COVID-19 Update

Health insurers in Virginia are responding to the COVID-19 coronavirus in a myriad of ways. Plans are eliminating barriers to care including waiving cost-shares, providing more virtual care options, and keeping members updated through mobile apps and websites with the latest information.

What follows is a high level summary of the health insurance industry’s response in Virginia, and we would encourage providers and patients to reach out to individual plans with specific questions. We have also included the nurse or physician line for each plan below, which is a good first step for members to contact if they suspect they may have contracted the virus.

Applicable to all lines of business and following federal guidance, insurers are working with state government to have insurance company employees remain essential so insurers can maintain vital functions for members.

Here’s what plans are doing across the various insurance markets; commercial, Medicaid, and Medicare.

Virginia’s health carriers have also responded to this crisis with donations and support to providers, food banks, local health clinics, and others on the front lines battling this pandemic. An overview of some of the charitable activities Virginia’s health insurance carriers have undertaken can be found here.

In the commercial market (individual, small group, and large group).

  • Health insurers are encouraging the use of telemedicine and virtual sites of care. This includes the following. A detailed chart across plans can be found here. UPDATED (6-2-20)
    • Encouraging the use of 24/7 nurse phone lines to virtually access clinical resources at no cost to members. The nurses are trained in the latest screening and testing referral protocols. The numbers for each plan are listed below.
    • Paying for telephone-only consultations with clinician staff of primary care, general practice, internal medicine, pediatrics, OBGYN, and nurse practitioners with no member out-of-pocket cost.
    • Utilizing mobile apps to answer member questions and conduct coronavirus assessments based on guidelines from the CDC and NIH.
    • Providing emotional support for those members experiencing stress or anxiety via a 24/7 phone line and online at no cost to members.
    • Following federal guidance on HIPPA compliance and allowing telehealth via other platforms such as FaceTime, Facebook Messenger video chat, Google Hangout video, Skype and GoToMeeting.
  • Health insurers across Virginia and the United States have agreed to waive cost-sharing requirements for testing, and are covering all medically necessary testing by licensed and credentialed providers, including at pharmacies, according to appropriate CDC guidelines.
  • Health insurers have eliminated prior authorization requirements for medically necessary diagnostic tests and covered services related to COVID-19 diagnosis.
  • Health insurers have extended pre-authorization approvals for elective surgeries for up to a year.
  • Health insurers have waived early medication refill limits on 30-day maintenance medications.
  • Health insurers are creating care packages to send to members diagnosed with COVID-19 and proactively reaching out to those members who may be more at risk at contracting the virus.
  • Health insurers are working with pharmacy partners to provide free delivery of medications and assist with mailing prescriptions.
  • Health insurers are working with lab partners to support access to testing as it becomes available.
  • The IRS has relaxed rules in regards to high deductible health plans, allowing insurers to lower cost-sharing and deductible amounts related to COVID-19 testing and treatment.
  • In the self-insured market, which comprises nearly 40% of the insured in Virginia and where the self-insured company makes coverage determinations, some insurance company administrators are automatically opting in companies to the COVID-19 provisions.
  • Some health plans are allowing employers to retain health insurance coverage for employees who have been furloughed provided that the businesses maintain one full time employee, premiums are paid, and the benefits are offered on a uniform nondiscriminatory basis. This is also subject to applicable state and federal law.

In Medicaid, which is administered by the six managed care organizations (MCOs).

  • DMAS has received approval for a 1135 waiver from the federal government granting more flexibility to enroll members in Medicaid and expand telehealth benefits during the crisis. For more details.

In Medicare.

  • CMS has changed rules to allow Medicare beneficiaries to receive more services without having to travel to a facility including loosening the requirement that members have an established provider relationship before seeking telemedicine services. For more information about this guidance.

For more detailed information on what each health plan in Virginia is doing both in the commercial space, Medicaid and Medicare, see the individual company links below.

