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COVID-19 Updates & Alerts for Employers

Questions and Answers for Employers


What is the coronavirus?

COVID-19 is a disease that affects breathing. It's caused by a new virus called a coronavirus, which can spread from person to person. People of all ages can get infected. Older adults and people with pre-existing medical conditions may be more likely to become gravely ill if infected. Medical conditions that include:

  • chronic obstructive pulmonary disease,
  • cancer,
  • obesity,
  • diabetes,
  • and heart disease.

The number of cases continue to increase throughout the nation and around the world.

Protect yourself and your community

We all have a role to play to help protect our families and community from the spread of COVID-19. You can follow these tips to prevent getting the virus:

  • Wear a mask.
  • Stay six feet apart from others.
  • Avoid crowds.
  • Wash your hands often – at least 20 seconds each time.
  • If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • Get a flu vaccine.

What is the COVID-19 vaccine?

A COVID-19 vaccine gives you the best chance of protecting yourself and your loved ones from getting COVID-19 symptoms and health problems in the future. All authorized vaccines at this time are given in two doses with a few weeks between each shot. After your first shot, you will get a card that reminds you not to forget your second shot. It's important to get both doses of the same vaccine.

Updated 4/1/21: When can I get the vaccine?

California is giving the vaccine to different groups of people in a phased approach. Visit Vaccinate All 58 for more information.

NOW VACCINATING

  • People 65 and older
  • Sector groups:
    • Health care workers
    • Long-term care residents
    • Education and childcare
    • Emergency services
    • Food and farming
    • People 16 and older at higher risk

STARTING APRIL 1, 2021

  • People 50 and older
     

STARTING APRIL 15, 2021

  • People 16 and older
     

Vaccination of people younger than 16 will start as soon as the COVID-19 vaccines are approved for them.

You can sign up at MyTurn or call (833) 422-4255 (Monday-Friday 8:00 a.m. to 8:00 p.m., Saturday-Sunday 8:00 a.m. to 5:00 p.m.) to see if it's your turn to get the COVID-19 vaccine. If you are not listed to get the vaccine at this time, you can sign up to get an alert when it's your turn.

How can I protect myself from COVID-19 until a vaccine is available to me?

We all have a role to play to help keep our families and community safe from the spread of COVID-19. Follow these tips to help prevent yourself and others from getting sick:

  • Wear a mask.
  • Stay six feet apart from others.
  • Avoid crowds.
  • Wash your hands often – at least 20 seconds each time.
  • If soap and water are not available, using a hand sanitizer with at least 60% alcohol.
  • Get a flu vaccine.

Where can I get the vaccine?

There will be a short supply of vaccine at first, but California expects supplies to increase over time. Check these options to find a vaccination site when you are able to get the vaccine:

  • Contact your doctor or pharmacist.
  • Reach out to your county public health department.
  • Visit MyTurn or call (833) 422-4255 (Monday-Friday 8:00 a.m. to 8:00 p.m., Saturday-Sunday 8:00 a.m. to 5:00 p.m.) Check VaccinateCA

Is the vaccine safe?

The safety of the COVID-19 vaccine is the main focus! The U.S. Food and Drug Administration (FDA) takes care to review all safety data from clinical trials. They then approve emergency vaccine use only when the expected benefits outweigh potential risks. Scientists tested COVID-19 vaccines across many diverse backgrounds. This helped to ensure the vaccines meet safety standards.

How will safety be tracked once a COVID-19 vaccine is made available to the public?

After a vaccine is authorized for use through the EUA, scientists and health professionals will keep tracking its use. Health care providers are required to report certain adverse events after vaccination to the Vaccine Adverse Event Reporting System (VAERS). When you receive your vaccine, you will also receive an information sheet. The sheet lets you know how to enroll in a program called v-safe. V-safe allows you to report problems or adverse reactions you have after getting a COVID-19 vaccine. Your report will go to the Centers for Disease Control (CDC). Plus, the FDA and CDC will keep tracking the safety of COVID-19 vaccines. They want to make sure that even very rare side effects are found as early as can be.

Is there a way I can I track my COVID-19 vaccinations on my phone?

V-safe is a smartphone-based tool. It uses texts and web surveys to provide customized health check-ins after you receive a COVID-19 vaccination. Visit v-safe to register! Through v-safe, you can quickly tell the CDC if you have any side effects after getting your COVID-19 vaccine. As a result of how you answered, someone from the CDC may call to check on you and get more information. V-safe will also remind you to get your second COVID-19 vaccine dose if you need one.

Will there be any side effects when I get the vaccine?

You may have soreness, swelling and redness around the point of where the shot was given. You could also develop fatigue, headache, body aches, chills or fever. Some people have nausea, vomiting or diarrhea. These reactions are normal. The side effects occur as your body begins to build immunity to help fight off future COVID-19 exposures. It is important to know that you cannot get COVID-19 from the vaccine. The vaccines in use today and the others that are being made do not contain a live virus.

Will there be any long-term side effects from contracting COVID-19?

