Information on COVID-19 for Employers and Brokers
MVP Health Care® continues to make the health and well-being of our members our top priority during the COVID-19 (coronavirus) pandemic. We are closely monitoring the virus and taking proactive measures to protect the health and safety of our members, in accordance with the guidelines provided by the Center for Disease Control and Prevention (CDC), New York State, and Vermont authorities.
MVP is also dedicated to ensuring our members, employers, and brokers continue to receive the care and support they need. We have contingency plans to ensure operations are maintained. The MVP Customer Care Center will still be open to answer member and provider questions, authorizations will be completed, and claims will be paid.
Does MVP cover the COVID-19 vaccine?
Yes, the COVID-19 vaccine is covered under all MVP health plans and free for all MVP members. There is no co-pay and $0 cost-share when a member receives the vaccine. Self-insured plan members may incur a cost share for the vaccine administration.
Fully insured and self-insured groups who carve-out pharmacy from MVP will follow standard rules, and administration costs for the vaccine administered by a pharmacist will be covered by the group’s pharmacy plan.
MVP is following state, federal, and the Centers for Disease Control and Prevention (CDC) guidance related to the COVID-19 vaccine and its distribution for New York and Vermont members. We will continue to keep provide updates as information and guidance for the COVID-19 vaccine becomes available.
Is the COVID-19 vaccine safe?
Yes, the COVID-19 vaccine is safe. Vaccines are only given to the public once they are considered safe and are approved by the Food & Drug Administration (FDA). Scientific data—including effectiveness and safety—from the COVID-19 clinical trials has been reviewed by the FDA and a separate independent advisory body, the Advisory Committee on Immunization Practices (ACIP). Learn more about the COVID-19 vaccines.
Experts are still researching the origin of the virus, but believe it is a new respiratory virus called SARS-CoV-2 that is spreading from human-to-human when an infected person coughs or sneezes (as with a cold). There have always been multiple strains of coronavirus; the disease that this new virus causes is called COVID-19 (Coronavirus Disease 2019).
Symptoms can include:
- Fever (most common)
- Shortness of breath/difficulty breathing
- Muscle aches may also occur
The CDC believes symptoms appear in as few as two days or as long as 14 days after direct exposure to the virus. A health care provider can determine the cause of the symptoms.
Protocol for Members with COVID-19 Symptoms
If an employee has been in close contact with a person known to have COVID-19, showing symptoms of COVID-19, or recently traveled from an area with ongoing community spread of COVID-19, he/she needs to be evaluated by a health care provider.
- Call a primary care doctor’s office or urgent care facility before you go to the location, or Start with Gia℠ and select “emergent or urgent care.”
- Wear a mask before you go into a doctor’s office, urgent care facility, or hospital.
- If an employee is low risk for COVID-19, but still feeling sick, consider using telemedicine alternatives.
Telemedicine/Telehealth Services and Coverage
Exclusively from MVP, GiaSM is a “digital front door” that is revolutionizing how patients find, access, and interact with their health care. Available 24/7 by phone, web, or mobile app, Gia expertly assesses members’ health needs and quickly refers them to the right care, including $0 telemedicine services for 24/7 emergency and urgent care, COVID-19 assessment, and in-person care when necessary.* Learn more at GiaforBusiness.com. To get started, download the Gia by MVP app on the Apple App Store or Google Play Store or visit GoAskGia.com.
During the State of Emergency, MVP member cost shares for telemedicine and telehealth services will be waived. This includes MVP’s telemedicine services received through Gia (UCM Digital Health), myVisitNow® (Amwell), and Physera, and telehealth services received from other providers.**
*Offered on all fully insured plans and select self-funded plans. Co-pays/cost-shares apply for in-person visits, per plan details.
**myVisitNow is offered on all large group, small group, and individual fully insured plans and select ASO plans. Physera is offered on all large group fully insured plans and select ASO plans.
Telemedicine services from MVP Health Care are provided by UCM Digital Health, Amwell, and Physera at no cost-share for members. (Plan exceptions may apply.) Members’ direct or digital provider visits may be subject to co-pay/cost-share per plan.
COVID-19 Testing Coverage
MVP continues to follow state and federal guidance related to COVID-19 testing. If COVID-19 testing has been deemed medically necessary, it will be available at no cost share to the member. Additionally, MVP will waive member cost shares for COVID-19 testing on New York fully insured health plans through March 5, 2021, and on Vermont fully insured health plans through July 1, 2021. This includes antibody tests, immunoassays, and testing ordered by a physician for diagnostic purposes.
MVP does not reimburse for COVID-19 tests performed on an asymptomatic individual solely to assess health status, even if required by parties such as government/public health agencies, employers, common carriers, schools, or camps, or when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status.
The Internal Revenue Service announced that high-deductible health plans (HDHPs) can pay for COVID-19-related testing before deductibles have been met. This also means that an individual with an HDHP that covers these costs may continue to contribute to a Health Savings Account (HSA).
COVID-19 Treatment Coverage
MVP will waive the member cost share for COVID-19 treatment on New York fully insured health plans and Medicare Advantage plans through March 31, 2021. Member cost shares for COVID-19 treatment will be waived on Vermont fully insured health plans through July 1, 2021.
Self-funded groups can elect COVID-19 treatment cost shares for their plan participants.
Hydroxychloroquine and Chloroquine
The U.S Food and Drug Administration (FDA) recently approved two drugs through an Emergency Use Authorization to treat COVID-19. However, hydroxychloroquine and chloroquine should only be used by patients who can be appropriately monitored either in the hospital or as part of a clinical trial. These will be covered by MVP for treatment of COVID-19 as part of a member’s inpatient stay (without prior authorization), or if they have met criteria for coverage within a clinical trial.