  • Aetna
    • Aetna will waive co-pays for all diagnostic testing related to COVID-19. That includes all member costs associated with diagnostic testing for Commercial, Medicare, and Medicaid lines of business. Self-insured plan sponsors will be able to opt-out of the program at their discretion.
    • Aetna is waiving all member cost-sharing and co-pays for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. Additionally, given the escalating mental health crisis resulting from or amplified by the pandemic, Aetna is extending all member cost-sharing waivers for in-network telemedicine visits for outpatient behavioral and mental health counseling services. These actions, which were scheduled to expire on June 1, 2020, have been extended through September 30, 2020. Aetna will continue working with self-funded plan sponsors to provide options.
    • Aetna is offering zero co-pay telemedicine visits for any reason, and is extending its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members.
    • Aetna is also taking additional steps to eliminate out-of-pocket costs for primary care services for Medicare Advantage members. Effective from May 13, 2020, through September 30, 2020, Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason, and encourages members to continue seeking essential preventive and primary care during the pandemic.
    • People diagnosed with COVID-19 will receive a care package.
    • Finally, home delivery of prescription medications and early refill limits on 30-day prescription maintenance medications are being waived through September 30, 2020.
    • For more information on Aetna’s coverage, visit www.cvshealth.com/covid-19.
  • Anthem (for consumers) / (for providers)
    • Anthem will cover the cost of coronavirus testing with no out-of-pocket cost and prior authorization is not required for diagnostic services related to COVID-19 testing. Anthem will waive copays, coinsurance, and deductibles for diagnostic tests for COVID-19, and is extending this to include copays, coinsurance, and deductibles for visits associated with in-network COVID-19 testing, whether the care is received in a doctor’s office, urgent care center, or emergency department. Anthem will waive the cost share for COVID-19 treatment received through December 31, 2020.
    • Anthem affiliated health plans are supporting customers by providing a one-month premium credit to members enrolled in select Individual plans and fully insured employer customers ranging from 10-15 percent. In addition, individuals in stand-alone and group dental plans will also receive a 50 percent credit. Consumers will receive the premium credit in July. Anthem’s health plan affiliates are also working with some employer groups on special payment arrangements as a bridge to continue to provide insurance for their employees during this difficult time.
    • Anthem is relaxing early prescription refill limits for members who wish to receive a 30-day supply of most maintenance medications.
    • Until September 30, 2020, Anthem’s health plan affiliates will continue to allow expanded telehealth coverage, including some physical, occupational and speech therapy, and will continue to waive cost shares for in-network telehealth visits, including telephonic visits, for medical and mental health or substance abuse disorders, for fully insured employer plans, Individual plans, Medicare Advantage plans, group retiree plans and Medicaid plans, where permissible. This will also include waiving cost shares when utilizing TeleDentists®, an in-network provider with Anthem offering online and mobile-app enabled teledentistry solutions for dental care. For telehealth visits providers are being reimbursed the same contracted rate as an in-person visit.
    • Anthem is simplifying access to care by temporarily suspending prior authorization requirements for respiratory services and medical equipment critical to COVID-19 treatment including Durable Medical Equipment such as oxygen supplies, respiratory devices, continuous positive airway pressure, or CPAP devices, non-invasive ventilators, and multi-function ventilators. Anthem’s health plan affiliates are temporarily extending prior authorizations on elective inpatient and outpatient procedures, issued before May 30, 2020.
    • For more information on Anthem’s coverage, visit www.anthem.com/coronavirus/.
  • CareFirst (for consumers) / (for providers)
    • CareFirst has launched a $5 million public-private sector philanthropic endeavor, “Care, delivered,” that will distribute personal protective equipment at no-cost to health care and social service organizations on the front lines of the pandemic. This initiative is part of CareFirst’s ongoing commitment to support the communities it serves as they navigate the complexities of this public health crisis. CareFirst will distribute 1.6 million gowns, gloves, masks and face shields to community-based organizations, federally qualified health centers and independent primary care providers in Maryland, the District of Columbia, and Northern Virginia who are on the front lines of the COVID-19 crisis.
    • CareFirst will provide premium credits totaling $25 million for fully insured small and large group customers, $4 million for small and large group fully insured dental customers, and rebates totaling over $80 million for individual members and fully insured small and large group customers who had CareFirst coverage in 2019.
    • CareFirst is waiving cost sharing (copays, coinsurance, and deductibles) for in-network or out-of-network visits to a provider’s office, lab fees, or treatments related to COVID-19 through September 30, 2020.
    • CareFirst is eliminating prior authorization requirements for medically necessary diagnostic tests and covered services related to COVID-19 diagnosis.
    • CareFirst is encouraging the use of telemedicine and virtual sites of care such as CareFirst Video Visit, and encouraging the use of a 24/7 nurse phone line to virtually access clinical resources trained in the latest screening and testing referral protocols, at no cost to members. CareFirst is reimbursing providers at the same level for a telemedicine visit with the same codes as for an in-network visit, and waiving member cost share (co-pays, co-insurance, and deductibles) for in-network, medically appropriate services provided by telehealth until July 24, 2020.
    • Finally, CareFirst is working to provide free delivery of medications and assist with mailing prescriptions.
    • For more information on CareFirst’s coverage, visit individual.carefirst.com/individuals-families/about-us/coronavirus-resource-center.page.
  • Cigna
    • Cigna has extended member cost-sharing waivers and other enhanced benefits through October 31, 2020, to include:
      • Cost share waivers for COVID-19 diagnostic testing, related visit and treatment, and
      • Cost share waivers for COVID-19 related virtual medical visits
    • Cigna is expanding its digital capabilities to help customers with COVID-19 by providing real-time, personalized support. Using data and technology to improve health, Cigna has partnered with Collective Medical to identify customers, in real-time, checking into emergency care settings with COVID-19 symptoms. Cigna has partnered with Medocity to create a simple solution, Medocity for Cigna, which allows customers with mild to moderate COVID-19 symptoms to track their symptoms, connect with care advocates and access behavioral and emotional supportive resources. If COVID-19 symptoms become more severe, Cigna Care Advocates can reach out to the customer directly to provide guidance and care coordination support. These new capabilities are available at no additional cost for customers in the United States who are covered by Cigna’s employer/union sponsored insured and self-funded group health plans and Individual and Family Plans.
    • Cigna is waiving out-of-pocket costs for COVID-19 visits with in-network providers, whether at a provider’s office, urgent care center, emergency room, or via virtual care, through July 31, 2020. Cigna is waiving out-of-pocket costs for COVID-19 FDA-approved testing. Cigna is waiving out-of-pocket costs for all COVID-19 treatment through July 31, 2020. The treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations.
    • Cigna will cover COVID-19 virtual care visits for screening and assessing risk for COVID-19, and out-of-pocket costs will be waived. Cigna members can also receive virtual medical care not related to COVID-19 by physicians and certain providers with virtual care capabilities through July 31, 2020. Out-of-pocket costs may apply. Providers will be reimbursed consistent with typical face-to-face rates.
    • Cigna’s Express Scripts Pharmacy offers free home delivery of up to 90-day supplies of prescription maintenance medications.
    • For more information on Cigna’s coverage, visit www.cigna.com/individuals-families/health-wellness/topic-disaster-resource-center/coronavirus-public-resources.
  • Magellan – Magellan is working hand-in-hand with federal and state customers, providers, and community organizations to implement emergency measures and provide access to care for COVID-19 and other medical, behavioral and social needs. This includes adoption of state and federal guidance around waiving of testing copays, prior authorizations, pharmacy and telehealth requirements to address immediate needs for care for members. Magellan is also reaching out to members, especially those that are most vulnerable, to help ensure they have support and continuity of care, including providing one of its digital cognitive behavioral therapy (DCBT) apps, RESTORE®, at no cost for individuals experiencing sleep difficulty and insomnia related to novel coronavirus (COVID-19). For more information on Magellan’s coverage, visit www.magellanhealth.com/news/covid-19/.
  • Optima – Optima is offering free telehealth visits for members with no copays or cost-share with Optima’s in-network virtual care partners including MDLIVE® and Sentara Medical Group (SMG) through June 30, 2020. Optima is waiving out-of-pocket costs for COVID-19 testing at any in-network lab locations for all commercial, Medicaid, or Medicare Advantage members. Optima is allowing for early refills, if needed, and allowing members to fill 90-day supplies of medication at most retail pharmacies and depending on the member’s benefits, by mail order. Depending on member coverage, Optima’s mail order pharmacy can deliver a 90-day supply of medications to member’s homes. For more information on Optima’s coverage, visit www.optimahealth.com/covid-19/.
