COVID-19: Optum Stop Loss – Apex Benefits

Optum

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

Funding: Stop Loss


COVID-19 Diagnostic Testing

Optum Stop Loss will comply with the Families First Coronavirus Response Act that will provide coverage for coronavirus diagnostic testing and associated office/facility visits (including visits provided through telehealth) at no cost to the member. No plan amendment or notice to Optum required.

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

Optum Stop Loss will comply with the Families First Coronavirus Response Act that will provide coverage for coronavirus diagnostic testing and associated office, urgent care and ER visits (including visits provided through telehealth) at no cost to the member. No plan amendment or notice to Optum required.

Treatment

COVID-19 treatment paid with no employee deductible or coinsurance. Optum Stop Loss will be allowing this to be covered by the underlying plan document with no pricing adjustment. Amendment or correspondence is required.

Telemedicine, Virtual Care

Optum Stop Loss will comply with the Families First Coronavirus Response Act that will provide coverage for coronavirus diagnostic testing and associated office/facility visits (including visits provided through telehealth) at no cost to the member. No plan amendment or notice to Optum required.

Medication, Early Refills

Allowed without prior approval but plan should be Optum Policy. Holders that modify plan benefits to allow an early refill on one-time per medication basis can do so at no impact to specific and aggregate premium. No plan amendment required.

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

Optum will follow the terms of the stop loss policy.

Required Documentation to cover COVID-19 mandated benefits

Optum Stop Loss will comply with the Families First Coronavirus Response Act with no documentation required.

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