Hydroxychloroquine and chloroquine remain covered without prior authorization if a member is currently taking for one of the FDA approved indications and has a refill history of the medication. If there is no history and/or diagnosis, the claim will come in for review.
At this time MVP is working to develop a list of appropriate CPT codes for COVID-19 treatment. MVP is not including behavioral health visits as physiological treatment for COVID-19. As a reminder, if a member utilizes myVisitNow or HIPAA-compliant telehealth platform to obtain behavioral health care services, those are available at no cost-share to MVP members during the State of Emergency.*
*MVP SmartFund MSA® members who have not reached their deductible limit will need to cover costs related to COVID-19 testing and treatment, as well as any telemedicine co-pays.
Are adverse reactions to the vaccine covered?
Yes. Treatment for any adverse reactions is medically necessary and covered by MVP. Members should refer to their schedule of benefits or call the Customer Care Center at the number located on the back of their MVP Member ID card for cost share information. Cost share is dependent upon place of service.
Health Care Site of Service Cost Differences
Your employees often have less expensive, more convenient options than the hospital emergency room. The chart below details estimated costs based on site of service for an upper respiratory infection.
Hospital Emergency Room $1,150 Urgent Care $173 Gia℠ $0 The costs above show averages of all rates in the MVP service area. They do not represent a specific region or county in the MVP service area, or any single MVP participating provider’s contracted rates.
New York Open Enrollment Extension Guidelines
New York State is extending the opportunity for uninsured individuals to enroll in a Qualified Health Plan On-Marketplace or Off-Marketplace through December 31, 2021.
Individuals who do not qualify for financial assistance or subsidies can shop for a plan and then enroll directly through MVP’s Shop for a Plan. Individuals who qualify for financial assistance or subsidies should contact NYSOH.
Vermont Special Enrollment Period Guidelines
Vermont has opened a Special Enrollment Period (SEP) for eligible, uninsured individuals and their families to enroll in a Qualified Health Plan through May 14, 2021. Coverage will begin on the following dates:
- Enroll by February 28 for coverage effective March 1
- Enroll by March 31 for coverage effective April 1
- Enroll by April 30 for coverage effective May 1
- Enroll by May 14 for coverage effective June 1
Individuals who do not qualify for financial assistance or subsidies can shop for a plan and then enroll directly through MVP’s Shop for a Plan. Individuals who qualify for financial assistance or subsidies can enroll by calling Vermont Health Connect Customer Support at 1-855-899-9600.
Prescription Medication Refills
MVP Commercial members will be able to obtain an early refill on a 30-day supply of maintenance medications at an in-network retail pharmacy. MVP Medicaid members may be eligible for an early refill of a 30-day supply of a maintenance medication at an in-network retail pharmacy. Medicaid members who are quarantined or whose provider suggests self-quarantine may contact CVS to request a 90-day supply of maintenance medications during the COVID-19 pandemic. MVP Medicare members may request a 90-day supply of medications at an in-network pharmacy (mail or retail). Members should speak with their pharmacist to enter the applicable emergency supply override code into their dispensing systems to trigger the early refill override.
Controlled substances and specialty medications will be exempt from this early refill override process. Please remember that most specialty medications may be obtained from the CVS Specialty Pharmacy, which already mails prescriptions to homes.
Members taking maintenance medications are encouraged to take advantage of the ability to receive a 90-day supply of medication through the CVS Caremark mail order pharmacy to have medications mailed directly to their homes. Some retail pharmacies will also mail prescriptions to a home address. Members should ask their pharmacist if this is an option.
COVID-19 Claims Codes
Coding for COVID-19 is in process. MVP providers have been notified of coding requirements related to COVID-19.
Employer Group Billing Policy
MVP is committed to making sure you have the health insurance coverage you need during the COVID-19 State of Emergency. While you are no longer able to defer premium payments, if you have experienced financial hardship please call your broker, MVP Account Representative, or MVP Premium Billing Representative to discuss your options.
Ancillary Product Changes Due to COVID-19
Flexible Spending Account Changes
The Consolidated Appropriations Act (CAA) and the American Rescue Plan Act (ARPA) extend many relief measures that were created by the Families First Coronavirus Response Act (FFCRA) and the Cares Act. The CAA and ARPA provide temporary relief for Medical FSAs, Dependent Care FSAs, and Limited Purpose FSAs. Employers are not required to apply these amendments. However, they can be used to provide employees with additional flexibility. If you would like to make a change to your FSA per the CAA or the ARPA, please review the available options and complete the FSA Amendment Form for Employers. Once completed, please return the form to your MVP Account Manager.
To comply with the provisions of Circular Letter 17 issued by the New York State Department of Financial Services (DFS) and to help expand hospital bed capacity in preparation for a surge of COVID-19 cases, MVP will be suspending pre-authorizations for the following services from December 23, 2020 through February 21, 2021:
- Urgent or non-elective scheduled in-patient surgeries or admissions
- Patient transfers between hospitals
- Home health care following discharge from an inpatient stay
- Inpatient rehabilitation and inpatient mental health services following an inpatient hospital stay
Pre-authorization will remain in place for all elective services performed.
Ambulance Claim Coverage
Effective March 13, 2020, Vermont members will have no cost-share for an ambulance claim if they have been diagnosed with COVID-19 or they have symptoms of COVID-19 (cough, shortness of breath, fever).
MVP will waive cost-shares for all in-person, in-network behavioral health services, including mental health and substance use disorders, for most MVP Commercial members in New York State until the State of Emergency is lifted, retroactive to May 2, 2020. Members enrolled in a qualified high-deductible health plan are responsible for their cost-shares until their deductible is met.
Self-funded employers can elect to waive cost-shares for in-person, in-network behavioral health services.
Information regarding COVID-19 is subject to change.