COVID-19: Coverage for our members
Last updated: Dec. 2, 2020
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– Mar. 31, 2021.*
- Covered treatment may be inpatient or outpatient from an in-network provider. Patients must have a confirmed primary COVID-19 diagnosis and be receiving evidence-based care for treatment to be fully covered.
- 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.
Learn more or share information with your patients using our COVID-19 FAQ page for members.
*Employer plans that are self-insured determine benefit coverage for their employees and dependents at their discretion.
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, 2021, 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. Our Medicare Vital plan has 20% coinsurance for virtual visits.
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 PCP visits through Mar. 31, 2021 and telehealth primary care, specialty and behavioral health services May 1 - Dec. 31, 2021***. 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.
***Excluding the Vital plan, which has 20% coinsurance for virtual visits.
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.