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COVID-19 Update: Telemedicine and Treatment Cost-Share Waivers Extended

June 26, 2020

We continue to monitor the COVID-19 pandemic and are committed to helping our employer customers and members stay informed. We have updates to some of our coverage dates. As always, members should call the number on their ID card for answers to their specific benefit questions.

Currently, there is no projected end date for the Office of Superintendent of Insurance rule that requires cost-share waiver for COVID-19-related testing and treatment for fully insured and Interagency Benefits Advisory Council (IBAC) members.

Initiative

Effective Date

Projected End Date

COVID-19 Testing

3/7/20

Cost-share waiver ends with the end of the Health and Human Services (HHS) public health emergency

For fully insured and IBAC members: There is no end date for NM’s rule requiring cost-share waiver for COVID-19-related testing and treatment

COVID-19 Testing-related visits

3/18/20

Cost-share waiver ends with the end of HHS public health emergency

For fully insured and IBAC members: There is no end date for NM’s rule requiring cost-share waiver for COVID-19-related testing and treatment

Telemedicine

3/18/20

Cost-share waiver extended through 8/31/20* (beyond 8/31/20, for COVID-19-related testing and treatment delivered by telemedicine for fully insured and IBAC members)

For Medicare (not Part D) and Medicare Supplement plans, cost-share waiver extended through 12/31/20*

COVID-19 Treatment

4/1/20

Cost-share waiver extended through 8/31/20* (and beyond 8/31/20 for COVID-19-related testing and treatment for fully insured and IBAC members)

Interfacility Transfer

4/1/20

7/31/20*

Prior Authorization extended on previously approved elective surgeries, procedures, therapies and behavioral health services**

Services scheduled between 1/1/20 and 6/30/20

12/31/20

Chest CT Scan

3/2/20

End of HHS public health emergency

*Date change/extension
**Behavioral Health services included in this extension

As we let you know in April, self-funded customers (ASO) who aligned with our decisions for fully insured members would continue that alignment unless we were notified. We will extend the cost-share waivers for telehealth and COVID-19 treatment through Aug. 31, 2020.

What this means to you:

  • An ASO account’s prior decision to waive cost-share for telehealth and COVID-19 treatment will be extended to Aug. 31, 2020, unless the account makes a request to us to end the cost-share waiver.

If your ASO client would like to make a change from their original decision, please contact your account executive no later than Tuesday, July 7. If you don’t communicate that change by July 7, your client’s decision will continue as currently coded. Change decisions made after July 7 cannot be accommodated for a July 1 effective date.

As a reminder, COVID-19 testing and testing-related visits are covered at no cost-share for fully insured and ASO members as required by the Families First Coronavirus Response Act until the end of the federal public health emergency.