TEMPORARY MARKETPLACE/COMMERCIAL WAIVERS EXPIRING FOR APPLICABLE COVID-19 TREATMENT AND TELEHEALTH SERVICES ON JUNE 1, 2021

Date: 06/01/21

As we continue to address the COVID-19 pandemic, we want to update you on important changes for our Marketplace/Commercial plans. Last year, we instituted temporary member cost share liability and prior authorization waivers for select services to ensure critical care could be quickly delivered to our members during a time of heightened need. On June 1, 2021, these temporary waivers will expire and our members’ Marketplace/Commercial plan benefits will be reinstated for the following services:

COVID-19 Treatment Related Services

• COVID-19 treatment related services (those billed with a confirmed ICD-10 diagnosis code) will continue to be eligible for coverage at this time, in accordance with the member’s plan benefits.
• Beginning June 1, 2021, prior authorization will be required for COVID-19 treatment related services, in accordance with CMS guidance and plan benefits.
• Providers should also resume collecting Marketplace/Commercial member liability at the point of service for applicable treatment related services on June 1, 2021 onward.

All Telehealth Services

• Any services that can be delivered virtually will continue to be eligible for telehealth coverage at this time.
• Providers should resume collecting Marketplace/Commercial member liability at the point of service on June 1, 2021 onward, in accordance with the member’s plan benefits.
• Providers should reflect telehealth care on their claim form by following standard telehealth billing protocols in their state.
• For further coding guidance for telehealth services, we recommend following what is being published by:
  • Department of Health and Human Services (HHS)
  • American Medical Association (AMA)
  • Centers for Commercial/Marketplace and Medicaid (CMS)

Prior authorization requirements and member cost share liability (copayments, coinsurance and/or deductible cost share amounts) will continue to be waived for COVID-19 testing, screening services and vaccinations at this time.

We are working in close partnership with state, local and federal authorities to serve and protect our members and communities during the COVID-19 pandemic, including ensuring that our providers have relevant and up-to-date information. We value your partnership during these unprecedented times.

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.