  • Piedmont Community Health Plan
    • Piedmont Community Health Plan is extending its waiver of out-of-pocket member costs associated with diagnostic testing for COVID-19 as long as it takes place at an in-network lab location, through December 31, 2020.
    • Piedmont is extending its waiver of out-pocket members costs for telehealth services through December 31, 2020. Piedmont is reimbursing in-network providers as if the services had been delivered through traditional in-person methods.
    • Piedmont’s pharmacy benefits manager, CVS Caremark, is waiving early refill limits on 30-day prescriptions for maintenance medications at any in-network pharmacy. Also, CVS Pharmacy is waiving charges for home delivery (where available) of all prescription medications. Finally, Piedmont is permitting online mental health counseling to all members at in-network providers.
    • For more information on Piedmont’s coverage, visit www.pchp.net/.
  • UnitedHealthcare – (for consumers) / (for providers)
    • UnitedHealthcare is waiving cost-sharing for COVID-19 testing and is waiving cost-sharing for COVID-19 testing related visits, whether the testing related visit is received in a health care provider’s office, an urgent care center, an emergency department, or through a telehealth visit. This coverage applies to Medicare Advantage, Medicaid, and fully-insured Individual and Group health plans.
    • UnitedHealthcare has suspended prior authorization requirements to a post-acute care setting and when a member transfers to a new provider.
    • UnitedHealthcare is extending the timely filing deadlines for claims during the COVID-19 public health emergency period, and is implementing provisional credentialing to make it easier for out-of-network care providers who are licensed independent practitioners to participate in one or more of its networks.
    • UnitedHealthcare is taking steps to accelerate payments and other financial support to health care providers in the U.S. to help address the short-term financial pressure caused by the COVID-19 emergency.
    • UnitedHealthcare has expanded access to telehealth. UnitedHealthcare is providing 24/7 access to Virtual Visits through designated telehealth providers Teledoc, American Well, Doctor On Demand, and other partners. UnitedHealthcare is waiving cost-sharing for in-network telehealth visits for Medicare Advantage, Medicaid, and fully-insured Individual and Group health plans, with an opt-in available for self-funded employers. UnitedHealthcare will pay the same rates for telehealth as for an in-person visit for the same service, unless the provider has another reimbursement arrangement in place already.
    • Members with UnitedHealthcare prescription drug coverage or an OptumRx pharmacy benefit who need an early prescription refill, may request one through the pharmacy. Pharmacy delivery is also available through Optum Home Delivery and several retail pharmacies.
    • UnitedHealthcare announced that UnitedHealth Group and Microsoft Corp. have joined forces to launch ProtectWell™, an innovative return-to-workplace protocol that enables employers to bring employees back to work in a safer environment. ProtectWell™ helps employees determine they are safe to go to work, co-workers know their colleagues have been screened, and employers feel confident that their workplace is ready to do business.
    • For more information on UnitedHealthcare’s coverage, visit www.unitedhealthgroup.com/newsroom.html.
  • Virginia Premier – Virginia Premier is covering COVID-19 testing for all health plan members, including waiving any co-pays or cost-sharing. Virginia Premier will cover telehealth benefits related to urgent and non-urgent office visits. This includes the use of videoconferencing, the Internet, store-and forwarding imaging, and other telecommunications technologies to support virtual patient health care. Virginia Premier will allow “virtual visits” for any members with or without coronavirus (COVID-19) related conditions across all product lines through June 30, 2020. Virginia Premier will waive co-pays, coinsurance, and deductibles for these virtual visits. During Virginia’s State of Emergency, Virginia Premier members can fill prescriptions at any pharmacy, even if it’s out of network. Members may also be able to change from a 30-day supply to a 90-day supply for any prescription drugs regularly taken. Finally, Virginia Premier lifted “refill too soon” edits on prescriptions and are making mail-order prescriptions available. For more information on Virginia Premier’s coverage, visit www.virginiapremier.com/members/coronavirus/.

For more information about what plans are doing nationwide.

Each plan has a nurse line, the majority of which are available 24/7 to answer member questions.

  • Aetna: 800-556-1555
  • Anthem: 800-700-9184
  • CareFirst: 800-535-9700
  • Cigna: 888-726-3171 or 855-667-9722.
  • Magellan: Members should call the Member Service phone number on the back of their ID cards.
  • Optima: 800-394-2237
  • Piedmont: 844-447-8470
  • UnitedHealthcare: Members should call the Member Service phone number on the back of their ID cards.
  • Virginia Premier: 800-256-1982