Insurance committee waives cost-sharing for COVID-19 testing

TSEA March 18, 2020 Comments Off on Insurance committee waives cost-sharing for COVID-19 testing
Insurance committee waives cost-sharing for COVID-19 testing

Staff Report

With concerns of COVID-19 spreading across Tennessee, many state employees are not only worried about exposure to the virus but how will testing for it be covered. State, local education, and local government insurance committee members approved on Tuesday to waive member cost-sharing for COVID-19 testing and evaluation, effective immediately. 

This special committee meeting was called in response to Gov. Bill Lee’s Executive Order No. 14 and the COVID-19 guidance outline by the TN Department of Commerce and Insurance. 

The benefits modifications include waiving member cost-sharing on in-network COVID-19 testing and in-network outpatient visits (provider’s office, urgent care, telehealth, emergency room) when the visit leads to a COVID-19 test, as well as any services (imaging, lab procedures) performed at the visit during which the COVID-19 test is performed. 

There are three types of cost-sharing: co-payment, deductibles, or coinsurance. 

For telehealth visits, a COVID-19 test must occur within 48 hours of the telehealth visit for the cost of the telehealth visit to be waived. The benefit recommendation does not include waiving member cost-sharing for future treatment associated with COVID-19. Future treatment would fall under the current benefit structure.

This benefit takes effect immediately and could also include prior claims, which meet these requirements.

The Benefits Administration also approved Pharmacy Benefits Manager, CVS Caremark, to relax early refill timelines on 30-day and 90-day prescriptions for maintenance medications at any in-network pharmacy. Members may now fill maintenance medication prescriptions ahead of schedule.

COVID-19 updates are ongoing, and the Benefits Administration will continue to monitor the situation as it evolves.  In the event that federal mandates dictate coverage or other rules that differ from state mandates or approvals granted by the Insurance Committees, federal law will prevail.   

TSEA is monitoring the ongoing coronavirus (COVID-19) outbreak. The situation is rapidly changing, so TSEA has compiled links and resources so you can have quick access to the most up-to-date information. To view the resource list, click here.

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