COVID-19: UHC & UMR Carrier Information - Apex Benefits

UnitedHealthcare & UMR

This information is subject to change and is being updated daily, as necessary. Please contact your Account Executive for more information.

UnitedHealthcare: Fully Insured


Effective Date

  • 4/1/2020 but will allow retroactive service dates

COVID-19 Diagnostic Testing

Tests must be FDA approved, medically necessary and ordered by a qualified medical professional. Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans) Employers will automatically be opted into this benefit unless UMR/UHC is notified

COVID-19 Office Call / Urgent Care and ER Associated Charges when filed with Testing

Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans) Employers will automatically be opted into this benefit unless UMR/UHC is notified

Treatment

Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans) Employers will automatically be opted into this benefit unless UMR/UHC is notified

Telemedicine, Virtual Care

Virtual Visits through Teladoc, Doctor On Demand and AmWell as well as Designated Virtual Visit Providers: Member Cost Share will be waived to encourage virtual visits rather than in home or ofice visits.

UHC will waive cost share for all virtual visits (even those not associated with the COVID-19 virus). This will continue through June 18.

UHC has expanded provider Telehealth Access to any provider able to meet the published criteria (these providers are not Designated Virtual Visit Providers). For these visits, cost share will be waived only for those visits associated with COVID-19 Testing.

https://www.uhc.com/health-and-wellness/health-topics/covid-19

Medication, Early Refills

Optum: Early refills are not encouraged but are available by calling customer service.

Will Carrier provide Stop Loss coverage if a Special Enrollment Period is offered for 4/1 effective date?

UHC is allowing employers to rollout an off-cycle enrollment event so that those having waived coverage previously could now enroll. The allowed period is 3/23-4/6/2020 for a 4/1 Effective Date. For those employers with scheduled OE during March and April 2020, UHC will automatically enroll members to their existing 2019 plan option updated for 2020 rates and benefits. UHC wil allow up to 30 days post renewal to advise of changes.

Any limitations to off-cycle Benefit Changes to reduce cost?

UHC will allow an employer with a single benefit plan to change that plan mid-year to a leaner plan design but will not allow an employer with multiple plans to to add an additional leaner plan.

Helpful Information and Tools

  • UHC is offering help to employees who are losing their health insurance coverage. Interested people should call 800-827-9990 to speak to an advisor.
  • Encourage registration at UHC and UMR.com now so if/when needed they will have access to additional resources.
  • UHC has made an emotional support help line free of charge to members and non-members: 1-866-342-6892
  • See Liveandworkwell.com for more information https://www.uhc.com/health-and-wellness/health-topics/covid-19
  • https://sydneycare.ai/

Special Consideration for customers forced to lay people off due to financial strain

Relaxing the AAW requirement through 5/31/2020. Allow allowing for reduced hours during this time. Will allow employers to waive the New Hire Waiting Period for those laid off due to COVID-19 upon return to work.

Grace Day Extension for Claims

n/a

Grace Day Extension for Premiums

UHC has not officially extended the grace period but may entertain on a case by case basis. Contact your Account Executive

Required Notice for communicating plan changes

No response but assume it will vary depending upon what is in the pipeline

UnitedHealthcare/UMR: Self Insured


Effective Date

  • 4/1/2020 but will allow retroactive service dates

COVID-19 Diagnostic Testing (includes antibody testing)

Tests must be FDA approved, medically necessary and ordered by a qualified medical professional. Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans) Employers will automatically be opted into this benefit unless UMR/UHC is notified

COVID-19 Office Call / Urgent Care and ER Associated Charges when filed with Testing

Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans) Employers will automatically be opted into this benefit unless UMR/UHC is notified

Treatment

Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans) Employers will need to opt into this benefit.

Telemedicine, Virtual Care

Virtual Visits through Teladoc, Doctor On Demand and AmWell as well as Designated Virtual Visit Providers: Member Cost Share will be waived to encourage virtual visits rather than in home or office visits for services related to testing for COVID-19.

UHC has expanded provider Telehealth Access to any provider able to meet the published criteria (these providers are not Designated Virtual Visit Providers). For these visits, cost share will be waived only for those visits associated with COVID-19 Testing.

Note: Customer must have Telehealth covered under the medical plan in order for these providers to be reimbursed.

https://www.uhc.com/health-and-wellness/health-topics/covid-19

Medication, Early Refills

Optum: Early refills are not encouraged but are available by calling customer service.

Will Carrier provide Stop Loss coverage if a Special Enrollment Period is offered for 4/1 effective date?

UHC-BP stop loss will not agree to coverage for newly enrolled individuals covered if a customer holds a Special Enrollment

Any limitations to off-cycle Benefit Changes to reduce cost?

n/a

Helpful Information and Tools

  • UHC is offering help to employees who are losing their health insurance coverage. Interested people should call 800-827-9990 to speak to an advisor.
  • Encourage registration at UHC and UMR.com now so if/when needed they will have access to additional resources.
  • UHC has made an emotional support help line free of charge to members and non-members: 1-866-342-6892
  • See Liveandworkwell.com for more information https://www.uhc.com/health-and-wellness/health-topics/covid-19

Special Consideration for customers forced to lay people off due to financial strain

UHC-BP stop loss- If group is subject to COBRA, as long as one person remains actively employed, terminated employees may elect to continue coverage under COBRA. For furloughed employees, as long as they remain an active employee during these periods, they will be covered. As long as employer continues to pay admin and claims costs along with the stop loss premium the individuals may continue to be covered

Grace Day Extension for Claims

No

Grace Day Extension for Premiums

No extension

Required Notice for communicating plan changes

No response but assume it will vary depending upon what is in the pipeline

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