COVID-19 Health Resources
- Aetna is waiving co-pays and cost sharing for all diagnostic testing and doctor visits related to COVID-19 testing. There is no limit to the number of COVID-19 tests covered under the plan. This coverage requirement began on March 18, 2020 (when the Families First Coronavirus Response Act was enacted) and remains in effect while there is a declared public health emergency (as defined under federal law).
- Where Can I get tested?
- Until June 4, 2020, Aetna waived member cost sharing for any covered telemedicine visits — regardless of diagnosis.
- All behavioral and mental health telemedicine visits will have the cost sharing waived through September 30, which has now been extended through December 31, 2020.
- Through Aetna's Healing Better program, members who are diagnosed with COVID-19 will receive a care package containing CVS over-the-counter medications to help relieve symptoms.
- Through existing care management programs, Aetna will proactively reach out to members most at-risk for COVID-19.
- Aetna is extending its Medicare Advantage virtual evaluation and monitoring visit benefit to all Aetna members as a fully-covered benefit.
CVS Health announced COVID-19 resources for Aetna members on March 6, 2020. View the announcement for more information.
While there is no evidence at this time of widespread shortages, it is important to ensure that members with ongoing needs can maintain access to medications, while also enabling patients with COVID-19 to obtain treatment. Some of the medications being identified as possible treatments for COVID-19 are also used by members to treat existing conditions like HIV and lupus. Aetna introduced a utilization management (UM) product bundle, which institutes quantity limits on medications that potentially treat COVID-19 and are used by members for other conditions.
Albuterol inhalers: limit of two (200 inhalations per device) per 30 days at retail or six devices per 90 days at mail
Chloroquine, hydroxychloroquine: 10-days’ supply, limit of one fill per 60 days
Kaletra: 14-days’ supply, limit of one fill per 60 days
Azithromycin: 250mg tablets, limit of six tablets or one blister pack of six tablets per five days; limit of one fill per 60 day
- Over-the-counter health care products as eligible expenses
The CARES Act permanently reinstated over-the-counter drugs and medicines as eligible expenses for Health Savings Account (HSA), Flexible Spending Account (FSA) and Health Reimbursement Arrangement (HRA) funds without a prescription. (Under the Affordable Care Act, only drugs and medicines that required a prescription were eligible for reimbursement.) This change takes place for over-the-counter drugs and medicines purchased dating back to January 1, 2020.
- Feminine care products as eligible expenses
The CARES Act also includes feminine care products such as tampons and pads to be considered eligible expenses for HSA, FSA, and HRA funds. This change takes place for feminine care products purchased dating back to January 1, 2020.
COVID-19 testing covered at no costThe CARES Act clarifies that all testing for COVID-19 is to be covered by private insurance plans (fully-insured and self-insured) without cost sharing. Coverage extends to any services or items provided during a medical visit—including an in-person or telehealth visit to a doctor’s office, an urgent care center, or an emergency room—that results in COVID-19 testing or screening. This coverage requirement began on March 18, 2020 (when the Families First Coronavirus Response Act was enacted) and remains in effect only while there is a declared public health emergency (as defined under federal law).
The Families First Coronavirus Response Act was signed into law on March 18, 2020. The implications to healthcare coverage for Loyola Medical Plan members is that in addition to the cost of the COVID-19 test, plans must cover the cost of a health care provider, urgent care center, or emergency room visit that results in the ordering or administration of a test for COVID-19. Coverage must be provided with no cost-sharing by the member. Aetna was already waiving for the cost share for the COVID-19 test and ER services, but has been expanded to urgent care cost-sharing as a result of this act.