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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 Aug. 1 through Oct. 31, 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

For services from Aug. 1 through Oct. 31, 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

For services from May 1 through July 31, 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 HealthChoice High, Basic and HDHP plan members

  • 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

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.
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.

Making sure you have access to an adequate supply of your medications is a priority. Check your current medication supply to make sure you have enough on hand. As always, we encourage you to refill your prescription on time.

  • As a part of your HealthChoice plan, you are allowed a 90-day prescription supply of your maintenance medications. Ask your physician or pharmacist for information on how to get a 90-day supply.

We understand you may not want or be able to visit a pharmacy to pick up your prescriptions. Home delivery is a good option to ensure you have the medications you need.

  • Ask your pharmacy about home delivery options.
    • Many retail pharmacies are offering home delivery service. Check with your pharmacy to find out if they offer home delivery and whether there are delivery fees.
  • Request your refills be delivered by mail.
    • You can have your 90-day supplies of maintenance medications delivered to your home, or any address you choose, once prescribed by your physician.

Frequently asked questions on COVID-19

Combatting 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 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

HealthChoice has elected to extend benefits through Dec. 31, 2020 – including the certification waiver for admissions to specified levels of care for COVID-19 and expanded telehealth coverage.

Effective Oct. 1, 2020, through Dec. 31, 2020, HealthChoice will again waive member cost sharing for all network telehealth services including copays, deductible and coinsurance regardless of whether or not related to COVID-19 (any diagnosis code billed).

Released Oct. 8, 2020

  • HealthChoice will continue to waive certification for admissions to specified levels of care for COVID-19.
  • HealthChoice will continue to offer expanded telehealth coverage to include all services that can be effectively performed via telehealth.
    • Please note that effective July 1, 2020 – standard plan provisions are applied to all telehealth services, including copays, deductibles and coinsurance unless related to diagnostic testing or treatment of COVID-19.

Released Sept. 23, 2020

  • HealthChoice HDHP members can continue to access telemedicine services through SwiftMD at no cost – extended until Dec. 31, 2020.
  • HealthChoice will continue to waive member cost sharing for COVID-19 testing and treatment.
  • HealthChoice will continue to waive certification for admissions to specified levels of care for COVID-19.
  • HealthChoice will continue to offer expanded telehealth coverage to include all services that can be effectively performed via telehealth. 
    • Effective July 1, 2020 – standard plan provisions apply to telehealth services including copays, deductible and coinsurance unless related to diagnostic testing or treatment of COVID-19.

Released June 17, 2020

  • HealthChoice is now waiving member cost sharing for FDA-authorized antibody testing while the Emergency Use Authorizations are in effect.

Released May 12, 2020 

  • HealthChoice is now waiving member cost-sharing for all covered network telehealth services. Members can now access $0 virtual care even when not related to COVID-19 through:
    • SwiftMD telemedicine services for minor illnesses or injuries.
    • Network providers who deliver virtual care, such as virtual check-ins, e-visits and other covered services that can be performed effectively using telecommunication technology.

Released April 15, 2020

  • HealthChoice is now covering problem-focused virtual dental visits under the HealthChoice Dental Plan, if offered by your dentist. This includes 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. For virtual dental visits, HealthChoice will waive member cost sharing, including deductible and coinsurance. Non-network services are subject to balance billing.
  • HealthChoice has updated coverage for testing administered by clinical diagnostic laboratories. 

Released April 8, 2020

  • For all COVID-19-related services, HealthChoice will waive 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.
  • HealthChoice has expanded telehealth coverage for both network and non-network providers to include all services that can be effectively performed via telehealth. Telehealth services that include real-time interactive audio and visual virtual care are now covered 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. Standard plan provisions, including copays, deductible and coinsurance, apply unless related to diagnostic testing or treatment of COVID-19.
  • HealthChoice is removing administrative barriers to facilities by waiving certain certification requirements for admissions related to COVID-19.

Released March 30, 2020

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