Telehealth Benefits for TN State Employees

by | Apr 17, 2020 | Coronavirus and Recovery

COVID-19 Benefits for State Health Plans & Retirees

The State Group Insurance Program has approved waiving all costs for Telehealth visits through carrier-sponsored Telehealth programs from March 17 – May 31, 2020.  In addition, they have also approved waiving all member costs for Covid-19 in-network testing and in-network outpatient visits associated with these tests.  Not everyone needs to be tested for Covid-19. Talk to your doctor, or other healthcare provider, about your need for a test.  Any in-network medical treatment that is received due to Covid-19 will also be waived.

What members can expect:

  • Benefit changes apply to health plan members, in all plans: Premier PPO, Standard PPO, Limited PPO, CDHP/HAS and Local CDHP/HAS, with both carriers: BlueCross BlueShield and Cigna.
  • Members will not pay for any Telehealth visits from March 17- May 31 through carrier-sponsored Telehealth programs, (Cigna: MDLive/AmWell and BlueCross BlueShield: PhysicianNow, even if the visit is for something other than Covid-19.
  • Members will not have to pay a copay, coinsurance or any money toward their deductible for in-network visits when the visit leads to a Covid-19 test, as well as any services performed at the visit during which the Covid-19 test is performed and medical treatment is received in the following:
    • Provider’s office
    • Urgent Care facility
    • Convenience clinic
    • Emergency room
    • Telehealth
    • Inpatient/Outpatient Hospital facility

 

Frequently Asked Questions (FAQs)

  • What should I do if I think I might have the COVID-19 virus? Should I go to the emergency room?
    • Not everyone needs to be tested for COVID-19. Talk to your doctor, or other healthcare provider, about your need for a test.
    • People should generally seek care if they experience a high fever, significant cough, shortness of breath or fatigue.
    • Additional Resources:
  • Is COVID-19 testing covered?
    • Members won’t have to pay a copay, coinsurance or any money toward their deductible for in-network COVID-19 tests and in-network visits in a provider’s office, urgent care, convenience clinic, emergency room or by Telehealth.
  • Is COVID-19 treatment covered?
    • Members won’t have to pay a copay, coinsurance, or any money toward their deductible for in-network COVID-19 medical treatment received in a provider’s office, urgent care, convenience clinic, emergency room, or inpatient/outpatient hospital facility as long as the visit is directly related to a COVID-19 diagnosis. All medical treatment not directly related to a COVID-19 diagnosis will be covered under the member’s enrolled health plan benefits with applicable member cost share.
  • What about Telehealth?
    • Members will not be required to pay for any Telehealth visits through carrier-sponsored Telehealth programs, (Cigna: MDLive/AmWell and BlueCross BlueShield: PhysicianNow), from March 17 through May 31, even if the visit is for something other than COVID-19. If you have questions, call BlueCross BlueShield or Cigna at the number on the back of your ID card and ask for help.
  • What will my Explanation of Benefits (EOB) show?
    • We are working closely with our carriers so that your EOB shows that you do not owe member cost share for in-network COVID-19 tests, in-network outpatient visits that lead to a test, and in-network medical treatment. However, for member cost share to be waived, the claim must be coded with a COVID-19 diagnosis code. If your EOB shows you owe a cost share, please contact either BlueCross BlueShield or Cigna, by calling the number on the back of your ID card for help. They will be able to explain the status of your claim and provide you with more information. Your provider may need to resubmit your claim with updated coding.
  • What if I pre-paid at the doctor’s office or hospital, will I get that money back?
    • If it is an eligible in-network COVID-19 charge, you can get your money back. Once you have your EOB, you can contact the provider or hospital and request a refund, or you can call BlueCross BlueShield or Cigna at the number on the back of your ID card and ask for help.
  • What if I go to the emergency room for a test and then I am hospitalized? What will I have to pay for?
    • The State Group Insurance Program is waiving cost sharing for in-network COVID-19 testing, in-network outpatient visits associated with these tests, and in-network medical treatment for a COVID-19 diagnosis. The benefit does not include waiving member cost-sharing for treatment that is not related to a COVID-19 diagnosis, which would fall under the current benefit cost sharing based on the health plan you are enrolled in.
  • I’m in the CDHP, will I have to pay for a test? Do I have to pay my deductible first?
    • If the eligible COVID-19 testing is in-network, then no, you would not have to pay anything toward your deductible for testing and in-network outpatient visits associated with the test.
  • Does this apply for all health plan members, in all networks, BlueCross BlueShield Network S, Cigna LocalPlus and Cigna OAP?
    • Yes, it applies to all members and retirees in all plans and in all networks.
  • What if I get a bill saying I owe money for a COVID-19 test? What do I do?
    • If you get a bill for a test, a COVID-19 related visit, or COVID-19 related treatment, wait until you have your Explanation of Benefits (EOB). If the EOB shows you owe money, then call BlueCross BlueShield or Cigna at the number on the back of your card and ask for help. If the EOB shows you do not owe money for the test, then contact your provider to request a bill correction.
  • What if I get a test and it’s negative, and then I need to go and get another test? Is the second test covered?
    • Yes, member cost share for all in-network COVID-19 testing and in-network outpatient visits associated with these tests is waived even if you need to get an additional test.
  • Are prescriptions for COVID-19 treatment covered?
    • Currently the FDA has not approved any prescription medications for the treatment of COVID19. Medications prescribed by your provider and obtained at a pharmacy will still have applicable member cost share.
  • When will these COVID-19 benefits take effect?
    • This benefit takes effect immediately and could also include prior claims, which meet these requirements.
  • How long will these COVID-19 benefits last?
    • The cost waiver for carrier-sponsored Telehealth program benefits goes through May 31, 2020. There is no specific end date currently for the other COVID-19 benefits. Benefit updates will be provided as decisions are made.