COVID-19 vaccines are being tested in large clinical trials to assess their safety. But it does take time, and more people will need to get a vaccine before we learn about any rare or long-term side effects. That is why safety tracking will continue. The CDC has a separate group of experts that reviews all the safety data. And, they provide regular safety updates. If a safety issue is found, quick action will be taken to see if the issue is linked to the COVID-19 vaccine. Also, steps will be taken to plot the best course of action.

How effective is the COVID-19 vaccine?

Moderna and Pfizer/BioNTech vaccines are 94-95% effective in keeping people from developing COVID-19 symptoms.

Does the COVID-19 vaccine protect against recent variants?

Yes. Pfizer/BioNTech and Moderna's COVID-19 vaccines have some effect against some strains of SARS-CoV-2 found in the UK (B.1.1.7) and South Africa (B.1.351) to date.

Am I required to get my COVID-19 vaccine?

No. But getting your COVID-19 vaccine will give you the best chance to protect yourself and your loved ones from getting COVID-19 symptoms. It can also help prevent any COVID-19 health problems in the future.

Can I choose which COVID-19 vaccine to take?

All authorized COVID 19 vaccines are safe and effective. Due to short vaccine supplies, it is best to get the vaccine that is available to you. If the vaccine requires two doses, make sure that your second dose matches the vaccine you received during your first dose.

I already had COVID-19. Should I still get the vaccine?

Even if you have had COVID-19, you should still get the vaccine. There's a chance you can contract COVID-19 more than once, so getting the vaccine is a safe choice.

How long does the vaccine immunity last?

It takes time for the body to build immunity after any vaccination. The Pfizer/BioNTech and Moderna COVID-19 vaccines require two doses. They provide the best protection one-to-two weeks after the second dose. Getting a COVID-19 vaccine will offer natural immunity. But, as of now, scientists do not know how long this protection will last.

Will I test positive for COVID-19 after being vaccinated?

No. The vaccine will not cause you to test positive for COVID-19. It may cause you to test positive for antibody tests. This is because the vaccine helps build antibodies to the virus.

If I have a food or medication allergy, should I worry about an allergic reaction to the vaccine?

Having an allergy to food or medicines does not mean you are at a higher risk of having an allergic reaction to the COVID-19 vaccine. Both the Pfizer/BioNTech and Moderna vaccines do not contain eggs, preservatives, or latex. Consult your doctor before getting a vaccine if you have severe allergies. If you have been told to carry an epinephrine auto-injector for any reason, continue to do so – most notably when you get a vaccine. The CDC suggests a period of 15 minutes for everyone getting a vaccine to be observed. This 15-minute period increases to 30 minutes for those with a history of having allergic reactions.

Who should not get vaccinated?

A few groups should not get the vaccine, and some others should consult with their doctor.

People who should not get the COVID-19 vaccine include:

  • People with a severe allergy to an mRNA vaccine component.
  • Those younger than 16 years of age (as of today vaccines are authorized only for ages 16 and older).
  • People that are isolating or are having symptoms of COVID-19. These people can get a vaccine after they have finished isolation and their symptoms have gone down.

People who may get the vaccine after thinking about the risks, benefits and talking with their doctor include:

  • People with a history of severe allergy to any vaccine or injected medication.
  • People who are pregnant.
  • People who breastfeed.
  • People on blood-thinning medication.

Can pregnant or breastfeeding individuals get the vaccine?

The American College of Obstetricians and Gynecologists suggests that the COVID-19 vaccine be offered to people who are pregnant or breastfeeding. It does not require people of childbearing age to have a pregnancy test before getting the vaccine. Please consult with your doctor to see if the COVID-19 vaccine is best for you.

Can my child get the vaccine?

As of right now, the Pfizer-BioNTech vaccine is suggested for people ages 16 and older. The Moderna vaccine is suggested for those ages 18 and older.

When I get the vaccine, can I stop wearing a mask or social distancing?

No. It will take time for your body to build immunity after the vaccine. To prevent yourself from getting sick it's important to:

  • Social distance
  • Wear a mask in public
  • Avoid crowds
  • Wash hands often – at least 20 seconds each time.

Can I get the COVID-19 vaccine at the same time as another vaccine?

No. The COVID-19 vaccine should be given 14 days before or after other vaccines. At this time there is limited information on the safety of getting other vaccines at the same time as the COVID-19 vaccine.

What if I got the first dose and do not want to get the second dose?

The Pfizer/BioNTech and Moderna clinical trials were not designed to test the effect of a single dose. People involved in the studies all received two doses. It is best to get two doses to achieve the best result.

What if I missed my second dose?

If you miss your second dose appointment at 21 days (for Pfizer/BioNTech vaccine) or 28 days (for Moderna vaccine), it is OK. Those dates are the earliest you can get the second dose. It is important to get your second dose as close to those dates to get the full strength of the vaccine.

The second dose of Pfizer/BioNTech and Moderna COVID-19 vaccines may be scheduled up to six weeks (42 days) after the first dose. There is a small amount of data on how well the vaccines work when given after that time.

What is Herd Immunity?

