Aetna: COVID-19 FAQs and resources

    Insurance coverage
     

    Effective March 6, 2020, a number of COVID-19 resources are available to Aetna members, including:

    • Waived co-pays for all diagnostic testing related to COVID-19 for Commercial, Medicare and Medicaid members

    • Until June 4, 2020, Aetna will offer zero co-pay telemedicine visits – for any reason.

    Read more about additional resources and more information available to Aetna members.

    Medication access
     

    The CDC encourages people to stay at home as much as possible. CVS Health provides convenient options to avoid visiting the pharmacy for refills or new prescriptions.

    Aetna offers 90-day maintenance medication prescriptions for insured and Medicare members.

    Read more about how CVS Health is working to ensure medication access for patients.

    Community support
     

    Aetna Resources For Living® (RFL) is offering support and resources to individuals and organizations who have been impacted by COVID-19. Through this liberalization, those in need of support can access RFL services whether or not it is part of their benefits.

    • Individuals and organizations who don’t have RFL can contact RFL at 1-833-327-AETNA (1-833-327-2386)

    • Members and Plan Sponsors who do have RFL should call their designated RFL number available in program materials

    Support to individuals and organizations that don’t have RFL includes:

    • In-the-moment phone support to help callers cope with the emotional impact of the event

    • Informational brochures about dealing with a crisis

    • Community resource referrals including local support services in the local area

    • Management consultation to help organizations respond to the needs of their employees, even if they’re not RFL customers

      • Employers may contact our specialized support line at 1-800-243-5240

      • Onsite services are available on a fee-for-service basis for companies to help their employees recover from the impact of these events on the workplace

    Telemedicine cost-sharing and co-pay waiver announcement (March 6)

    What are the start and end dates for the telemedicine cost share waiver?

    For Commercial plans, the cost share waiver began on the day of the CVS Health press release, March 6, 2020, will end on June 4, 2020Or as specified by state or federal regulation for medical services. Aetna is extending all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services through September 30, 2020. Aetna self-insured plan sponsors offer this waiver at their discretion.

    For Medicare Advantage plans, Aetna has eliminated out-of-pocket costs for primary care services for all in-network primary care visits, whether done in-office and via telehealth, for any reason, as well as in-network telemedicine visits for outpatient behavioral and mental health counseling services, through September, 30, 2020.

    Aetna and self-insured plan sponsors, as appropriate, will continue to cover member cost sharing for services included in the Families First Coronavirus Response Act (such as COVID-19 testing and visits resulting in a COVID-19 test).

    What happens to the telemedicine cost-share waiver after 90 days, can my self-insured plan sponsor extend it?

    Aetna has extended member cost share waivers for inpatient admissions for the treatment of COVID-19 or associated complications for Commercial and Medicare plans, covered in-network outpatient behavioral and mental health telemedicine services for Commercial and Medicare plans, and out-of-pocket costs for primary care services for Medicare Advantage plans through September 30, 2020.

    CVS Health and Aetna will continue to monitor the situation with COVID-19 as it unfolds. Any updates or changes to the policies and procedures will be communicated through the appropriate channels. Plan sponsors cannot make independent extensions at this time.

    Do the cost share waivers for telemedicine apply to all providers or just Teladoc®? What about MD Live? What about third-party custom telemedicine arrangements?

    Yes, this benefit for telemedicine cost share waiver is at the CPT code level and any in-network provider can bill for telemedicine using the appropriate telemedicine codes. One caveat to note is that MD Live is not able to apply the waiver at the point of care. However, the claim will adjudicate without a cost share and members will receive a refund.

    Does the zero copay apply to the plan sponsors who have opted-in to the caregiver services through Teladoc®?

    No, as this is not a benefit for the member.

    Will a customer who is currently opted out of Teladoc® get access to all channels of telemedicine at $0 cost share to the member, if they opt into the recent 90-day initiative to support COVID-19 services?

    No. Plan sponsors who opted out of Teladoc® would not have Teladoc® during the 90-day initiative but would have the $0 cost share for telemedicine through in-network providers.

    If plan sponsors remain opted-in to ALL channels of telemedicine – Teladoc® and providers doing virtual care – would all have a $0 cost share? It’s all or nothing, right?

    Yes. If plan sponsors remain opted in for the $0 telemedicine co-pay offering, it will apply to all visit types.

    Can plan sponsors opt-out of the telemedicine cost share waivers for just behavioral health?

    No. The only cost-share wavier opt-out options are provided on the form. Examples of designs that cannot be administered include:

    • Applying cost share for behavioral health, dermatology, care giver, etc. only. $0 cost share must apply to all types of telemedicine visits or to federally mandated COVID-19 diagnosis.

    • Applying different cost share levels for types of telemedicine visits (i.e., behavioral health, dermatology, care giver, etc.).

