We are offering financial support to our members and employers facing challenges during the COVID-19 pandemic in the form of premium credits and waiving cost share in these ways:
- As of Jan. 1, 2021, we added $0 virtual visits* for behavioral health so all Priority Health Medicare Advantage members can see in-network primary care, specialists and behavioral health providers and pay a $0 copay as part of their medical benefits through 2021. Out-of-network virtual visits are typically not covered but have been due to COVID-19 as a service to our members. This exemption will continue through Jul. 31, 2021. After that, out-of-network virtual visits will not be covered.
- MyPriority Individual plan members will have a 15% premium credit for June and July 2020.
- Small group employers (2-50 employees) will have a 15% premium credit issued in June and July 2020.
- Large, fully funded employers will have the opportunity for premium credits in the fourth quarter, when the total amount of excess funds available can be determined.
*Excluding the Vital plan, which has 20% coinsurance for virtual visits
Why distribute excess funds?
With many health procedures either being delayed or canceled due to COVID-19, and members accessing fewer health care services overall, our expected costs have been reduced. Our team is focused on people, not profits, so we will return any revenue above our low, ten percent administrative rate back to employers and members.
We do not pay dividends to shareholders, which allows us to spend more on member care. And, we operate with some of the lowest administrative rates in the country, spending 90 cents1 of every dollar on member care.
Many members are suffering and we’re working hard to offer them resources and support, while also constantly looking for ways to make their coverage more affordable.
What other types of support are available?
We don’t want cost to be the reason someone loses coverage or avoids seeking treatment, so we offer our members, employers and physician and provider partners support in the following ways:
- Fully covering the cost of physician-ordered COVID-19 testing for all members
- Waiving all copays, deductibles and coinsurance for the treatment of COVID-19 from in-network providers through Sept. 30, 2021.
- Expanding $0 virtual care to most members for routine care through Dec. 31, 2020
- Expanding free home medication delivery for all members
- Providing free access for all members to myStrength, an online mental wellness tool
- Accelerating value-based payments and quality bonuses to offer physician and provider partners financial stability
- Offering flexibility to employer groups on premium payments and eligibility criteria
1 According to Priority Health Medical Cost Ratio for most recent fiscal year ending June 30, 2019.