Herd Immunity is a term used to describe when enough people within a large group have protection—either from previous infection or vaccination. The desired result is that the disease spread slows and, in time, stops. Once achieved, everyone within that group is protected, even if some people don't have any protection themselves.

What is a COVID-19 Vaccination Record Card?

A COVID-19 Vaccination Record Card is a small and handy paper card that will be given to you when you receive your first COVID-19 vaccine. This will help you keep track of when you received your first dose and when you should get your second dose. It's an easy way to help you keep track of your vaccines.

I lost my COVID-19 Vaccination Record Card. What should I do now?

If the vaccine requires two doses, people should get the same vaccine for both doses in two different visits. Call the health center or provider you received your first dose from to ask about your vaccine information. Be sure to confirm your second appointment and the place to get it.

I am due for my second dose. Can I go to any provider?

The provider should have scheduled a second appointment with you at the same place when you received the first dose. But, you can get your second dose from another provider/place. You'll need to show your COVID-19 Vaccination Record Card so the provider knows what vaccine you have received.

Do members have to pay for their vaccine? Or get prior approval?

No. The COVID-19 vaccine will be at no cost to members. Members do not need to get a prior approval for their vaccine. They may be asked to provide their health insurance information for tracking data.

Do members need a doctor's script or referral prior to getting their COVID-19 vaccine at a pharmacy?

  • No, members are able to receive COVID-19 vaccination without a doctor's script or referral at any pharmacy. Follow your health plan's guidelines for where to get other non-COVID-19 vaccines.
  • Members can also visit a different place for their second dose, if needed.
  • Members can receive their vaccinations at any place. This includes mass vaccination centers, if/when they are open.

If members go the pharmacy, will the pharmacy bill the health plan or do they have to pay out of pocket and request to be paid back?

  • There is no cost to get the vaccine at a pharmacy.
  • The pharmacy will bill the vaccine administration fee straight to the health plan.
  • Members may be asked to provide their health insurance information.

A member is due for their second dose. They got their first dose from a provider who is not their PCP but don't have their contact information. What do they do now?

The provider should have scheduled a second appointment with the member at the same place when they received the first dose. But, they can get their second dose from another provider/place. They'll need to show their COVID-19 Vaccination Record Card so the provider knows what vaccine they have received.

When did the COVID-19 vaccine receive Emergency Use Authorization?

The US Food and Drug Administration (FDA) authorized the Pfizer/BioNTech COVID-19 vaccine for emergency use to prevent COVID-19 in ages 16 years and older on 12/11/2020. The Moderna COVID-19 vaccine was granted FDA approval on 12/18/2020 for use in people18 years of age and older.

I am planning to travel outside the United States. How can I get the vaccine?

When it's your turn to get the vaccine, check these options to find where to get the vaccine:

  • Contact your doctor or pharmacist.
  • Reach out to your county public health department.
  • Visit MyTurn or call call (833) 422-4255 (Monday-Friday 8:00 a.m. to 8:00 p.m., Saturday-Sunday 8:00 a.m. to 5:00 p.m.) Check VaccinateCA.

During the COVID-19 crises, should members get a flu shot?

Yes. An annual flu shot is recommended for most people six months and older to help keep them healthy, unless your doctor identifies a medical reason not to take the flu vaccine.

What is Health Net doing to reach vulnerable populations to ensure these individuals continue to receive needed health care services, while practicing appropriate social distancing?

Health Net is waiving all COVID-19 related prior authorizations and member cost sharing for screenings, tests and treatment. This specifically applies to all Commercial employer group business and Individual and Family Plan members. In addition, Health Net covers all telehealth services that are associated with COVID-19 for its members, as well as all covered healthcare services that can be administered virtually until further notice.

Also, Health Net assembled a COVID-19 taskforce to identify, and is reaching out to members who are at high risk for COVID-19. The purpose of the outreach is to connect with identified high-risk members and confirm they have access to the support and services they need. The taskforce began making outbound calls to this membership at the beginning of April.

In addition to the above, our parent company, Centene Corporation is:

  • Facilitating the sourcing, ordering, and shipping of personal protective equipment (PPEs) to our provider partners that enable them to meet the urgent needs of patients. Centene is already in the process of expediting the distribution of approximately 2 million pieces of PPE including safety goggles, facemasks, hand sanitizers and disaster kits, and will continue these efforts in coming weeks.
  • Partnering with our providers to deploy resources to service areas that have been most impacted by newly created quarantine and isolation centers.
  • Providing data and support that enable providers to reallocate resources based upon utilization changes caused by the COVID-19 pandemic.
  • Working to ensure that our community Safety Net providers and organizations have long-term sustainability beyond the immediate crisis.
  • Providing assistance in securing small business loans to specifically help behavioral health providers and community-based behavioral health organizations, long-term service support organizations and other Safety Net providers gain access to government-sponsored small business loans, and telehealth technology.

Which transportation services are offered to help members get their COVID-19 vaccines?

Members may be able to get transportation help by contacting United Way-211 to access local transportation resources. This may include the Lyft Vaccine Alliance Program.

