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Health Net Alerts

Coronavirus: Updates on What's Covered & More

Member Questions and Answers

Updated 4/9/20 – The following sections were added and/or updated with additional guidance and information:

  • Benefits, Eligibility and Products (added)
  • Claims (added)
  • Continuation of Coverage (added)
  • COVID-19 Testing (added)
  • COVID-19 Testing/Screening Cost-Shares and Prior-Authorizations (added)
  • Customer Service (added)
  • General Questions (added)
  • Health Net's Business Continuity Plan (added)
  • Mental Health and Coping Assistance (added)
  • Official websites for information and guidance on COVID-19 (added)
  • Prescriptions – Refills and Emergency Supply (added)
  • Screening and testing guidelines for COVID-19 (added)
  • Special Enrollment Period for Individual and Family Plans - Now through 6/30 (added)
  • Telehealth (added)

Benefits, Eligibility and Products

Will employers be able to continue benefits if the entire workforce is laid off?

Standard Policy COBRA and state continuation protocols apply if one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.

For employees that enroll in an Individual & Family plan, how quickly will their coverage be effective?

Covered California is offering a Special Enrollment Period (SEP) through June 30, 2020, to help uninsured consumers get 2020 health care coverage. Health Net will allow this SEP for Individual & Family Plans available through both Covered California as well as enrollment on our off-exchange plans. Effective dates of coverage are:

Enroll by   Effective date
April 30   May 1, 2020
May 31   June 1, 2020
June 30   July 1, 2020

Questions about IFP coverage should be directed to Health Net Direct Sales at 1-877-878-7983. Our representatives will assist your clients to determine their eligibility for subsidies, as well as provide information for IFP plans through Covered California, off-exchange IFP plans, and Medi-Cal.

If I waived health coverage through my employer, can they offer a Special Open Enrollment period for employees?

Health Net will allow a special COVID-19 enrollment period for both large group and small group clients for employees who previously did not elect health benefit coverage for themselves, spouses or children. From April 1 to April 20, 2020, employers may hold a special enrollment for employees, spouses or children who waived coverage, with an effective date of April 1, 2020, provided they remit full premium for the month of special enrollment.

If I am on a temporary leave of absence, can I keep my benefits intact for a few months without being paid a salary?

Through May 31, 2020, Health Net is temporarily relaxing its requirement that employees be actively working to be eligible for coverage and will allow employers to cover their reduced-hour employees, as long as employers pay the monthly premium. Employers must offer this coverage on a uniform, non-discriminatory basis.

Is Health Net waiving cost-share requirements for COVID-19 related treatments?

Effective immediately, Health Net will waive member cost sharing for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members.

Is Health Net waiving prior authorizations for COVID-19 related treatments?

Effective immediately, Health Net and its delegated entities will waive prior authorizations for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members. Inpatient admission notification is still required as soon as possible to Health Net and the member's assigned delegated participating physician group (PPG) or IPA, if available.

Claims

Will there be any delays on processing claims?

Health Net intends to provide the same level of service and claim processing support as it does during normal circumstances.

Continuation of Coverage

Will Health Net be able to offer coverage options if I have been laid off and lose my work-based insurance?

Standard Policy COBRA and state continuation protocols apply provided that one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.

Covered California is offering a Special Enrollment Period (SEP) through June 30, 2020, to help uninsured consumers get 2020 health care coverage. Health Net will allow this SEP for Individual & Family Plans available through both Covered California as well as enrollment on our off-exchange plans. Effective dates of coverage are:

Enroll by   Effective date
April 30   May 1, 2020
May 31   June 1, 2020
June 30   July 1, 2020

If you are interested in IFP coverage, please call Health Net Direct Sales at 1-877-878-7983. Our representatives will assist you to determine your eligibility for subsidies, as well as provide information for IFP plans through Covered California, off-exchange IFP plans, and Medi-Cal.

COVID-19 Testing

Testing can be ordered only by physicians or other authorized health care providers. Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.

COVID-19 Testing/Screening Cost-Shares and Prior-Authorizations

Is Health Net waiving cost-share requirements for screening and testing?

All member cost-share requirements (copayment, coinsurance and/or deductible amounts) related to the screening and testing for COVID-19 will be waived across all products.

Health Net covers screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law and Health Net's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Is Health Net requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Customer Service

How is Health Net addressing potential technical issues?

We have thorough Business Continuity Plans in place for our IT systems, Call Centers and other operations. Health Net and Centene offices remain open, with essential personnel in place. We have implemented appropriate technology, and work from home capabilities for the majority of our employees under HIPAA/PHI/PII compliance guidelines. There are no changes to business hours.

General Questions

What if as a Health Net member I require proof of insurance to re-enter the country?

Members may download proof of coverage or their ID card from our website. We encourage all members to register on our website and update their current contact information, including email and cell phone number.

Health Net's Business Continuity Plan

What is Health Net doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans Health Net has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Health Net regularly reviews and updates its emergency business continuity protocols.

As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations.

Mental Health and Coping Assistance

Is coping assistance offered to members impacted by COVID-19?

Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.

Official websites for information and guidance on COVID-19

Where can I obtain the latest information and guidance on COVID-19?

For more information about COVID-19 and the latest guidance from public health officials visit any of these websites:


Prescriptions – Refills and Emergency Supply

How do I obtain an emergency supply of a prescription?

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.

Screening and testing guidelines for COVID-19

On March 19, 2020, the state of California launched a new coronavirus awareness website. According to this website:

  • California is expanding the coronavirus testing capacity daily.
  • Currently, testing is being prioritized for people who have the coronavirus symptoms AND have one of these risk factors:
    • Have had contact with a person who has tested positive for COVID-19, OR
    • Are health care providers or work with vulnerable populations (such as a long term care facility), OR
    • Traveled to an affected country in the past 14 days, OR
    • Are over age 60, have a compromised immune system or have serious chronic medical conditions
Special Enrollment Period for Individual and Family Plans - Now through 6/30

Due to the COVID-19 virus, a Special Enrollment Period has been created and is open now through June 30 for those who need 2020 health care coverage. Proof of this qualifying event is not needed.

Consumers must:

  • Enroll by the last day of the month in order to start coverage on the first day of the following month.
  • Pay their first premium payment to begin coverage.
Telehealth

Is Telehealth a covered benefit for Medical and Behavioral Health issues, even if the plan design does not currently include that benefit? If so, then what provider network do members use (Teladoc®, Doctor on Demand, etc.)?

Yes, telehealth is a covered benefit for both medical and behavioral health issues for all plans during this time. Health Net currently uses Teladoc® for telehealth services. However, during this state of emergency, Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

Will Health Net allow access to telehealth services to increase access to care?

To limit members' risk of COVID-19 infection, Health Net encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for all services.

During the course of this declaration of emergency for Commercial and Medi-Cal members, Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).


3/20/20

What you need to know about COVID-19

Coronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. Though the risk of getting COVID-19 in the U.S. is low, learn how you can help keep yourself and others healthy.


3/7/20

Health Net Assisting Members in California During State of Emergency

In response to Gov. Gavin Newsom's declared state of emergency, Health Net, LLC wants to help ensure everyone is informed about what they can do to help protect themselves from the coronavirus (COVID-19).

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Important Notice

General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.


Policy Effective Date and Defined Terms.
The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative.


Policy Amendment without Notice.
Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective.


No Medical Advice.
The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.


No Authorization or Guarantee of Coverage.
The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.


Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.


Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:


1. To improve function; or
2. To create a normal appearance, to the extent possible.


Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.


Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.


Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.


Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.

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