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Guidance for the COVID-19 Public Health Emergency


Federal Guidance

Note that during the COVID-19 public health emergency, we're adhering to federal guidance. To see how this impacts care delivery for our members, review this short summary.

A Quick Request

Please complete this brief survey to tell us about your telephone and telehealth capabilities — and to let us know if your office is still open. It takes less then 5 minutes and will help us better direct our members to the care they need.

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COVID-19 Testing

Coverage
Following the release of new CMS guidance, we’re waiving all member copays for COVID-19 testing. We are also waiving prior authorization (PA) requirements for testing. 

How to order testing
For patients who meet current guidance for evaluation of COVID-19, order the test from one of our laboratory partners in your state:

  • Arizona
    Sonora Quest
  • Florida, Ohio, and Texas
    Labcorp
    Quest Diagnostic

Do not send patients directly to our laboratory partners locations. Instead, collect the appropriate specimen at the healthcare facility where the patient was seen and the test was ordered. Appropriate specimens include:

  • Nasopharyngeal (NP) or oropharyngeal (OP) swab in viral transport medium
  • NP or OP washes/aspirates in sterile cups
  • Bronchial washings or bronchoalveolar lavage (BAL) specimens in sterile cups

Use standard procedures to send the specimen. Test results will be available in 3-4 days. Get more details about the test from LabCorp and Quest Diagnostics.

COVID-19 Treatment

Coverage
With the exception of monoclonal antibody infusion therapy, coverage of COVID-19 treatment will follow our regular health plan policy. We'll cover primary care provider (PCP) visits and hospital stays as normal. 

Monoclonal antibody COVID-19 infusion
During the COVID-19 public health emergency, Medicare will cover and pay for bamlanivimab, casirivimab, and imdevimab infusions (when provided according to their emergency use authorizations) the same way it covers and pays for COVID-19 vaccines. Find more information at CMS.gov.

Referrals and Prior Authorizations

Referrals
Referrals are not required due to state of emergency guidance, but are encouraged to support coordination of care.

Prior authorizations
Services, procedures, and items that normally require authorization will still need an authorization.

For emergency inpatient admissions related to the treatment of COVID-19, we require only notification. CT scans of the chest do not require a prior authorization per existing policies.

As our knowledge of COVID-19 evolves and treatment patterns become more clear, we will continue to monitor our prior authorization list to ensure timely access to care for members.

Telehealth Services 

In response to COVID-19, CMS has expanded the range of reimbursable telehealth services. They’re also waiving potential HIPAA violations for providers who use everyday technologies, like FaceTime or Skype, to treat patients for COVID-19 and other medical concerns. These changes aim to limit community spread of the virus by encouraging people to stay home when they need routine care or have only mild symptoms.

How to get started
If your provider office has limited telehealth capabilities or wants to expand them, check out our Telehealth Quick Reference Guide (QRG). We continually update this guide to let you know the services you can use and the latest guidance from CMS. 

Covered telehealth services
We cover four types of telehealth visits at $0 cost share: 

  • Telehealth Visits
  • Telephone Services
  • Virtual Check-Ins
  • E-Visits

For more details on covered services, see:

Our Messaging to Members

Social distancing
To keep our members safe, we’re asking them to practice social distancing and to stay home.

Medical care
We tell our members to call their PCPs right away if they have cough, fever, or shortness of breath and think they may have COVID-19. We emphasize that they should call before going in for an appointment.

We’ve also developed a COVID monitoring program for members who have been exposed to COVID, are exhibiting symptoms, or have been diagnosed with COVID. Our nurse clinical guides call members on a regular cadence to check on their symptoms and help them connect with care if needed. As part of the program, we also send pulse oximeters to members with confirmed cases of COVID.

Medications
We've lifted early refill restrictions so members can get an early refill for up to a 100-day supply of their medication. And we’re encouraging members to take advantage of CVS free delivery and mail order.

Vaccination
We’re encouraging all members without contraindications to get the vaccine. We’re also closely tracking when the vaccines will be ready to distribute in our members’ areas, so we can let them know.

How You Can Help

To encourage our members to stay home, we’re asking our partners, hospitals, and providers to consider adopting the following practices: 

  • Have a phone process in place so those with COVID-19 symptoms can avoid office visits or urgent care (when possible and clinically safe)
  • Use telehealth visits when possible (see the latest CMS guidance
  • Ask members to sign up for mail-order (it's safer, cheaper, and better for adherence) and send up to 100-day scripts with 3 refills to the mail-order pharmacy
  • Have nonessential personnel work from home

Who’s at Risk

Check the latest CDC guidance on the clinical and epidemiological criteria for COVID-19 infection risk. 

We’ll continue to keep a close eye on what’s happening with the virus. If you have any questions, call our Provider Services team at 1-877-762-3515