When employees are rehired, will Deductibles and Out-Of-Pocket Max (OOPM) accruals start over?

So long as the employee remains on the same plan with the same member ID, the deductible and OOPM will pick up where it left off when the employee re-enrolls later in the year.

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.

Can health benefits be extended through the end of the month if a significant portion, or all, of an employer's workforce is laid off?

If premiums have been remitted for the month the employee is laid off, coverage will continue through the end of that same month.

If employees enroll in a short-term plan, how quickly will their coverage be effective?

Health Net does not offer short term coverage.

Can an employer reduce their current minimum hours threshold down to 20 hours off-anniversary?

Through the end of the public health emergency, 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.

Will eligibility be closely monitored? If an employer's workforce goes to less than 30 hours a week or below the hourly requirement, will flexibility be allowed?

Through the end of the public health emergency, 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.

If an employee took a sabbatical or temporary leave of absence, can they keep their benefits intact for a few months without being paid a salary?

Through the end of the public health emergency, 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.

What is required in order to re-enroll/reinstate the member without the waiting period?

Health Net will waive the normal waiting period for rehired employees. Employees rehired through the end of the public health emergency will not be subject to a waiting period. Rehired employees must submit a new enrollment form. Please write "COVID-19 SEP" on the enrollment form.

What Benefit Enhancements has Health Net implemented for California Small Group Fully Insured Members related to COVID-19 services?

COVID-19 Testing and Screening:
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.

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

Pharmacy:
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.

Mental Health Resources:
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.

Telehealth:
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. Member cost share is waived for telehealth services until further notice.

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.

CARES Act - H.R. 748

Sweeping legislation to respond to the COVID-19 pandemic was cleared by Congress and signed into law by President Trump on March 27, 2020. The Coronavirus Aid, Relief, and Economic Security Act ("the CARES Act" or "the Act") authorizes more than $2 trillion to battle COVID-19 and its economic effects, including immediate cash relief for individual citizens, loan programs for small business, support for hospitals and other medical providers, and various types of economic relief for impacted businesses and industries.

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.

Will Health Net be able to offer coverage options to employees that have been laid off and lose their work-based insurance? Will employers be able to offer continuation coverage to their employees at their own expense?

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 May 15, 2021, due to the COVID national emergency. This SEP qualifying event is available if you enroll through Covered California as well as enrollment on our off exchange plans.

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

For employee health and safety, the Center for Disease Control and Prevention (CDC) recommends focusing on preventing exposure to the COVID-19 virus in the workplace. There are specific measures that have proven beneficial in preventing infection. These measures include conducting daily health checks, practicing hand hygiene, social distancing (at least 6 feet from others), wearing cloth face covering, installing barrier shields such as plexiglass when feasible, and improving the building ventilation system.1 Daily health checks including temperature checks and symptom questionnaires are especially essential in workplace settings where it is difficult to maintain consistent social distancing.

Employees who screen positive for, or report symptoms related to COVID-19 infection, should be excluded from work and referred to a healthcare provider for evaluation and potential testing.2 /sup> These employees should stay home and should not return to work until the criteria to discontinue home isolation are met, under the guidance of a healthcare provider.1

For asymptomatic employees who have a recent known or suspected exposure to COVID-19, testing is recommended if they had close contact with the infected person. Close contact entails being within 6 feet of the infected person, for a total of 15 minutes or more, without personal protective equipment. It is important to quickly identify and quarantine such employees. Early testing after exposure at a single point in time may miss many infections so testing that is repeated at different points in time, also known as serial testing, may be more useful. For detecting current COVID-19 infection, viral tests are recommended. Antibody testing is not recommended.2

In certain workplaces where physical distancing is difficult, workers are in close contact with co-workers or the public, and community transmission is high, viral testing of asymptomatic workers without known or suspected exposure to COVID-19 may be considered. In these circumstances, the CDC recommends that employers contact their local health department for guidance.2

Please refer to these CDC website links for more details. This information is current as of May 2020 and October 21, 2020.

1 Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Interim Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 (COVID-19), May 2020.

2 Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 Testing Strategy: Considerations for Non-Healthcare Workplaces. Updated October 21, 2020.

Where can members receive COVID-19 testing/screenings/treatments under their plan coverage?

Members can receive covered services when ordered, referred and/or performed in the In-Network places listed below:

  • Physician's/Practitioner’s Office
  • Independent Laboratory/Diagnostic Facility
  • Urgent Care Center
  • Emergency Department

Services include:

  • Medically-required COVID-19 diagnostic testing.
  • Medical screenings and/or treatment.
  • Related doctor's visit.

Unsure if you have been exposed to or are at-risk of having COVID-19? Schedule a visit with a telehealth provider. It’s a good option for non-urgent care.

What are the symptoms?

Some people can have COVID-19 and be contagious without showing symptoms. People with COVID-19 symptoms have mild to severe breathing problems. Other symptoms include:

  • fever or chills
  • cough
  • shortness of breath
  • fatigue
  • body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting
  • diarrhea

What else causes similar symptoms?

