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 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 Oct. 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 Oct. 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 Oct. 31, 2021. Non-network services are subject to balance billing charges.
- For other covered telehealth services that include real-time interactive audio and/or visual virtual care, HealthChoice will consider these telehealth visits to be the same as an in-person visit. Covered services include both urgent and routine medical care, outpatient behavioral care, and physical, occupational and speech therapies (not an all-inclusive list).
- For network services, HealthChoice is waiving member cost sharing, including copays, deductible and coinsurance, through June 30, 2020. Effective July 1 through Sept. 30, 2020, standard plan provisions including copays, deductible and coinsurance apply unless related to diagnostic testing or treatment of COVID-19. Effective Oct. 1, 2020, through Oct. 31, 2021, HealthChoice will again waive member cost sharing for all network telehealth services, including copays, deductible and coinsurance, regardless of whether or not related COVID-19.
- For non-network services, standard plan provisions including deductible and coinsurance apply unless related to diagnostic testing or treatment of COVID-19. Non-network services are subject to balance billing charges.
COVID-19 treatment
- For all COVID-19 related services through Oct. 31, 2021, HealthChoice is waiving 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 will also cover 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.
- 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.
- Through Oct. 31, 2021, Admissions to the following levels of care for COVID-19 will not require certification:
HealthChoice dental coverage
- HealthChoice dental coverage:
- Through June 30, 2020, for virtual dental visits, which include a real-time interactive audio and visual virtual care consultation to triage patients or offer an evaluation to determine if the situation is urgent or emergent, HealthChoice waived member cost sharing, including deductible and coinsurance. Non-network services are subject to balance billing.
