Trust Plan Coverage as it relates to COVID-19

March 20, 2020

Trust Plan Coverage as it relates to COVID-19

An update from CareFirst Administrators as of 3/18/2020:

As a mission-driven healthcare company, the actions we take in times of significant public health concern are critical to caring for the people we serve. Our associates have risen to the occasion to ensure CareFirst can support appropriate public health readiness and response.

With the World Health Organization (WHO) declaring a pandemic, the United States declaring a state of emergency, and many state and local governments instituting enhanced measures, we continue to closely monitor information shared by the Centers for Disease Control (CDC) and coordinate with state and local health departments. The CareFirst leadership team and our clinical staff throughout the company are working around the clock to understand and respond to new developments, anticipate needs and institute proactive steps. We are taking all appropriate precautions to protect our staff, ensure business continuity and take responsible action as we do our part to protect communities and respond to community healthcare needs.

While all our plans contain coverage for the treatment of illnesses, we are now taking additional measures to ensure members are not subject to deductibles, copays or coinsurance as indicated below. These changes are effective retroactively for dates of service on and after February 4, 2020 and will be in effect for the duration of the public health crisis. We are taking this action because the COVID-19 outbreak poses a unique and serious threat. To best support public health readiness and response, we cannot allow financial barriers to interfere with members getting the care they need in the safest possible setting. Through these enhanced policy measures, combined with responsible public and private action, we can collectively help to mitigate the impact of this disease in our workplaces and communities.

CareFirst will be taking the following actions:

• In response to CDC and public health officials’ strong recommendation to practice social distancing , encouraging the use of telemedicine, telephonic consultations, and virtual sites, offered through CareFirst Administrators or direct partnerships
• Copays, coinsurance, and deductibles* will be waived for the duration of this public health emergency for the following:
  • Testing related to COVID-19
  • Office Visits related to COVID-19
  • Treatment of COVID-19
  • CareFirst Administrators Video Visit (MD LIVE)– for medical visits, including lactation support, nutrition counselling and urgent care services
  • Telephone Calls with providers – for clinical staff of primary care, general practice, internal medicine, pediatrics, OBGYN and associated nurse practitioners
• Covering in-network and out of network** visit to diagnose or test for COVID-19 regardless of the care setting (doctor’s office [online/telephonic/in person], urgent care, ER, etc.). When services are rendered in-network, member cost share (copays, coinsurance and deductibles) will be waived. When services are rendered out-of-network, CareFirst Administrators/Plan Sponsor pays 100% up to our allowed amount, but member may be balance billed.
• Covering the medically necessary in- and out-of-network** treatment for members who have been diagnosed with, or are strongly suspected of having, COVID-19. When services are rendered in-network, member cost share (copays, coinsurance and deductibles) will be waived. When services are rendered out-of-network, CareFirst Administrators/Plan Sponsor pays 100% up to our allowed amount, but member may be balance billed.

CareFirst Administrators is committed to doing the right thing for our members during this time of crisis and believe all of these actions collectively bundled (including the waiver of testing communicated on March 12^th) to remove financial barriers for our members will have a positive impact. 

* CareFirst Administrators will follow IRS guidance for members who are enrolled in high-deductible health plans.  (Diagnostic testing for COVID-19 will not be subject to deductible or coinsurance for HSA plan participants.)**

**CareFirst Administrators will process and pay medically necessary and appropriate out-of-network claims at the in-network level.  The member will be responsible for the difference between the CareFirst allowed amount and the out-of-network provider’s billed charge.

In addition to supporting our members when they need us most, CareFirst has taken the following actions to protect our staff and ensure business continuity.

• Established an internal Coronavirus task force that meets daily and is leading all efforts to escalate concerns, provide direction, share information, and respond to questions.
• Audited divisional Business Continuity Plans.
• Stress-tested operational areas to assess telework and remote capabilities.
• Implemented temporary meeting and travel policies.
• Implemented enhanced remote work accommodations, prioritizing those most impacted or at risk and enabling substantially expanded remote work capacity.

As CareFirst associates, we are all doing our part to stay informed and to be practical. We’ve been encouraged by our leaders to consider our role in protecting those who are most at risk in our communities. Everyone in our organization has been advised that, even if they feel healthy and confident, making reasonable adjustments to personal habits can protect others in the community and help hospitals and doctors maintain the capacity they need to effectively care for the sick.

Supporting members we serve is at the core of what we do at CareFirst. Please visit www.carefirst.com to view a message from our President & CEO, Brian Pieninck, which provides additional information around our stance during this time of crisis.  As things are changing rapidly in relation to the conditions and recommendations, we ask that you visit our website for the most up to date information.