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Information on COVID-19 for HealthChoice members and providers

HealthChoice information on care and coverage for COVID-19

HealthChoice takes member health and well-being very seriously. We are closely monitoring the developing effects of the coronavirus (COVID-19) pandemic and how it relates to you and your health plan benefits. Helping our members and providing support to the medical community is our No. 1 priority.

New updates to coverage expansions

Update on COVID-19 Vaccine and Coverage:

For services from May 1 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) through July 31, 2022. Non-network services are subject to balance billing charges.
  • Certification waiver for admission to specified levels of care for COVID-19 expire April 30, 2022.

Released April 27, 2022

For services from Jan. 1 through April 30, 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) through April 30, 2022. Non-network services are subject to balance billing charges. 

Released Feb. 16, 2022

For services from Jan. 1 through April 30, 2022: 

  • Certification waiver for admission to specified levels of care for COVID-19 expired Dec. 31, 2021.  HealthChoice has elected to reinstate the certification waiver for services from Jan. 1 through April 30, 2022, for admission to specified levels of care for COVID-19.  

Released Jan. 26, 2022

For OTC COVID-19 tests starting Jan. 15 through April 30, 2022:

  • 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. Specific details are found in the FAQs below. 
  • 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. Orders will ship free starting in late January.

    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.

Released Jan. 20, 2022

Jan. 15, 2022, through the end of the Public Health Emergency

  • HealthChoice will be covering FDA approved OTC COVID-19 test kits. Continue to check this page for details.

Released Jan.14, 2022

For services from Jan. 1 through April 30, 2022:

  • Effective Jan. 1, 2022, many temporary COVID-19 benefits will return to standard plan provisions. These include member deductibles, copays, and coinsurance. HealthChoice will continue to waive member cost share for COVID-19 testing through April 30, 2022, for covered network and non-network providers. Non-network services are subject to balance billing charges.
  • COVID-19 vaccinations qualify at 100% of allowable amounts when rendered by a participating network provider and are now considered a preventive service. 

Released Dec. 20, 2021

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.

Frequently asked questions on COVID-19

Combating COVID-19 Fraud

Emotional support resources – During this stressful time, it may be hard to cope. Mental health is just as important as physical health when it comes to responding to COVID-19. Here are some additional ways to connect to help. Each of these resources is free and available to everyone.   

  • Emotional support helpline from ODMHSA – The Oklahoma Department of Mental Health & Substance Abuse has a helpline and other mental health resources. Visit coronavirus.health.ok.gov for more information and resources. The helpline is available 24/7 at 877-215-8336 or 2-1-1.
  • Emotional support helpline from Optum – This Optum helpline is staffed by professionally trained mental health experts. The helpline is available 24/7 at 866-342-6892. 
  • On-demand emotional support mobile app – This Sanvello app offers clinically validated techniques, coping tools and peer support. You can download the app from the Apple App store or Google Play store.

SwiftMD telemedicine services – Talk to a board-certified physician 24/7 for a diagnosis or medical advice on minor illnesses or injuries such as allergies, ear infections, pink eye and more. Call SwiftMD at 833-980-1442 or log in at swiftmd.com (use group passcode HCOK20 to get started).

HealthChoice Care Management Program – A team of registered nurses, pharmacists and doctors who understand your plan benefits are available to supplement your doctor’s care and assist you in your health journey. Call a care manager at 888-750-3232 or visit hccarecoordination.com to learn more.

Pharmacy Benefits Manager – for questions regarding your prescription refills or home delivery options call the CVS customer care team at 877-720-9375 or visit the HealthChoice pharmacy benefit page for more information.

Centers for Disease Control and Prevention – The COVID-19 situation continues to evolve quickly. Visit cdc.gov for the latest information from the CDC on COVID-19, including how to protect yourself and what to do if you are sick.

Note: If you believe you might have been exposed to COVID-19 or have symptoms such as fever, cough or difficulty breathing, call your PCP or health care provider right away. Your doctor is in the best position to advise you on needed care.


Previous updates to coverage expansions

HealthChoice has elected to extend benefits through Dec. 31, 2021 – including the certification waiver for admission to specified levels of care for COVID-19 and expanded telehealth coverage.

Released Oct. 19, 2021

Certification waiver for admission to specified levels of care for COVID-19 expired July 31, 2021.  HealthChoice has elected to reinstate the certification waiver for services from Aug.1 through Oct. 31, 2021 for admission to specified levels of care for COVID-19.  

Telehealth coverage for Applied Behavioral Analysis, Mental Health/Substance Use Disorder Intensive Outpatient Program and Mental Health/Substance Use Disorder Partial Hospital Program was set to expire July 31, 2021. HealthChoice has elected to reinstate this telehealth coverage from Aug. 1 through Oct. 31, 2021.

Released Aug. 13, 2021

Certification waiver for admission to specified levels of care for COVID-19 will expire July 31, 2021. Normal plan provision will apply starting Aug. 1, 2021. 

Telehealth coverage for Mental Health/Substance Use Disorder Intensive Outpatient Program and Mental Health/Substance Use Disorder Partial Hospital Program expires July 31, 2021. Normal plan provisions will apply starting Aug. 1, 2021.   

HealthChoice has elected to extend benefits for COVID-19 testing and vaccinations through Oct. 31, 2021. HealthChoice is waiving cost sharing, including copays, deductible and coinsurance, for covered network and non-network providers. Non-network services are subject to balance billing charges. 

HealthChoice has elected to extend benefits for Inpatient and Outpatient COVID-19 treatment. HealthChoice is waiving member cost sharing including copays, deductible and coinsurance, for covered network and non-network providers. Non-network services are subject to balance billing charges. 

HealthChoice has elected to extend Telehealth coverage for services that can be effectively performed via telehealth. (Excludes ABA, IOP, and PHP services.)

Released July 7, 2021

HealthChoice has elected to extend benefits though July 31, 2021 – including the certification waiver for admission to specified levels of care for COVID-19 and expanded telehealth coverage.

Released March 26, 2021

For network services, FDA-approved COVID-19 vaccine(s) and administration costs will continue to be covered 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.

Released Dec.  28, 2020

  • Through Oct. 31, 2021, HealthChoice is removing administrative barriers to facilities by waiving certain certification requirements for admissions related to COVID-19. Providers are responsible for obtaining certification when required. Refer to your HealthChoice health handbook for more information.
    • Through Oct. 31, 2021, Admissions to the following levels of care for COVID-19 will not require certification:
      • Acute inpatient.
      • Long-term acute care.
      • Acute inpatient rehab.
      • Skilled nursing facilities.
    • Effective Nov. 1, 2020, through Oct. 31, 2021, post-acute admission for covered services and related care for any other admission or diagnosis to the following levels of care will not require certification: 
      • Long-term acute care.
      • Acute inpatient rehab.
      • Skilled nursing facilities.

HealthChoice has elected to extend benefits through April 30, 2021 – including the certification waiver for admissions to specified levels of care for COVID-19 and expanded telehealth coverage.

Released Jan. 27, 2021

HealthChoice has elected to extend benefits through Jan. 31, 2021 – including the certification waiver for admissions to specified levels of care for COVID-19 and expanded telehealth coverage.

Effective Nov. 1, HealthChoice will waive certification for post-acute admissions to specified levels of care.

     Released Dec. 15, 2020