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Extension of Member Cost-Share Waiver for COVID, non-COVID Telehealth Services

Audience: Professional Providers and Certified Home Healthcare Agencies

Member Cost-Share for Telehealth Services 

  • For Medicare Advantage members, we will continue to cover both COVID-19 and non-COVID-19 related telehealth services with no member cost-share through the end of the public health emergency, currently set to expire January 21, 2021. This date may be extended based on NYS and/or federal requirements.

COVID-19-Related Telehealth Services

  • Under federal guidance, COVID-19-related telehealth services will remain covered in full with no member cost-share through the end of the federal public health emergency (which is currently set to expire January 21, 2021) for all lines of business.

Non-COVID-19-Related Telehealth Services

  • In accordance with the NYS emergency regulation, for members covered by commercial fully insured products and members enrolled in self-funded groups that opted in to waive member cost-share, all telehealth services (COVID-19 and non-COVID-19) must be covered in full with no member cost-share through the expiration of the NYS emergency regulation (which is currently set to expire on January 8, 2021; date subject to change). For these members, we will re-institute the customer cost-share responsibility under the member’s benefit for non-COVID-19 telehealth services when the NYS emergency regulation expires.                                     
  • Some of our self-funded groups have opted out of waiving member-cost share for non-COVID-19 services provided via telehealth. The list of those groups who have opted out was included in our communication to you dated August 17, 2020.  You should apply member cost-share (i.e., copay, coinsurance, deductible) for non-COVID-19 related telehealth services provided to our members who have coverage through the employer groups who have opted out of coverage in full for non-COVID-19 services.  Be sure to check eligibility and benefits using our online tool to confirm coverage and cost-sharing details for our members.

Reimbursement for Telehealth Services

As previously communicated, we will continue to reimburse all telehealth services at the same rate as the corresponding face-to-face CPT/HCPCS code through at least December 31, 2020. This applies to all lines of business and may be extended for some or all programs based upon NYS and/or federal requirements. We will determine an appropriate level of reimbursement for telehealth services for 2021 and will provide advance written notice of any changes.

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