As the coronavirus continues to disrupt our daily lives, the federal government, the state of Texas, and various insurance carriers are issuing important guidance. We’ve forwarded some of this information to our clients, but we also wanted to make this information available in a central location. Below are several pieces of guidance that you should review. As we receive additional information, we’ll post it on this page. Note that we’ll only post insurance-related information that we believe is important for JME Insurance Agency clients. For other guidance about COVID-19, please visit www.coronavirus.gov, which is maintained by the Centers for Disease Control. Thank you.
Click on the blue headings to access the guidance. The text be below the heading links is only a short summary.
Blue Cross and Blue Shield of Texas (BCBSTX) has set up a resource page to house all of their COVID-19 member guidance. There are links to some of that guidance below.”
On March 18, Blue Cross and Blue Shield of Texas (BCBSTX) “announced that it will temporarily lift cost-sharing for medically necessary medical and behavioral health services delivered via telemedicine. This applies to all fully insured members who receive covered telemedicine services.”
This flier provdes information for BCBSTX members about MD Live, which provides 24/7 access to an independently contracted, board-certified doctor via online video, mobile app or telephone and, if necessary, have an e-prescription sent to your local pharmacy.
This March 11 communication from Blue Cross Blue Shield of Texas expands on the below communication from March 7 and reminds members that “Effective immediately for all fully insured members, for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance: No prior authorization needed, No member copays or deductibles.” This includes HSA qualified high-deductible health plans. Additionally, “With regard to treatment for COVID-19, our plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of the member’s benefit plan. Members should always call the number on their ID card for answers to their specific benefit questions.”
This March 7 communication from Blue Cross Blue Shield of Texas says: “Effective immediately, we won’t require prior authorization and won’t apply member co-pays or deductibles for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control guidance.” For COVID-19 treatment, “Blue Cross and Blue Shield of Texas plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of your benefits.” Read the entire notice for additional information.
Baylor Scott & White Health Plan (BSW) has set up a resource page to house all of their COVID-19 member guidance. Here’s one important update from this page: Right now, Scott and White Health Plan is waiving all member out-of-pocket copays and cost-sharing for telemedicine eVisits and tests for the diagnosis of COVID-19. We also continue to be committed to providing our members with access to all their prescription medication needs. This applies to fully insured Commercial Group and Individual policies, as well as Medicare plan members.”
From Texas State Representative Morgan Meyer: “To help those impacted the most, we are setting up our COVID-19 Relief site to help connect those in need with resources. Working in partnership with the United Way of Dallas, our intention is to connect those in need with the proper organization that will serve their specific needs as related to basic needs (food, necessities), job opportunities, information on unemployment or other government services, etc.”
As COVID-19 continues to spread, our office has received questions from both employer and individual clients about eligibility for health insurance coverage. Some employers have asked about adding part-time employees or employees who did not previously sign up for coverage to the group health insurance plan. Some individuals who do not have health insurance through their employer or their spouse’s employer have asked if they can purchase an individual policy.
Medicare has setup a website with informtion and resources about COVID-19. Click the blue heading link above to visit the site. Important excerpts about coverage and about telehealth are reprinted below.
Medicare covers related needs
- Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs.
- Medicare covers all medically necessary hospitalizations. This includes if you’re diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.
- At this time, there’s no vaccine for COVID-19. However, if one becomes available, it will be covered by all Medicare Prescription Drug Plans (Part D).
- If you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits beyond the ones described below. Check with your plan about your coverage and costs.
- Scammers may use the coronavirus national emergency to take advantage of people while they’re distracted. As always, guard your Medicare card like a credit card, check Medicare claims summary forms for errors, and if someone calls asking for your Medicare Number, hang up!
Telehealth & related services
Medicare has temporarily expanded its coverage of telehealth services to respond to the current Public Health Emergency. These services expand the current telehealth covered services, to help you have access from more places (including your home), with a wider range of communication tools (including smartphones), to interact with a range of providers (such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social worker). During this time, you will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. This will help ensure you are able to visit with your doctor from your home, without having to go to a doctor’s office or hospital, which puts you and others at risk of exposure to COVID-19.
- You may be able to communicate with your doctors or certain other practitioners without necessarily going to the doctor’s office in person for a full visit. Medicare pays for “virtual check-ins”—brief, virtual services with your established physician or certain practitioners where the communication isn’t related to a medical visit within the previous 7 days and doesn’t lead to a medical visit within the next 24 hours (or soonest appointment available).
- You need to consent verbally to using virtual check-ins and your doctor must document that consent in your medical record before you use this service. You pay your usual Medicare coinsurance and deductible for these services.
- Medicare also pays for you to communicate with your doctors using online patient portals without going to the doctor’s office. Like the virtual check-ins, you must initiate these individual communications.
- If you live in a rural area, you may use communication technology to have full visits with your doctors. The law requires that these visits take place at specified sites of service, known as telehealth originating sites, and get services using a real-time audio and video communication system at the site to communicate with a remotely located doctor or certain other types of practitioners. Medicare pays for many medical visits through this telehealth benefit.