    • Steering members to designated telemedicine vendors by using different levels of cost sharing.

    • Any option not listed as Acceptable.
       

    What is the cost for a Teladoc® or telemedicine visit that would now need to be covered by the self-insured plan sponsor if they chose to opt-in to waived cost-share?

    The retail cost of a Teladoc® visit that would need to be covered by the self-insured plan sponsor is $45 for those plan sponsors that opted into 2020 pricing, and $40 for plan sponsors that remained on 2019 pricing.

    For a telemedicine visit, which can be billed by any network provider and will be covered with no cost sharing to the member, Aetna's policy is that we reimburse all providers at the same rate as in-person visits.

    Who will pay the member cost share for telemedicine visits?

    Self-funded plan sponsors will be responsible for covering their employees’ member cost share for all covered in-network general medical, mental health and dermatology visits while the Aetna cost share waivers are in effect, unless they have opted out. Aetna will cover member cost shares for covered in-network fully insured telemedicine visits.

    Aetna and self-insured plan sponsors, as appropriate, will continue to cover member cost sharing for services included in the Families First Coronavirus Response Act (such as COVID-19 testing and visits resulting in a COVID-19 test).

    What kind of Teladoc® visits are covered by the COVID-19 cost share waiver?

    Member cost shares for Commercial members will be waived for covered in-network Teladoc® medical visits for any reason from March 6, 2020 to June 4, 2020. Member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for Commercial plans has been extended through September 30, 2020. Self-insured plans offer this waiver at their own discretion.

    Aetna and self-insured plan sponsors, as appropriate, will continue to cover member cost sharing for services included in the Families First Coronavirus Response Act (such as COVID-19 testing and visits resulting in a COVID-19 test).

    Member cost shares will be waived for in-network covered Teladoc® general medical visits through September 30, 2020 for Medicare Advantage members.

    Are MinuteClinic® Video Visits included in the 90-day telemedicine co-pay waiver for Aetna members?

    Yes. MinuteClinic Video Visits are now covered by most Aetna Commercial plans. Until June 4, 2020, Aetna is waiving member cost sharing for any in-network covered telemedicine visit, including MinuteClinic Video Visits for those plans3. Aetna self-insured plan sponsors offer this waiver at their discretion.

    MinuteClinic Video Visits are also covered by most Aetna Medicare Advantage plans and copays are waived  through September 30, 2020. At this time, MinuteClinic Video Visits are not covered by these plans: Aetna Better Health of Virginia (HMO SNP), Aetna Better Health of Ohio, a MyCare Ohio plan (Medicare-Medicaid Plan), Aetna Better Health of Michigan Premier Plan (Medicare-Medicaid Plan), and Aetna Better Health of Illinois Premier Plan (Medicare-Medicaid Plan).

    Aetna and self-insured plan sponsors, as appropriate, will continue to cover member cost sharing for services included in the Families First Coronavirus Response Act (such as COVID-19 testing and visits resulting in a COVID-19 test).

    Some employers (plan sponsors) do not have Teladoc® and are confused. How does the telemedicine cost share waiver work?

    In order to help members avoid unnecessary exposure to COVID-19, Aetna is encouraging the use of telemedicine for appropriate symptoms or conditions to limit potential exposure in physician offices.

    Teladoc®, MD Live, and other third-party telemedicine vendors, are one way for members to receive a telemedicine visit. Member cost sharing will be waived on any of these visits, subject to claim processing rules and any other requirements in their benefit plan, including whether the vendor’s providers are in-network.

    Telemedicine CPT codes can be found in the internal provider FAQs. Keep in mind, some self-insured plan sponsors may not offer the telemedicine cost share waiver, which would apply to any telemedicine visits (Teladoc® or otherwise), except those mandated by the Families First Coronavirus Response Act (resulting in COVID-19 testing).

    Do the cost sharing waivers for telemedicine and diagnostic testing apply to Aetna Funding Advantage products?

    Yes.

    How is Aetna’s 90-day waiver for member out-of-pocket fees for all telemedicine services compliant with a High Deductible Health Plan?

    The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law on March 27, 2020, indicates that a plan shall not fail to be treated as a high deductible health plan for failing to have a deductible for telehealth and other remote care services.

    Cost-sharing and co-pay waivers announcement (March 25)

    Will Aetna cover the cost of COVID-19 treatment for members?

    Aetna will waive member cost sharing for diagnostic testing related to COVID-19. This policy covers the cost of the office, clinic or emergency room visit that results in the administration of or order for a COVID-19 test. The test can be done by any approved laboratory. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The policy also aligns with new Families First legislation and regulation requiring all health plans to provide coverage of COVID-19 testing without cost share. The requirement also applies to self-insured plans. Per guidance from the Centers for Medicare & Medicaid Services (CMS), the Department of Labor and the Department of the Treasury, all Commercial, Medicaid and Medicare plans must cover certain serological (antibody) testing with no cost-sharing.