Influenza (the flu) is another illness that affects breathing. It’s caused by flu viruses (Type A and Type B). The flu is highly active in the United States during the winter months. Everyone six months of age and older should get a flu vaccine.

I may have symptoms. What do I do?

If you have been exposed or begin showing symptoms of COVID-19 or the flu, contact your health care provider or health department right away.

Will members be charged for any out-of-pocket costs for COVID-19 testing and screening?

No. We will cover medically-required COVID-19 testing and medical screenings at no charge to members. We will do this when these services are ordered and/or referred by a licensed health care provider. If relevant, member's plan will waive the costs for required COVID-19 diagnostic testing along with the doctor visit. This includes:

  • copayment
  • coinsurance
  • deductible cost-sharing

If a member needs treatment for COVID-19, is that covered by their plan?

Yes. Any medically-required treatment linked to COVID-19 would be a covered benefit for all:

  • Medicare,
  • Cal MediConnect,
  • Medi-Cal,
  • Commercial fully-insured members

We are committed to making sure members have access to COVID-19 treatment services per federal and state law.

Is prior approval needed for COVID-19 testing, screenings and/or treatment under the member's plan coverage?

No. We will not require prior approval, prior notice and/or step therapy rules for:

  • Medically-required COVID-19 diagnostic testing.
  • Medical screenings.
  • Treatment when ordered and/or referred by a licensed health care provider.

Will Health Net cover COVID-19 serological tests?

During this emergency period, Health Net's benefit plans cover medically necessary serologic (antibody) testing, using AMA approved CPT codes and CDC guidance for appropriate use of FDA approved antibody tests.

Will Health Net cover testing if a member is not showing any COVID-19 symptoms?

Health Net complies with the DMHC "essential worker" COVID testing guidelines. Essential workers may seek a voluntary (no symptoms) COVID test, by obtaining their in-network doctor's order, and getting the test from an in-network diagnostic testing location.

Essential workers may be eligible for more frequent COVID diagnostic testing, as outlined under the DMHC all plan letter regarding essential worker testing. The essential business will establish frequency guidelines, based upon the needs and exposure of their workforce.

For non-essential workers, voluntary and return to work testing is not covered. For medically necessary COVID testing, all non-essential workers and their families must obtain an in-network doctor's order for a COVID test, and seek diagnostic services from an in-network provider. We strongly encourage all services be provided by an in-network provider. Please follow the CDC guidelines related to frequency of testing.

How often can the member get a COVID test?

In compliance with the DMHC "essential worker" testing guidance, essential businesses may determine that more frequent testing is required (i.e., hospital workers). Health Net will cover more frequent COVID diagnostic testing for verified "essential workers."

For non-essential workers, Health Net follows the CDC guidelines for COVID testing.

What if in order for the member(s) to go back to work/continue working, they must get tested regularly (weekly, bi-monthly, monthly) does Health Net cover the testing since it is required by their employer?

Health Net will comply with the DMHC guidelines regarding "essential worker" testing. Yes, we will cover essential worker COVID testing. Essential workers should get an in-network doctor's order for COVID testing, and seek diagnostic testing from an in-network provider. Essential worker testing frequency will be established by the essential business, in accordance with the DMHC all plan letter.

Non-essential worker return to work testing is not covered. However, medically necessary COVID testing is covered. Non-essential workers should get an in-network doctor's order for a COVID test, and seek diagnostic testing from an in-network provider. We strongly suggest members obtain COVID tests from an in-network provider.

Will Health Net deny voluntary testing required by the member's employer? Or what if it is not required by the employer, will Health Net still deny the testing?

Health Net will comply with the DMHC guidelines for "essential worker" testing. Health Net will cover voluntary testing for essential workers.

Health Net will not cover return to work testing for non-essential workers. However, Health Net covers medically necessary COVID testing, and follows the CDC and CDPH guidelines. Members should get an in-network doctor's order for a COVID test, and seek in-network COVID testing services.

Does Health Net have a list of approved testing locations?

No, Health Net does not maintain a list of approved testing locations. Employees should seek an in-network doctor's order for a COVID test, who will direct the member to the most convenient testing location. In some cases, their physician will be able to provide the service at their facility.

If a member paid out of pocket for COVID-19 testing, what is the process for members to be reimbursed?

Members who paid out-of-pocket for COVID-19 test should submit a claim form to Health Net. Members may find a claim form on www.healthnet.com or by calling the Customer Contact Center at the telephone number listed on their ID card.

Who should my employee contact to be screened and tested for COVID-19 and where can my employee be tested?

For guidance on COVID-19 testing and screening, employees should call their physician or other authorized health care provider. Health Net members can also access telehealth services through Babylon.

If your employee's physician or other health care provider determines that they meet COVID-19 testing criteria, their physician will direct them on where to obtain the test.

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.

Will there be a change in our contacts? Or contact phone numbers (cell phones)?

There will be no change in our contacts. Health Net has made all necessary arrangements for its employees to assure uninterrupted 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.

What are some of the details about the 2020 law California enacted about COVID-19 in the workplace and Workers’ Compensation coverage?

