Temporary Enhancement of health insurance benefits for coronavirus (COVID-19)
Arkansas Blue Cross and Blue Shield and Health Advantage insured members
Arkansas Blue Cross and Blue Shield and Health Advantage are committed to providing health insurance benefits that support the safety and well-being of our members.
In pursuit of that mission, we are working closely with state and federal agencies during the coronavirus outbreak (COVID-19 or "CV") to make it easier for our members to access their health insurance benefits, and thereby hopefully expand access to needed care.
Effective immediately, Arkansas Blue Cross and Blue Shield and Health Advantage have declared a special, temporary benefits enhancement period, running from today's date through May 15, 2020. During this temporary benefits enhancement period (which may be extended if circumstances warrant at the end of the period), we will apply the following health insurance enhancements designed specifically to help our members who may contract the coronavirus, or need testing for potential diagnosis of CV:
No-Cost Access to In-Network CV testing:
From today's date through May 15, 2020, we will waive the normal member cost share (copay, coinsurance and deductible) that otherwise would apply under each fully-insured member's applicable insurance policy or benefit certificate for CV diagnostic testing that is conducted by any in-network provider in accordance with testing protocols or guidelines of the Centers for Disease Control and Prevention (CDC). In short, if a fullyinsured member's in-network provider determines that under CDC guidelines, the member needs to be tested for CV, any normal copay, coinsurance or deductible that the member would otherwise have to pay toward the cost of such testing will be waived during this temporary benefits enhancement period. NOTE: currently, the only CDCapproved screening test for CV is the RT-PCR Test.
Relaxed Paperwork Requirements for Providers to begin testing or treatment of CV:
From today's date through May 15, 2020 we will waive the normal "prior approval" or "prior authorization" requirements that otherwise would apply under some fully-insured members' applicable insurance policies or benefit certificates for CV diagnostic testing or treatment of CV by any in-network provider, provided that all such testing and treatment complies with applicable CDC protocols or guidelines, and with all other requirements of each member's applicable insurance policy or benefit certificate, including the primary coverage criteria as outlined therein.
Waiver of CV Medicine Refill Limitations:
From today’s date through May 15, 2020, we will waive any early prescription medication refill limitations that otherwise would apply for 30-day prescription maintenance medications under each fully-insured member’s applicable insurance policy or benefit certificate for treatment of CV, provided that all such prescriptions comply with applicable CDC protocols or guidelines, and with all other requirements of each member’s applicable insurance policy or benefit certificate, including the primary coverage criteria as outlined therein. In addition, if any CV-treating medication is in short supply or otherwise unavailable, we will expedite review for formulary exceptions to try to minimize or avoid added charges to members for non-formulary alternatives, as clinically appropriate
Arkansas Blue Cross and Blue Shield and Health Advantage will monitor and evaluate the status of CV in our state during the special, temporary benefits enhancement period as defined above, and may decide to extend the benefits enhancement period based on subsequent developments or conditions.
PLEASE NOTE the following important conditions and clarifications that apply to the special, temporary benefits enhancements for fully-insured members outlined above:
This document and the special, temporary benefits enhancements and enhancements period described herein are subject to any different or additional requirements (if any) which may be imposed by law or regulation of the Arkansas Insurance Department, as applicable to Arkansas Blue Cross and Blue Shield or Health Advantage. We will, in every case, comply with applicable laws and regulations, including any which impose new, different or additional requirements for coverage of CV testing or treatment.
For members who are not fully-insured members of Arkansas Blue Cross and Blue Shield or Health Advantage, but instead receive services from our companies’ third party claims administrator divisions (e.g., BlueAdvantage Administrators of Arkansas, or Health Advantage claims administration services for Arkansas State and Public School employees), as part of coverage under their employer’s self-funded health benefit plan, this document and its benefits enhancement statements do not apply to such self-funded members and their self-funded health plan benefits. For all of our self-funded health plan members, any decisions regarding special or enhanced benefits related to CV must be made by each applicable employer and/or Plan Administrator, not by Arkansas Blue Cross and Blue Shield/BlueAdvantage Administrators or Health Advantage.
The benefits enhancements outlined in this document apply solely for and exclusively during the temporary period specified herein and will not be available otherwise or thereafter unless (i) required to be extended by applicable law or regulation; or (ii) Arkansas Blue Cross and Blue Shield and Health Advantage elect, in their sole discretion, to issue a new document that specifically extends such enhancements beyond the defined special, temporary benefits enhancement period defined herein.
The benefits enhancements outlined in this document apply solely and exclusively to testing and treatment for COVID-19 and do not extend to any other form, type, category or classification of testing, diagnosis, conditions, symptoms, illness, medical or psychological advice, counseling, services, medications, drugs, procedures, surgeries or treatments (the preceding excluded elements collectively referred to as “Services”). In short, for any Services other than testing and treatment of COVID-19, this document and the special, temporary benefits enhancements outlined herein do not apply, and all normal health insurance policy and benefit certificate standards, conditions, exclusions and limitatations will instead apply.
Other than the specific, temporary waivers that are spelled out in detail in this document, none of the normal terms, conditions, exclusions and limitations of any member’s health insurance policy or benefit certificate are waived or relaxed in any manner. All other terms conditions, exclusions or limitations in a member’s applicable health insurance policy or benefit certificate continue to apply and must be satisfied in order for any benefits to be paid or payable with regard to CV testing or treatment, or with regard to any other testing or treatment. Such non-waived provisions include but are not limited to such things as eligibility standards, primary coverage criteria, Allowance and Allowable Charge payment limitations (as defined in the applicable health insurance policy or benefit certificate), and network differentials (benefit reductions for use of out-ofnetwork providers).
Unless mandated by law or regulation, no payments made pursuant to this document’s special, temporary benefits enhancements and defined benefits enhancement period will be paid based upon a provider’s billed charges, but, instead, all payment will be made based on the Allowance or Allowable Charge as defined in the member’s applicable health insurance policy or benefit certificate.
Consistent with the normal way in which Arkansas Blue Cross and Blue Shield and Health Advantage insurance policies function, members will always receive a higher level of insurance benefits for covered CV testing or treatment if they utilize an innetwork provider for such services. This document and the temporary, special benefits enhancements outlined herein do not change the normal in-network vs. out-of-network provisions of any Arkansas Blue Cross and Blue Shield or Health Advantage insurance policy or benefit certificate. To the extent that any covered service or treatment is available in-network, and does not involve Emergency Care as defined in the applicable insurance policy or benefit certificate, normal network standards apply, which means that benefits will be reduced by the applicable policy’s network differential (typically 20%) when out-of-network providers are used. It also means that an out-of-network provider can bill the member for the difference between the Allowance or Allowable Charge set by Arkansas Blue Cross and Blue Shield or Health Advantage for in-network services, and the total billed charges that the out-of-network provider chooses to bill. And, finally, it should be noted that the member cost share waivers outlined in this document for the temporary, special benefits enhancement period, will not apply to out-of-network services, meaning members who use out-of-network providers for covered CV testing or treatment will still be responsible for normal copays, coinsurance and deductible (unless CV testing or treatment is not available from an in-network provider, or the services constitute Emergency Care as defined in the applicable insurance policy or benefit certificate).
Federal or state government programs, including the Public Health Service, may cover some or all costs of CV testing; in the event that government program/Public Health Service funding is available for any of our members, we will defer to the funding mechanism and particulars of those programs, meaning that if such programs cover the costs of CV testing, Arkansas Blue Cross and Blue Shield and Health Advantage will not be obligated to make any such payments.
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