    Aetna will waive member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured Commercial and Medicare Advantage plans and is effective immediately for any such admission through September 30, 2020. Self-insured plan sponsors offer this waiver at their discretion.

    Will Aetna cover the cost of COVID-19 treatment for its Medicare members?

    Yes, Aetna will cover the cost for treatment of COVID-19 for our Medicare Advantage members in full in the provider office. We will also cover the cost of the hospital stay for all of our Medicare Advantage members admitted March 25, 2020, through September 30, 2020.

    Will Aetna cover the cost of COVID-19 treatment for its Medicaid members?

    Regulations regarding cost-sharing for Medicaid beneficiaries vary by state and continue to evolve in light of the current situation. We have suspended cost-sharing requirements, including premiums and copays, for adults and children covered by Medicaid and CHIP, in those states where permitted to do so by the appropriate regulators.

    When will Aetna start covering the cost of COVID-19 treatment for its members?

    This change was effective March 25, 2020, and will apply to any such inpatient admission or health complications associated with COVID-19 through September 30, 2020.

    For COVID-19 treatment required prior to March 25, 2020, will cost sharing be waived for Aetna members?

    All claims received for Aetna-insured members going forward will be processed based on this new policy. If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service to so the claim can be reprocessed accordingly.

    How many hospitals are considered in-network?

    More than 6,000 hospitals are part of our network.

    How does this change impact the business going forward? Are premium spikes expected?

    Similar to other COVID-19 waivers previously announced, Aetna-insured plan sponsors can expect the following:

    • Current premiums will not change as a result of COVID-19 or the changes we’ve made to cost sharing policies.

    • We can identify and isolate the direct costs associated with COVID-19, as well as any cost sharing waiver policies that we implement. These costs can be considered separately from “normal” plan costs.

    • We will use sound actuarial principles to set future rates. This may include making adjustments to experience from the COVID-19 outbreak and/or utilizing actuarial and economic models to anticipate future utilization in the wake of the outbreak.

    Treatment Prior Authorization

    Why is Aetna liberalizing prior authorizations now?

    Removing the need for prior authorizations for those members requiring in-patient treatment for COVID-19 allows for delivery of timely and seamless access to care.

    What segments does this liberalization apply?

    All segments – Commercial, Medicare and Medicaid, where applicable by state regulation.

    In what states do prior authorization liberalizations apply?

    We are constantly evaluating the needs based on rising instances of COVID-19 to determine when and how we apply this policy. We’ve made this available in states with highest prevalence of confirmed cases as well as where it’s required by state mandate or gubernatorial suspensions of elective procedures.

    Aetna Dental

    What is considered a dental emergency?

    Aetna will allow your dentist to determine what constitutes an emergency and Aetna will cover emergency care for both PPO and DMO members with no referral required.

    Where can I go for emergency and urgent dental services?

    You should call your dentist’s office to find out how they are handling emergencies and follow their instructions. If you are having trouble reaching your dentist directly, you can contact Aetna member services and our team will assist you with finding a dental provider.

    What if a member’s only option for emergency care is an out-of-network dentist?

    Aetna will pay all out-of-network emergency claims as in-network during this time for both DMO and PPO members.

    What options are there for members who are losing coverage soon and cannot schedule a cleaning before that termination date?

    Aetna will grant an extension once dental offices reopen. More details will be communicated in the coming weeks.

    What is Aetna’s policy on telehealth (tele-dentistry) services for dental members?

    During this time many dentists are offering tele-dentistry services to facilitate emergency oral evaluations of their patients using telephone and video-conferencing capabilities.  We encourage members to contact their current dentist to see if such services are offered.

    If they are being offered, Aetna’s policy has always been that any oral evaluation covered under our dental plans will be reimbursed no matter whether it is performed via tele-dentistry or in a traditional practice setting. Aetna will cover all emergency exams at 100% during the COVID-19 pandemic crisis.

    Does Aetna provide tele-dentistry services for members if my provider doesn’t offer it?

    Yes. Aetna has launched a new tele-dentistry program to provide dental members with a simple, convenient solution to access care from the convenience of their homes.

    How it works:

    • If a member has a dental emergency and their existing provider is not available, they can contact customer service who will assist them in finding a tele-dentistry provider. Members will not be charged for emergency exams provided via tele-dentistry during the COVID pandemic. Aetna will continue to reassess this policy based on need as circumstances warrant.

    • Once the COVID-19 pandemic is over, members will still have access to this tele-dentistry program. Costs for these services will be based on the member’s current benefit plan.

