Dear PEC Members:
The MA Division of Insurance issued a Bulletin addressing COVID-19 testing and treatment. A copy of the Bulletin is attached. The Bulletin imposes requirements on insurers that are focused on (1) ensuring that members can obtain all medically necessary and appropriate testing and treatment for COVID-19 and (2) fighting the spread of COVID-19.
The Bulletin is mandatory for fully-insured groups but optional for self-insured groups like the City. To protect the health and wellness of our employees and their dependents, the City will adopt the requirements in the Bulletin. The City will take direction from the Division of Insurance as to the expiration of the requirements in the Bulletin.
In accord with the Bulletin, on a non-precedent setting basis, during the effective dates of the Bulletin, the City will:
Remove co-pay, co-insurance, or deductibles for medically necessary testing, counseling, and vaccination (once available) for COVID-19 provided at in-network doctors’ offices, emergency rooms, and urgent care centers for all members. This also applies to out-of-network doctors’ offices, urgent care centers, and emergency rooms when access to urgent in-network testing and treatment in accord with Massachusetts Department of Public Health (“MDPH”) and Center for Disease Control (“CDC”) requirements is not available from in-network providers.
Remove co-pay for medically necessary COVID-19 treatment, in accord with MDPH and CDC guidelines, at in-network doctors’ offices, emergency rooms, and urgent care centers. This also applies to out-of-network doctors’ offices, urgent care centers, and emergency rooms when access to in-network alternatives is not available.
Eliminate cost-sharing for Telemedicine.
Further, for the duration of the effective dates of the Bulletin, our insurance carriers will remove administrative barriers, such as prior authorizations and referrals, for medically appropriate care for COVID-19. They will also, for the duration of the effective dates of the Bulletin, establish a dedicated Coronavirus helpline, advise members of their benefits, and encourage members to use Telemedicine.
Please share this information with your members as soon as possible.
If you have any questions or concerns or need any additional information, please contact Marianna Gil at 617-635-4570 or each respective carrier as follows:
AllWays Member Services: 1-866-567-9175
BCBS Member Services: 1-800-262-2583
HPHC Member Services: 1-888-333-4732