Updated November 25, 2020
We recognize the challenges COVID-19 and associated state and federal mandates regarding business operations pose to you, your employees, and your business. Our top priority is connecting your employees to care and supporting you, our valued business partners, during this evolving crisis.
The following information is a compilation of the most frequent questions we have received to date. We have attempted to provide responses that apply in the broadest sense. As always, your account executive is always available to answer questions specific to your plan.
The health of our members is our top priority. Read the latest actions we’re taking to support our members.
No pre-auth and cost-shares for COVID-19 testing and treatment
No pre-authorization is required for COVID-19 testing if determined necessary by a doctor.
Antigen and molecular diagnostic testing, including provider visit, is covered with no cost share, including those with high-deductible health plans with HSAs. Tests must be performed at a CLIA-certified lab, or the test manufacturer must have FDA Emergency Use Authorization.
Through March 31, 2021, no cost shares (deductibles, copayments and coinsurance) or pre-authorization for members’ COVID-19 treatments at in-network providers.
We also cover COVID-19 antibody tests at no member cost share when ordered by a member’s attending physician and part of appropriate medical care. Tests must be performed at a CLIA-certified lab, or the test manufacturer must have FDA Emergency Use Authorization.
- As with other tests for employment, such as drug tests, COVID-19 testing for employment, surveillance, or extracurricular activities, such as travel, school, sports or summer camps are not covered by insurance.
Enhanced support for high-risk members
We’re in contact with high-risk members using our case management services to ensure they have the support they need.
As we learn of members diagnosed with the virus, we are reaching out to provide personalized support.
- We’re moving members on infused medications from hospital to home settings or infusion centers.
Access to needed medications
Members can request a 90-day refill of medications for chronic conditions such as heart disease, asthma, diabetes and others. Some drugs are not eligible for extended day supply, including controlled substances and certain specialty drugs (ineligible drugs are those in the “Narcotics” section or marked “SP” on our drug lists).
- Members with prescription coverage through Regence can order home-delivery prescriptions through the AllianceRx Walgreens Prime website.
Enhancing coverage for virtual care
To help slow the spread of infection and ease pressure on providers’ offices and emergency rooms, we’ve enhanced coverage for virtual care:
Members have access to telehealth vendors that provide services such as video visits and secure messaging with doctors and nurses, and home health visits in select areas. These options may differ by employer, and employers can consult their summary of benefits coverage (SBC) for their specific telehealth offering. Employees should sign-in or create an account on regence.com, or download the Regence app, to learn about the virtual care options included in their plan. A flyer and video on regence.com contain all the instructions for doing this; be sure all employees have access to these instructions.
We’ve expanded the services that can be delivered by providers using virtual care options and we’re paying them the same as we would for in-person treatment into 2021.
- Members’ own providers, including PCPs, behavioral health specialists, and others, may also have virtual care options. If members don’t have a doctor or therapist, they should call Customer Service for help finding one.
Expanding resources for self care
To help members address a wide range of emotional and physical health needs, we’ve broadened access to three useful tools:
myStrength - interactive, activity-based resources specifically designed to support mental wellness, stress management, parenting, feelings of social isolation and other emotional challenges. Part of Livongo for Behavioral Health powered by myStrength, a digital behavioral health app, the resources are available at no charge through the end of 2020.
Active&Fit – members have free access to 200 on-demand digital workout videos and daily live workouts from Active&Fit. Enrollment in Active&Fit is not required; Regence members need only to access the Active&Fit website from their Regence account page and register there to receive access to the workout videos.
Regence Empower™ – provides members tips for staying healthy, what to do when sick, and advice to help slow the spread of the disease. Includes self-guided programs for managing stress, enhancing physical activity, and building resilience, along with personal challenges supporting sleep, nutrition, physical activity, and social and emotional well-being.
- Symptom Checker – offers members timely guidance and support to help them determine whether medical attention is needed. Not intended to replace a clinical assessment or the judgment of health care professionals.
Groups may use the standard leave of absence guidelines up to three months for employees for any acceptable reason by the group, including for a reduction of hours. Leave of absence is at the employer's discretion and is managed by the employer.
At the end of three months, employees need to return to an active, at-work status, or terminate from the plan. Options for coverage may include state continuation of coverage, FMLA, COBRA or state exchanges.