CA Senate Bill 1159 (CA SB 1159) became effective on September 17, 2020. The law creates a rebuttable presumption that workers who contracted COVID-19 did so at work, unless the employer can prove otherwise. Previously, employees had to show that that their illness or injury was caused at the workplace. The presumption that COVID-19 was contracted at the place of employment applies retroactively to July 6, 2020, and through January 1, 2023.

This means that employees' COVID-19 treatment could be covered under workers' compensation coverage.

Below is a high-level summary of the law. CA SB 1159 is complicated, and this summary is for informational purposes only, and is not legal advice. We suggest employers contact their workers' compensation carriers and legal counsel for more information about the law and reporting requirements.

Impacted Employers

  • First Responders and Health Care Workers: CA SB 1159 presumes COVID-19 cases contracted by certain first responders and front line health care workers from July 6, 2020 through January 1, 2023 occurred on the job.

    These workers include but are not limited to firefighters, peace officers, employees of health facilities who provide direct patient care or custodial services, nurses, EMTs, and employees who provide direct patient care for home health agencies, and other employees of designated health facilities.

  • Other California employers with 5 or more employees: CA SB 1159 presumes the employee contracted COVID-19 at work under any of the following "outbreak" conditions:
    • If the employer has between 5 and 100 employees, four employees who test positive for COVID-19 within 14 calendar days
    • If the employer has 101 or more employees, 4 percent of the number of employees test positive for COVID-19 within 14 calendar days
    • The place of employment is ordered closed by certain public authorities due to a risk of infection with COVID-19

  • CA SB 1159 defines employees' place of employment as the building, store, facility, or agricultural field where an employee performs work at the employer's direction and explicitly excludes work performed in the employee's home or residence, unless the employee provides home health care services to another individual at the employee's home or residence.

New Employer Reporting Requirements

Employers who become aware that an employee has tested positive for COVID-19 must report the following information to their workers' compensation claims administrator within three business days.

  • An employee has tested positive. But the employer shall not provide any personally identifiable information regarding the employee who tested positive for COVID-19 unless the employee asserts the infection is work related or has filed a worker's comp claim form.
  • The date that the employee tests positive (the date the specimen was collected for testing).
  • The specific address or addresses of the employee's place of employment during the 14-day period preceding the positive test.
  • The highest number of employees who reported to work in the 45-day period preceding the last day the employee worked at the place of employment.

Failure to do so may result in a civil penalty of up to $10,000.00 imposed by the California Labor Commissioner.

What Health Net Is Doing

Health Net will continue its standard process of coordinating with your workers' compensation carrier.

For up-to-date information refer to the following:

How can employers access previous Health Net invoices to get information for a Paycheck Protection Program (PPP) loan?

Employers (and brokers with delegated access) are able to obtain this information through the self-service option on the employer portal (available for active groups) or by calling their Account Manager.

What if a Health Net member requires 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.

If an employer is indefinitely closing their offices due to COVID-19 guidelines, how does this affect open enrollment?

Health Net will suspend all face-to-face open enrollment meetings until further notice, and will offer online/virtual open enrollment meetings.

How is Health Net handling late or partial premium payments from employer groups? Will there be extensions?

There will be no change to our 30-day grace period policy for employer groups. Health Net requires full payment of premium for employees covered.

If an employer lays off the bulk of their workforce, and are experiencing cash flow issues, can they remit payment for the "true" amount of their bill for the upcoming benefit month, to allow for 1-2 billing cycles to be trued up?

Yes, employers may choose to adjust their premium remittance for current terminations as long as they:

  1. do not terminate employees retroactive to the current invoice remittance, and
  2. clearly identify on their remittance, the employees who will remain active on their payroll, so we can appropriately and timely process any terminations.
  3. Remit the "true" amount which is Current Due total less terminated employees

Employers should submit their remittance with appropriate updates to the “Current Membership” and “Membership Changes” sections of their Group bill. Members on the current invoice have coverage until the end of the invoice month.

How will Voluntary premiums be impacted?

Current requirements continue to apply to voluntary premium/products.

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.

How is mental health covered as related and unrelated, to COVID-19? If done through telemedicine, is it at a $0 copay?

Health Net will waive member cost share (deductible, copayment and coinsurance) for all telehealth services (including behavioral telehealth services), whether COVID-19 related or not, until further notice. Behavioral health services provided in person will be covered in accordance with the member's plan benefits, and applicable cost sharing will be applied.

If the member is enrolled in a PPO plan, and uses an out-of-network provider, the out-of-network provider may bill the member for the difference between the provider's charge and what the plan pays. This is known as balance billing.

Are there strategies for coping with the COVID-19 outbreak?

Worry and stress can rise about the spread of COVID-19. Concern for friends and family who live in places where COVID-19 cases are growing is natural. So is concern about the continued spread of the disease. Try these tips to help you cope:

  • Take care of your body. Take deep breaths, stretch or meditate.
  • Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.
  • Share the facts about COVID-19 and the real risk to others. People who have returned from places of ongoing spread for more than 14 days, and do not have symptoms of COVID-19, have a much lower chance of putting others at risk. Wearing masks, washing hands and social distancing help to keep the risk very low.
  • For more information, see the CDC's suggestions for mental health and coping during COVID-19.

