COVID-19: Anthem Carrier Information – Apex Benefits

Anthem

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

Anthem: Fully Insured


Effective Date

  • For COVID-19 Testing, retro to 1/1/2020
  • Telemedicine 3/17/2020

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)

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)

Treatment

Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans)

Telemedicine, Virtual Care

~March 17 – June 14

Deductible, copayments and coinsurance are being waived for eligible telehealth visits including visits for mental health (including High Deductible Health Plans).

These visits do not need to be associated with the COVID-19 Virus.

  • The providers are not limited to Telehealth providers.
  • Any contracted provider is able to bill for Telehealth Services during this time.
  • LHO Fees: $59 Medical and $75-$175 for Mental Health.
  • Virtual Care Text Sessions now available by downloading the Sydney Care mobile app. Members will be allowed one virtual text session at no cost between now and June 14, 2020. Subsequent Virtual text sessions will cost $19  https://sydneycare.ai/

Medication, Early Refills

Relaxed early refill limits for members who wish to receive a 30-day supply of most maintenance medications, where permissible. Anthem recommends members speak with their physician about converting their 30-day prescriptions to 90-days prescriptions for convenience.

Special Enrollment Provision

Allowing employers to rollout an off-cycle enrollment event so that those having waived coverage previously could now enroll. The allowed period is 3/23-4/15/2020 for a 4/1 effective date. Enrollment must be submitted by 4/20.

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

Contact account executive

Helpful Information and Tools

The Sydney Care Mobile App will provide convenient support immediately in terms of checking for symptoms and connecting with a doctor via a Virtual Care text session (based upon the CDC and NIH guidelines) to help individuals quickly and safely evaluate their symptoms and assess their risk of having COVID-19. Based on the results, Anthem members will be able to connect directly to a board-certified doctor via text or secure two-way video via the Sydney Care app who can then recommend care options.

Sydney Care is available for Anthem members to download on Android or iOS. This app should accompany their Sydney Health or Engage benefits app. Coronavirus Assessment is live. https://sydneycare.ai/

Emotional support by way of Anthem EAP is being offered to all Anthem customers. AnthemEAP.com. Log in and find the EAP Can Help tab.

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

Are customers able to continue employee health benefits if part of the workforce is laid-off in response to the COVID-19 crisis?

Fully Insured Plans: Yes. Anthem’s requirement for employees to be actively working in order to be eligible for coverage will be relaxed through July 31, 2020 as long as the monthly premium payment is received. Coverage must be offered on a uniform, non-discriminatory basis to all employees and employee premium contributions must be the same or less prior to the layoffs.

Grace Day Extension for Claims

n/a

Grace Day Extension for Premiums

Anthem will not allow an extension.

Required Notice for communicating plan changes

30-90 days depending upon complexity and system/platform

Anthem: Self Insured


Effective Date

  • For COVID-19 Testing, retro to 1/1/2020
  • Telemedicine 3/17/2020

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)

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)

Treatment

Deductible, copayments and coinsurance are waived (including Qualified High Deductible Health Plans)

Telemedicine, Virtual Care

Recommends following fully insured. Anthem reaching out directly to employers for decision.

Medication, Early Refills

Recommends following fully insured. Anthem reaching out directly to employers for decision.

Special Enrollment Provision

Allowing employers to rollout an off-cycle enrollment event so that those having waived coverage previously could now enroll. The allowed period is 3/23-4/3/2020 for a 4/1 effective date.

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

Contact account executive

Helpful Information and Tools

The Sydney Care Mobile App will provide convenient support immediately in terms of checking for symptoms and connecting with a doctor via a Virtual Care text session (based upon the CDC and NIH guidelines) to help individuals quickly and safely evaluate their symptoms and assess their risk of having COVID-19. Based on the results, Anthem members will be able to connect directly to a board-certified doctor via text or secure two-way video via the Sydney Care app who can then recommend care options.

Sydney Care is available for Anthem members to download on Android or iOS. This app should accompany their Sydney Health or Engage benefits app. Coronavirus Assessment is live. https://sydneycare.ai/

Emotional support by way of Anthem EAP is being offered to all Anthem customers. AnthemEAP.com. Log in and find the EAP Can Help tab.

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

Are customers able to continue employee health benefits if part of the workforce is laid-off in response to the COVID-19 crisis?

Self-Insured Plans: Yes. Payment of administrative fees, claims cost and stop loss premium is required to continue to continue coverage for laid-off employees who are not actively at work. Coverage must be offered on a uniform, non-discriminatory basis to all employees and employee premium contributions must be the same or less prior to the layoffs. If Anthem is not a customer’s stop loss carrier, Anthem recommends verifying coverage with the customer stop loss carrier.

Grace Day Extension for Claims

Anthem will not allow an extension.

Grace Day Extension for Premiums

Anthem will not allow an extension.

Required Notice for communicating plan changes

30-90 days depending upon complexity and system/platform

Anthem: Life & Disability


Additional Help

Resource Advisor automatically comes with Anthem Life and Disability. There are resources on the website including information on how to tap into the LiveHealth Online video chat for counseling needs

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