Trust Plan Coverage during the COVID-19 Pandemic
The O’Grady Catholic Health Trust is committed to the health and safety of our members during the current coronavirus (COVID-19) outbreak. Effective March 6, 2020, CareFirst Administrators (CFA) has made important benefit updates to our Plan to remove cost and other barriers to ensure all of their members have access to necessary care.
The Trust has determined that the changes described below are necessary and will apply for the duration of the pandemic:
- Copays, Deductibles, and Coinsurance are waived for the following:
- Testing or treatment related to COVID-19
- Office Visits related to COVID-19
- Treatment of COVID-19
- MDLIVE Video Visits for medical visits (including lactation support, nutrition counselling and urgent care services) and behavioral health visits
- Telephone Calls with providers – for clinical staff of primary care, general practice, internal medicine, pediatrics, OBGYN and associated nurse practitioners
- The plan will cover in-network and out of network** visits 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, the Plan pays 100% up to our allowed amount, but member may be balance billed.
- The plan will cover 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, the Plan pays 100% up to our allowed amount, but member may be balance billed.
- CFA has eliminated prior authorization requirements for diagnostic tests and covered services that are medically necessary and consistent with CDC guidance for members diagnosed with COVID-19. Additionally, members can call the customer service phone number on the back of their member ID card for help with questions related to medical services.
- CFA is waiving early medication refill limits on 30-day maintenance medications (consistent with our benefit plan) and encouraging members to use their 90-day mail order benefit. Member cost sharing will apply as normal. CFA will also ensure formulary flexibility if there are shortages or access issues. Members will not be liable for additional charges that stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.
- Antibody Testing is covered at 100% with a doctor’s order