We will look to the client to monitor eligibility that is passed to our systems. Temporarily employees can maintain their coverage on their Regence plans as long as the reduction in hours/layoff is a temporary measure resulting from COVID-19, the group continues to pay premiums and the employees are not terminated.
Yes, if the employee is recalled within three months of termination and had previously satisfied the waiting period.
Yes. They can return to the plan within three months. If the employee maintains their Regence member ID #, their out-of-pocket accumulators will be carried forward.
Employers up to 100 employees may temporarily self-administer hours of eligibility to the contract minimums without prior approval. Minimums are established by states as follows:
- Idaho – 20 hours
- Oregon – 17.5 hours (no state minimum, market standard)
- Utah – 30 hours
- Washington – 20 hours (no state minimum, market standard)
Yes, to 50 percent of the lowest-cost health plan offered to your employees. The employee contribution would increase to cover the full premium.
Yes, as long as there is active enrollment on the plan. If all employees are terminated from a plan, the contract will be cancelled and you would need to reapply for coverage.
We are not offering special COVID-19 enrollment at this time. Some state-based exchanges are offering a special enrollment period for individual participants.
Yes. Groups with fewer than 50 employees would need to establish a new 12-month contract by completing a renewal GMA. During that process, they can select lower benefits, a different contribution amount, and different eligibility guidelines. Groups 51+ should contact their account executive to determine the options that best fit their needs. For groups with 50 or fewer employees, a renewal GMA is required.
Small employers may with underwriting approval change benefits off anniversary. This requires a new contract, including rates and current mandated benefits. If employers make a mid-year contract change, employees may then select a new plan and enroll (if eligible) or disenroll in coverage.
Mid-size (51-100) employers may with underwriting approval make a mid-year benefit buy down. Underwriting and sales will map enrollment from one plan to the other and no additional enrollment changes will be allowed. Employees may not voluntarily change plan elections outside of a contract re-write or their scheduled open enrollment.
Premium grace periods are state specific and comply with emergency orders:
- Idaho – 30 days
- Oregon – 60 days
- Utah – 30 days
- Washington – 30 days
We are covering COVID-19 antigen and molecular diagnostic testing (and the associated office visit) during the state of emergency, and treatment at no cost share to the member through Dec. 31, 2020. Testing must be ordered by a physician. We also cover COVID-19 antibody tests at no member cost share when ordered by a member’s attending physician and part of appropriate medical care. COVID-19 tests must be performed at a CLIA-certified lab, or the test manufacturer must have FDA Emergency Use Authorization. As with other tests for employment, such as drug tests, antibody tests for employment purposes are not covered by insurance.
Your health plan may include an Employee Assistance Plan (EAP) benefit. Telehealth vendors also provide behavioral health services. In addition, members’ regular providers may be able to offer telehealth services through our temporary expanded telehealth services.
Yes, you can add Doctor on Demand. Call your account executive to learn more.
To help prevent the spread of infection and ease pressure on urgent care centers and emergency rooms, we have temporarily expanded the services available through our telehealth benefit. Any contracted provider may now offer virtual care services, even on a non-HIPAA-compliant platform. This includes routine preventive appointments with members’ primary care doctors and behavioral health providers. This expansion remains in effect through each state’s emergency declaration. The member’s coinsurance and deductible will apply to these services.
This rule applies to ERISA groups only. COBRA remains an employer-specific responsibility. The following represents our understanding at this point in time.
The DOL, IRS and HHS guidance under the EBSA Disaster Relief Notice 2020-01 extends certain COBRA timeframes and deadlines for participants to consider coverage elections and benefits decisions.
Specifically, Final Rule provides plan participants, beneficiaries, qualified beneficiaries, and claimants with relief from meeting the below referenced periods and dates during the period of March 1, 2020 until 60 days after the announced end of the COVID-19 National Emergency (or such other date announced by the Agencies in a future notice):
- The 30-day period (or 60-day period, if applicable) to request a special enrollment;
- The 60-day election period for COBRA continuation coverage;
- The date/deadline for making COBRA premium payments;
- The deadline for individuals to notify the plan of a qualifying event or determination of disability;
- The deadline within which employees can file a benefit claim, or a claimant can appeal an adverse benefit determination, under a group health plan’s or disability plan’s claims procedures;