    Aetna Vision

    During this unprecedented time, please know that Aetna is continuing to administer your vision benefits with the same dedicated level of customer service you’ve come to expect. The health and well-being of our members is our top priority, and Aetna is following all COVID-19 guidance and protocols provided by the Centers for Disease Control and Prevention (CDC), as well as state and local public health departments. We recommend that you follow CDC guidelines regarding routine eye exams, including postponing routine visits.

    Many of our clients and members have asked questions about vision benefits and eye safety during the COVID-19 crisis. Below is helpful information regarding vision benefits. We will continue to provide updates as more questions come in.

    Can I still use my vision benefits during this time?

    Yes. We recommend you follow CDC guidelines regarding routine eye exams, including postponing routine visits.

    However, should you need care, lose or break your glasses or require replacement contacts, we recommend calling your provider directly to verify amended store hours or closing. You have 24-hour access to provider contact information via our Provider Locator. You may also call our Customer Care Center directly at 877-973-3238.

    You also have the option of utilizing online in-network options through glasses.com, contactsdirect.com, ray-ban.com, lenscrafters.com, and targetoptical.com. Your Aetna benefits will automatically be applied during checkout, and your glasses or contacts will be mailed directly to your home. Many of these online providers are offering free, expedited shipping and no-cost returns for extra convenience. Check with online providers to verify available offers.

    What if I don’t have a current prescription and cannot leave my home?

    We recommend first contacting your provider to discuss your options. While many states do regulate the expiration timeframe for prescriptions, most providers have the discretion to extend them as they deem necessary.

    If you are unable to reach your provider and you need glasses or contacts in the event of an emergency, please contact our Customer Care Center at 877-973-3238. Members may be eligible to receive an emergency pair of replacement Adlens Adjustable Glasses (subject to availability). These temporary, emergency glasses can be adjusted to switch focus for reading, computer and distance.

    We are continuing to work closely with the American Optometric Association (AOA) and state optometric departments with the goal of providing prescription relief, and we are actively monitoring Department of the Interior (DOI) orders as they relate to vision. Updates will be made available as we have them.

    Note: Regulations have already been changed to allow Medicare members to use expired prescriptions during the outbreak. Medicare members will need to contact the provider they last visited for replacement materials.

    Are telehealth services available for exams?

    At this point in time routine exams still require an in-person office visit.

    Who should I contact if I have an emergency?

    We encourage you to contact your optometrist’s office directly to determine if your condition qualifies as an emergency. If so, they will provide instructions on what to do.

    Where do I go if I have more questions?

    Aetna is here to make things easier for you by providing you with different service options.

    • Our Customer Care Center is available during normal business hours at 877-973-3238 for information on nearby in-network providers and any changes to their hours of operation.

    • 24/7 service is available via aetnavision.com through our mobile app (available on both iPhone and Android). Use these tools to access to provider contact information, your benefits, eligibility and more.

    Specialty – Voluntary

    Voluntary – Accident, Critical Illness, Hospital Indemnity Plans

    Is COVID-19 testing covered under the Health Screening Benefit for Aetna’s Accident, Critical Illness and Hospital Indemnity Plans?

    Yes. If your plan includes a health screening benefit and it hasn’t been used yet this year, you can use the benefit for COVID-19 testing if needed. The claim can be filed the same way as any other health screening benefit. Aetna will pay claims received after March 1, 2020 regardless of the date of service. COVID-19 will also remain on our list of covered health screening benefits.

    Are there other benefits for COVID-19 available in Aetna’s Accident, Critical Illness and Hospital Indemnity Plans?

    Please see below for each plan:

    • The Aetna Hospital Indemnity Plan includes benefits if you need to be hospitalized due to COVID-19, such as hospital admission and daily stay.

    • The Aetna Accident Plan covers accidents and therefore does not pay benefits for COVID-19 or any other illness, unless the plan includes the inpatient sickness rider.

    • The Aetna Critical Illness Plan does not include COVID-19 as a covered condition. However, if a covered condition occurs while being treated for COVID-19, these benefits will cover that condition.

    I have an Aetna Accident plan. Can I use telemedicine services instead of going to the doctor’s office?

    Yes. Aetna's Accident plans include coverage for Telemedicine visits either as a specific Telemedicine benefit (newer Accident plans) or as an Initial or Follow-up Office Visit benefit (older Accident plans).

    If my surgery or other covered service(s) related to a covered accident under my Aetna Accident Plan was postponed due to COVID-19, will Aetna waive the time requirement?

    Yes, Aetna will waive the timeframe for care a member receives related to an accident that’s postponed due to COVID-19. Member must be covered at the time of care and care must be received by December 31, 2020.

    Voluntary – Fixed Indemnity Plan

    Does the Fixed Indemnity plan cover COVID-19?

    The Aetna Fixed Indemnity Plan includes benefits if you need care and treatment related to COVID-19, such as hospital admissions, daily stays, office visits, telemedicine visits, diagnostic testing, x-ray and laboratory services.

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