Skip to main content

In-Network Cost Sharing for Fully Insured Medical Plans

The following chart outlines benefit enhancements/adjustments that fully insured carriers are offering to assist plan members who could potentially be impacted by COVID-19.

CarrierIn-Network Diagnostic TestingMaintenance MedicationsTelemedicineCarrier Resources
AetnaMember Cost-Share WaivedWaiving early refill limits on 30-day supply
Waiving charges for home delivery of prescription medications
Offering 90-day supply for Commercial and Medicare members
Member cost-share waived, through 6/1/2020www.aetna.com
AmerihealthMember Cost-Share WaivedWaiving early refill limits on 30-day supplyMember cost-share waived, through 6/1/2020www.amerihealthnj.com
CignaMember Cost-Share WaivedNo waiver at this timeTelemedicine is available at the existing benefit levelwww.cigna.com
EmblemHealthMember Cost-Share WaivedNo waiver at this timeTelemedicine is available at the normal cost-sharewww.emblemhealth.com
EmpireMember Cost-Share WaivedNo waiver at this timeYou can contact Nurse Line anytime at 877-825-5276 with questions.
You can LiveHealth Online to see a doctor from your phone, tablet, or computer.
Log in at www.empireblue.com to learn more about LiveHealth online.
www.empireblue.com
Horizon BCBSNJMember Cost-Share WaivedWaiving early refill limits on 30-day supplyAccess to telehealth will be provided 24/7, and member cost-share will be waived.
In addition, 24/7 access to licensed nurses who can assess and assist members with symptoms consistent with suspected COVID-19 infection.
Those services are available through the “Horizon Blue” app, online at HorizonBlue.com, or by phone at 1-888-624-3096.
www.horizonblue.com
Independence Blue CrossMember Cost-Share WaivedWaiving early refill limits on 30-day supplyMember cost-share waived, through 6/1/2020www.ibx.com
OscarMember Cost-Share WaivedNo waiver at this timeTelemedicine is available at the normal cost-share.
$0 non-HSA plan/$15 HSA members
www.hioscar.com
UnitedHealthcare OxfordMember Cost-Share WaivedNo waiver at this timeTelemedicine is available at the existing benefit levelwww.myuhc.com

HDHP Coverage for COVID-19

On March 11, 2020, the Internal Revenue Service (IRS) issued Notice 2020-15 to advise that high deductible health plans (HDHPs) can pay for 2019 Novel Coronavirus (COVID-19) testing and treatment before plan deductibles have been met, without jeopardizing their status. According to the IRS, this also means that individuals with HDHPs that cover these costs may continue to contribute to their health savings accounts (HSAs).

The IRS also noted that any COVID-19 vaccination costs count as preventive care and can be paid for by an HDHP without cost sharing.

Health Plan Coverage

To protect the public from the growing spread of COVID-19, many states are directing or encouraging health insurance issuers to cover COVID-19 testing without imposing a deductible or other cost sharing. These states include, for example, California, New York, Oregon and Washington. Some issuers are voluntarily waiving cost sharing for COVID-19 testing, without a state directive. Self-funded plans may also voluntarily waive these costs due to the public health emergency posed by COVID-19.

Only individuals who are covered by HDHPs can make contributions to HSAs. To qualify as an HDHP, a health plan cannot pay medical expenses (other than preventive care) until the annual minimum deductible has been reached. IRS Notice 2020-15 provides an exception to this general rule to remove financial barriers that might otherwise delay testing for and treatment of COVID-19.

Action Steps

Employers with HDHPs should consult with their plan’s issuer or benefits administrator regarding their plan’s benefits for COVID-19 testing and treatment, including the potential application of any deductible.

We understand that this is an evolving situation and further updates will be provided as information becomes available. If you have any questions, please complete the form below: