COVID-19: Coverage for our members
Member coverage and costs for COVID-19 testing
Copays and deductibles are waived for COVID-19 tests deemed medically necessary by a doctor. This means there is no member copay, deductible or coinsurance for diagnostic testing of COVID-19.
Member coverage and costs for COVID-19 treatment
COVID-19 treatment is available to our members with no out-of-pocket health plan costs when received from an in-network provider between the dates of Mar. 11– Dec. 31, 2020.
- If a member visits an out-of-network doctor, their treatment will be covered as outlined by their health plan and cost sharing will apply, if applicable. Note that some plans do not have out-of-network benefits. We encourage members to receive care from providers in our network.
- COVID-19 treatment may be inpatient or outpatient, however, this does not apply to prescriptions. There are currently no official drug treatments for COVID-19.
Learn more or share information with your patients using our COVID-19 FAQ page for members.
Member coverage and costs for virtual visits
In efforts to keep our members safe and healthy, we've continued to expand access to $0 virtual care services beyond COVID-19 related care.
- For dates of service Mar. 19 through Jun. 30, 2020, our members had no cost-share (copays, deductibles or coinsurance) for virtual care codes: 99441-99444, 99421-99423 and 98970-98972. Priority Health Medicare members have had access to $0 behavioral health virtual care since Mar. 19, 2020.
- For dates of service Jul. 1, 2020 through Dec. 31, 2020, we’re covering the cost of all services provided via virtual care or telehealth, including behavioral health, at 100% (no copays, coinsurance or deductibles) for most members*. You should not collect member cost-sharing for services provided virtually.
For more information about billing for virtual visits, HIPAA requirements, telehealth policies and more, visit our COVID-19 virtual visits information page for providers.
*Self-funded employer groups determine benefit coverage for their employees and dependents at their discretion and must opt-in.
Free access to COVID-19 mental wellness tools
To empower our members we've partnered with a digital health specialist to offer free access to MyStrength, a mental wellness resource specifically focused on the COVID-19 pandemic.
For immediate behavioral health support
Our on-staff behavioral health team is available 24 hours a day, seven days a week. Members should call the number on the back of their member ID card or log in to their member center.
Financial relief for members in response to COVID-19
We're offering financial support to our members facing challenges during the COVID-19 pandemic in the form of premium credits and waiving cost share in these ways:
- Medicare Advantage members have no cost-share for in-person and telehealth primary care services May 1 – Dec. 31, 2020. Because we're waiving cost-sharing for these members, providers should not collect copays for these services. Providers will still be reimbursed the full contracted amount for these services.
- MyPriority Individual plan members will have a 15% premium credit for June and July 2020.
Frequently asked questions: member coverage
What options do my patients have for getting prescriptions?
Priority Health members can get free at-home delivery for a limited time through a few retail/local pharmacy vendors. Learn more on our COVID-19 member page in the FAQs.