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.

Covered California offers extended enrollment due to COVID-19 national emergency.

During this challenging time, we want to help individuals and families access the care they need.

Covered California is offering a Special Enrollment Period (SEP) through May 15, 2021, to help uninsured people get health care coverage in 2021. Health Net will make this SEP for Individual & Family Plans (IFPs) available through Covered California as well as enrollment on our off-exchange plans.

Here's what you need to know:

  • Any uninsured individual or family can use this SEP to apply for 2021 health care coverage.
  • This SEP is for new enrollment only and not available for plan changes.
  • Financial help is available through Covered California to those who qualify.
  • To enroll in one of our off-exchange plans, go to MyHealthNetCA. Proof of a qualifying event is not needed to enroll. Or, you can use the existing 2021 IFP enrollment forms to apply by mail.
  • Effective dates of coverage are:

    Enroll By Effective Date
    February 28 March 1, 2021
    March 31 April 1, 2021
    April 30 May 1, 2021
    May 15 June, 1 2021

    After May 15, 2021, the regular special enrollment period qualifying events apply.
  • First month's payment is required to activate coverage.
  • The impact of COVID-19 on small businesses may be causing individuals to lose their health coverage through their employer. Individuals can use this SEP to enroll with Health Net to regain health care coverage.

Grace period

To maintain health care coverage, members' premium payments are due by the first of the month. Current grace period rules apply until further notice.

Will members be able to refill their prescriptions before the refill date?

Yes, members will be able to refill their prescriptions prior to the refill date.

What is Health Net doing to address possible drug shortages related to coronavirus?

First, we are closely monitoring the spread of the coronavirus to prepare for any impact. We are also actively monitoring for news of any drug shortages. Second, if needed, we may send prescriptions from another one of our pharmacy locations. This will help ensure our members have continued access to medications. Finally, we always encourage members to refill maintenance medications in a timely manner.

Are medications safe? Could they be contaminated or at risk? Are medications from China?

The US Food and Drug Administration (FDA) monitors drug safety. It sends alerts in case of any safety or contamination issues. We check all prescriptions for safety and quality, and will let our members know of any safety concerns. Members should continue to take their prescription medications as advised by their doctor.

Is there a drug to prevent Coronavirus?

Not at this time, but our pharmacists are monitoring the new drug pipeline for any medication or vaccine that may become available.

Where can I get credible information?

You can visit these websites that provide the most current information available:

If a state of emergency is issued, will Refill Too Soon on member prescriptions be lifted?

We will work with our members on a case by case basis to ensure they have access to their medications.

How much medication should members have on hand during this crisis?

Members should have at least a one-month supply of the prescription medications they need to manage their medical conditions.

If members don't have a one-month supply can they get more medication before its refill date?

Yes, Health Net has relaxed the refill limits so members can have more of their medications. Members should contact their pharmacy to get an added supply. Also, members should be sure to request a refill several days in advance of when their current supply runs out. This will allow extra time for the pharmacy to prepare it.

Can members get more than one prescription refilled early?

Yes. As a matter of fact it's best for members to arrange for all their prescriptions to either be picked up or delivered all at the same time. If they have more than one prescription, they should try to have them refilled on the same date. Health Net has been working with pharmacies to allow them to fill most prescriptions sooner than normal. This helps when trying to get prescriptions filled that have different refill dates.

What is a good way to limit being exposed to other people at the pharmacy?

Use the pharmacy drive-thru. Many pharmacies now have drive-thru windows. If your pharmacy has one, it may be a good option to use. A drive-thru limits coming in contact with other people picking up their medications.

Members can also wait in the car for their prescription. If their pharmacy doesn't have a drive-thru and they need to wait for a prescription to be ready, they might want to sit in their car rather than the pharmacy waiting area. By waiting in their car, members reduce the time they are exposed to other people. Some pharmacies will bring medications to the car. Note: Because of COVID-19 many pharmacies are changing the hours they are open. Members should contact their pharmacy to confirm business hours.

My client doesn't want to go out unless they really need to – is there a way to avoid going to the pharmacy?

Yes, the member should ask the pharmacy if they will deliver medications. During this pandemic, many pharmacies have offered to have medication delivered for free or at a low cost. CVS and Walgreens will deliver for free. Members should make sure to talk to their pharmacist to confirm their prescriptions qualify for delivery and if there is a delivery charge.

Are there other options besides going to the pharmacy?

Yes, members can use their mail-order option. Mail order will fill 30-day medication supplies. Or, members may be able to receive a larger amount – up to a 90-day supply for maintenance medications.

How can members change my prescription from a 30-day supply to a 90-day supply?

If you have a maintenance prescription, ask your pharmacist if you are able to get a 90-day supply. Mail order is also an option for filling a 90-day supply.

My employee has never used a mail-order pharmacy. Is this the right time to start? If so, how does it work?

