can be effectively performed via telehealth.
- For virtual check-ins, which are short patient-initiated communications with a health care practitioner that do not require audio or video services, HealthChoice is waiving member cost sharing, including copays, deductible and coinsurance, through Dec. 31, 2021. Non-network services are subject to balance billing charges.
- For e-visits, which are online digital evaluation and management services through an online patient portal, HealthChoice is waiving member cost sharing, including copays, deductible and coinsurance, through Dec. 31, 2021. Non-network services are subject to balance billing charges.
COVID-19 vaccinations
For HealthChoice High, Basic and HDHP plan members:
- For network services, FDA-approved COVID-19 vaccine(s) and administration costs will be covered at 100% of allowable amounts as a preventive service with no cost share to members.
- For non-network services, FDA-approved COVID-19 vaccine(s) and administration costs will be covered with no cost sharing, including copays, deductible and coinsurance, to members through the end of the public health emergency. Non-network services are subject to balance billing charges.
COVID-19 testing
Services related to COVID-19 Testing
- Through July 31, 2022, HealthChoice is waiving member cost share for all network and non-network office visits that result in COVID-19 diagnostic testing (at a provider’s office, via telehealth, urgent care or emergency department.) Non-network services are subject to balance billing charges.
Over-the Counter COVID-19 Diagnostic Test Kits
- As of Jan. 15, 2022, HealthChoice covers up to eight FDA authorized or approved at-home OTC COVID-19 diagnostic tests every 30 days per eligible member.
There are two ways to acquire OTC COVID-19 tests. You can go to a participating network pharmacy and use your prescription card to receive an OTC COVID-19 test with no out-of-pocket cost to you. The other option is to purchase an OTC COVID-19 test from a retailer or online and request reimbursement. You will be reimbursed up to $12 per test, excluding sales tax.
You can order four individual diagnostic at-home COVID-19 tests free of charge from the United States government. Visit www.covidtest.gov or www.usps.com/covidtest. Limit of one order per residential address.
Note: There is no OTC COVID-19 test coverage for members on HealthChoice SilverScript Medicare supplement plans. For additional information, contact HealthChoice Customer Care at 800-323-4314.
COVID-19 treatment
- For all COVID-19 related services through Dec. 31, 2021, HealthChoice waived member cost sharing, including copays, deductible and coinsurance, for covered network and non-network services. This includes diagnostic testing and services as well as treatment for any illness related to COVID-19 that results in the need for standard covered medical treatment. This includes telehealth, primary care physician visits, specialty physician visits, facility visits, labs, home health, emergency department visits and ambulance services. Non-network services are subject to balance billing charges. (Refer to telehealth provision above.)
- HealthChoice also covers full member cost sharing for FDA-approved COVID-19 vaccines and medications, along with associated office visits or facility charges, when or if they become available.
Certifications
- Effective March 6, 2020, through April 30, 2022, HealthChoice waived certain certification requirements for admissions related to COVID-19. Providers were responsible for obtaining certification when required. Admissions to the following Levels of Care for COVID-19 did not require certification:
- Acute inpatient.
- Long-term rehab.
- Acute inpatient rehab.
- Skilled nursing facilities.
