Information on COVID-19 for Employers and Brokers
Updated May 19, 2020:
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.
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 use MVP’s myERnowSM (virtual emergency room services).
- 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
myERnow is powered by United Concierge Medicine (UCM) and is a virtual emergency room telemedicine service. At no cost to MVP members, myERnow offers 24/7 access to trained emergency room providers who can diagnose, prescribe medications when appropriate, order labs/diagnostic imaging, and make any necessary referrals to specialists. myERnow providers also routinely follow up with members post-visit to ensure their health care needs were met. Self-funded employers can choose to offer this benefit to their employees.
MVP members can download the myERnow app by searching “myERnow” in the App Store® or Google Play™, or call 1-833-myERnow (1-833-693-7669). For more information, visit mvphealthcare.com/myERnow.
If employees feel sick but are at low risk for COVID-19 based on their symptoms, they should consider myVisitNow to avoid potential exposure. MVP members will now have access to $0 telemedicine visits through myVisitNow for the duration of the State of Emergency. Self-funded plan participants should contact their employer to understand if they have the myVisitNow benefit as part of their MVP plan.
Other Telehealth Solutions
Telehealth visits offered by providers in the MVP network will also be available at no-cost to members.
COVID-19 Testing Coverage
MVP continues to follow state and federal guidance related to COVID-19 testing. At this time, MVP will waive member cost-shares for FDA-approved COVID-19 antibody tests and immunoassays (qualitative, semiquantitative, and single step method) for all members. MVP will waive member cost-shares for all additional FDA-approved, medically necessary COVID-19 testing ordered by a physician for diagnostic purposes.
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 costs for COVID-19 treatment at any site of service, including inpatient hospitalizations, emergency room visits, and urgent care visits for members on most plans. Claims from 4/1/2020 through 5/31/2020 will be reviewed and processed with no member cost-share.
Medications administered in the hospital for the treatment of COVID-19 are covered under the hospital charges at no cost-share to the member through May 31, 2020. Prescriptions filled during the illness would be covered under the member’s standard prescription drug coverage.
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.
Self-funded employer groups have the option to waive COVID-19 treatment costs for their plan participants.
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.
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 myVisitNow $49 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.
Special Enrollment Period Guidelines
New York State and Vermont are allowing individuals to enroll in a Qualified Health Plan On-Marketplace or Off-Marketplace during a Special Enrollment Period. New York State and Vermont individuals may enroll through June 15 with coverage effective June 1 or July 1.
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
In an effort to provide much-needed health care services to our members, we are following our current premium payment policies for our large group employer clients.
The New York State Department of Financial Services recently issued emergency regulations which allow QHP Individual contract holders, Student Plan policyholders, CHP full pay policyholders, and Small Group policyholders the ability to defer premium payment until 11:59 p.m. June 1, 2020 if they can attest to financial hardship. MVP has communicated these new guidelines to the above constituents in writing. The COVID-19 Financial Hardship Attestation can be found here.
Over-the-Counter Item Eligibility for HSAs, FSAs, and HRAs
The Special Interest Group for IIAS Standards (SIGIS) has amended the CARES Act to add over 17,000 over-the-counter (OTC) items and menstrual care items to the list of qualified medical expenses for Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Health Reimbursement Arrangements (HRA).* Since menstrual care items have never been qualified, they will need to be reviewed before being added to the list. Menstrual care items will likely be approved on or around May 15.
MVP members may choose to use their CareFund Debit Card® to pay for qualified OTC and menstrual care items. These purchases may be declined for members with an FSA or HRA due to merchants (i.e. pharmacies, grocery stores) having out-of-date Inventory Information Approval Systems (IIAS). If this occurs, members can still pay for their qualified items out-of-pocket and submit a claim to MVP for full reimbursement out of their FSA or HRA. Purchases will not be declined for members with an HSA as these accounts are not subject to the IIAS, but members should continue to retain receipts for purchases made with their HSA for reference.
Members can use MVP’s myHealthSpend app Check Item Eligibility feature to scan the item’s barcode and see if the item is eligible for reimbursement. As SIGIS adds qualified items to the list, they will populate as eligible in the myHealthSpend app.
*It is the employer’s choice to allow for reimbursement of OTC items out of an HRA.
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).
myVisitNow from MVP Health Care is powered by American Well. Regulatory restrictions may apply.
Information regarding COVID-19 is subject to change.