Board of Trustees approves temporary Health Plan coverage changes in response to COVID-19
Subject to Health Plan rules and requirements below, all patient cost sharing (i.e., co-pays, co-insurance and deductibles) will be waived for COVID-19 related testing and telemedicine/telepsychology visits will be covered until further notice.
During this challenging and unprecedented time caused by the coronavirus outbreak, the Board of Trustees has decided that certain temporary changes to your health benefits are warranted for the protection and safety of all Plan participants. Further details are provided below but, effective for services and supplies rendered on or after March 18, 2020, and continuing until further notice, all patient cost sharing (i.e., co-pays, co-insurance and deductibles) will be temporarily waived for all COVID-19 related testing. In addition, many physicians’ offices and therapists’ offices are no longer seeing patients in-person to prevent further spread of the virus. As a result, the Board of Trustees has approved telemedicine and telepsychology visits on a temporary basis. These changes take into account the importance of COVID-19 testing and related treatment, as well as the need for limiting in-person interactions and social gatherings to the extent possible, as recommended by health authorities.
Telemedicine and telepsychology visits (network and non-network) covered until further notice
The Health Plan’s Board of Trustees has unanimously approved a Plan amendment that will temporarily provide coverage for both network and non-network telemedicine and telepsychology services. This means that, effective March 16, 2020, and until further notice, the Health Plan will cover office visits that can properly be conducted online with a licensed provider, as long as those visits and services would otherwise be covered under the terms of the Health Plan.
You may visit your network or non-network provider online or use Anthem’s LiveHealth Online network providers, subject to the Health Plan’s applicable deductibles and co-insurance rules. For further information regarding Anthem’s telemedicine and telepsychology programs, please visit www.livehealthonline.com, call 1-888-LiveHealth (548-3432) or email to help@livehealthonline.com. When emailing, make sure to include your name, email address and phone number where you can be reached.
Except as provided below for COVID-19 testing, all other Health Plan rules remain in effect, including but not limited to the exclusion of services that are not medically necessary, the exclusion of marriage, family or relationship counseling and/or therapy, and the exclusion for charges in excess of the Allowable Charge limit (meaning you will be responsible for any out-of-network charges above the Allowable Charge or Reasonable and Customary Charge limit).
Because this change is temporary, you will be notified when this special telemedicine benefit ends.
For more information about Anthem’s LiveHealth Online, visit our LiveHealth online page.
Cost Sharing waived for COVID-19 related testing
Effective for services and supplies rendered on or after March 18, 2020, and continuing until further notice, all patient cost sharing (i.e., deductibles, co-pays, co-insurance and prior-authorizations) will be waived for all testing for the detection and diagnosis of the COVID-19 virus and COVID-19 antibodies. This means you will not have any cost-sharing for these services, regardless of whether they are in-person or via telemedicine/telepsychology and regardless of whether they are in-network or non-network.
The Plan’s waiver of cost sharing will apply to testing-related office visits, telemedicine visits, urgent care centers, and hospital emergency room visits for the purpose of COVID-19 testing. There are some important things to keep in mind about these new changes regarding cost-sharing:
- The waiver of cost sharing only applies to items and services furnished to an individual during visits that result in an order for, or administration of, a COVID-19 diagnostic test, but only to the extent that the items or services relate to testing for the virus or the evaluation of the individual to determine if he or she needs testing. An order from your healthcare provider is required to cover your COVID-19 test at 100%. Please see below for instructions on where to submit the order.
- The waiver of cost sharing only applies to diagnostic and antibody testing that has been determined to be medically appropriate, as determined by the individual’s attending healthcare provider. The cost sharing waiver does not apply to testing conducted for the purpose of returning to work or school, for public health surveillance, or for any other purpose that is not primarily intended for the diagnosis of the COVID-19 virus. You must provide the Health Plan with a copy of the attending healthcare provider’s orders for any COVID-19 testing.
- The waiver of cost sharing does not apply to medical treatments following a diagnosis of COVID-19. Those treatments are subject to all other Health Plan rules.
These new rules are intended to comply with, and will be administered and applied in accordance with, the requirements of the new Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act.
Please email a copy of your attending healthcare provider’s order(s) to hpclaims@dgaplans.org, fax it to (323) 782-9287 or mail it to 5055 Wilshire Blvd, Suite 600, Los Angeles, CA 90036.
If you have already incurred a claim
If you have already incurred a claim for services affected by the aforementioned Health Plan coverage changes, you may be eligible for reimbursement. We recommend that you reach out to the provider you received services from and ask that they submit a claim to Anthem on your behalf (or directly to the Plan in the case of non-network providers). If they are unable to do so, you will need to submit a claim form and copy of the itemized bill to Anthem (or to the Plan). For more information on how to submit a claim, please visit our Filing a Medical Claims page.
If you have questions, please reach out to the Participant Services Department at (323) 866-2200, Ext. 401.
How to protect yourself and others
It is important to take appropriate preventive measures to ensure the health and safety of yourself, your loved ones and those around you. To that end, the Centers for Disease Control and Prevention (CDC) offer the following recommendations:
- Stay home when you are sick from any illness.
- If you have personally suffered symptoms of acute respiratory illness, stay home until you are free of fever (100.4° F or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing or other symptom altering medicines (e.g., cough suppressants).
- Avoid close contact with people who are sick.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Wash your hands often with soap and water for at least 20 seconds. Regularly use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash. While sneezing in your elbow is certainly preferable to sneezing in your hand, the clothing on your elbow can contain infectious viruses that can be passed on for up to a week or more. Clean and disinfect frequently touched objects and surfaces. All surfaces where infectious droplets land can remain infectious for about a week, on average.
- To the extent possible, use knuckles to touch light switches, elevator buttons, etc., and please avoid handshaking and other physical contact.
Where to find updated information
For updates on the coronavirus, the CDC and the World Health Organization have created special websites with a wealth of information regarding what the coronavirus is, how it is contracted, what countries are under a travel advisory, etc. This information is updated regularly as the situation evolves and can be found on the following websites:
Call your doctor if you develop a fever, have a cough, or have difficulty breathing. Let your doctor know if you have been in close contact with a person known to have COVID-19, or if you live in or have recently traveled to an area where the virus has spread.
