COVID-19 Update: Telehealth and Treatment Cost-Share Waivers

June 25, 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. 

Initiative	Effective Date	Projected End Date
COVID-19 Testing	3/7/20	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	There is no end date for NM’s rule requiring cost-share waiver for COVID-19-related testing and treatment
Telehealth/Telemedicine	3/18/20	Cost-share waiver extended through 7/31/20* (and beyond 7/31/20 for COVID-19-related testing and treatment)
COVID-19 Treatment	4/1/20	There is no end date for NM’s rule requiring cost-share waiver for COVID-19-related testing and treatment
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 Health and Human Services 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 suspend the cost-share waiver for COVID-19 treatment as of June 30, 2020, and extend the cost-share waiver for telehealth through July 31, 2020.

What this means to you:

• An ASO account’s prior decision to waive cost-share for COVID-19 treatment will be suspended effective July 1, 2020, unless the account contacts us to request continuance of the cost-share waiver for COVID-19 treatment. 
  • ASO options are to extend to Aug. 31, 2020, Dec. 31, 2020, or update benefits as part of their renewal for their future plan year.
• An ASO account’s prior decision to waive cost-share for telehealth will be extended to July 31, 2020, unless the account contacts us to request ending the cost-share waiver on June 30, 2020.

If your ASO clients would like to make a change from their original decision, please contact your account executive no later than Friday, July 3. If you don’t communicate that change by July 3, your client’s decision will continue as currently coded. Change decisions made after July 3 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.