Yes! Using a mail-order pharmacy or getting prescription delivered helps with social distancing. It lowers the risk of being exposed to COVID-19 and can reduce chances of getting sick. Benefits of mail-order pharmacies include:

  1. Simple, fast, and free delivery: Many mail-order pharmacies offer free shipping and can deliver prescriptions usually within five business days.
  2. Time and money saved: Some benefits offer discounts on medications if members get them through a mail-order pharmacy. Members can also save on time and transportation costs since they don't have to make a trip to a pharmacy.

How it works:

  • Option 1: Members should ask their doctor to send an electronic prescription (eRx) to CVS Caremark Mail Service Pharmacy. It should be for a prescription of up to a 90-day supply of your maintenance medication.
  • Option 2: Members can sign up or sign in at Caremark.com. Select Prescriptions from the navigation bar. From the drop-down menu, select Request a New Prescription. Search for the drug name and strength. Add it to the cart by choosing Request a New Prescription, and complete the order.
  • Option 3: If a member cannot contact their doctor or they are not able to sign up at Caremark.com, CVS Caremark Mail Service Pharmacy can contact their doctor. To start this process, complete the Start Mail Service request form.
  • Option 4: Members can call Caremark mail order at the toll-free number 1-888-624-1139 (TTY 711), 24 hours a day, 7 days a week.

Members can also contact Health Net Customer Service toll-free at 1-800-522-0088 for help. Please allow 14 days for shipment to arrive from mail order.

What if my employee's medication comes from a specialty pharmacy?

Specialty pharmacies ship medications straight to a member's home or office. Members can have their specialty prescription drug shipped most likely within a few days. Members should contact the specialty pharmacy for their refills.

What about medications that need prior approval?

Health Net has extended prior approvals scheduled to end in the next couple of months. This helps to ensure that you will get your medications without delay of getting a new approval. Many doctors are sending requests online from their homes. Health Net has waived the need for a signature to make it easier for doctors.

How do members 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, 8:00 a.m. to 6:00 p.m. Pacific time (PT) for questions or assistance.

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

How else can members get health care services?

Babylon is a useful way for Health Net members to get telehealth services. This service is for non-emergency medical and behavioral health issues. Members will receive 24-hour access to in-network health care providers. Members will get medical advice, be diagnosed, or get a prescription by video or phone. Get more information about Babylon and other health plan services.

What is Babylon?

Babylon is a mobile telehealth/telemedicine app that combines the power of Artificial Intelligence (AI) with human medical expertise. Users can meet with a licensed physician via telephone and/or video for any non-life threatening health issue or behavioral health.

Babylon healthcare providers are available for appointments 24/7. The clinical support team is available 7 days a week, 5:00 a.m. to 7:00 p.m. Pacific time. That means if your clinical support need arises after 7:00 p.m. Pacific time, you can leave a message for a return call on the next day. Or you can schedule a virtual visit within the app.

Please note that Behavioral health appointments are scheduled, not offered on-demand.

How do I use Babylon?*

All members will need to visit the Babylon website or Health Net telehealth web page to select and download the Babylon mobile application. At that time, members will be required to register.

*Babylon is not available on all group plans.

Can a member use Babylon for any health issues that may not be related to COVID-19?

Yes, Babylon is available for general medical and behavioral health issues and can be used for issues not related to COVID-19.

Are behavioral health services available thru Babylon, and if so what happens if there is a crisis situation during a call?

Yes, behavioral health services are available thru Babylon. The Babylon clinical team follows standard crisis protocols.

Can Babylon provide members with a doctor's note, i.e. missed work due to illness?

Yes, Babylon can provide members with this type of documentation.

How often is COVID-19 guidance updated within the Babylon app?

The app is updated on a regular basis to provide the most current information from the Centers for Disease Control (CDC).

If the Babylon provider determines the member needs to be referred for an in-person testing location, how is the referral tracked?

All referrals to in-person testing locations are tracked in the medical record and included in the encounter summary for members to access within in the Babylon app.

What is the member share of cost for telehealth services through Babylon?

Health Net will waive member cost-sharing for all diagnoses, COVID-19 related or not, provided via any telehealth solution, including Babylon. This applies to effective for dates of service starting March 17, 2020 and will continue until further notice when the plan's usual cost-sharing arrangements will resume.

Can the developmentally delayed population access these apps with support of a relative, conservator or staff from the local regional center?

Yes, a relative, conservator, or staff member can assist members who have special needs.

If a member accesses Babylon after the COVID crisis ends, will they be informed of any cost share prior to the appointment?

Yes. Health Net will communicate all cost-sharing changes to members prior to the change being implemented. This timeline will be defined as we learn more about the crisis.

Can I request the same Babylon healthcare provider each time?

If you wish to make an appointment with the same healthcare provider you've used before, please contact their support team at 1 (800) 475-6168. A support agent will book your appointment for you.

If you book through the Babylon App, the healthcare provider available will depend on the date and time requested. Any healthcare provider you book a consultation with will have access to notes related to your care from your previous Babylon appointments, if you have had any.

How will the Babylon appointment start?

You'll get an incoming video call from the healthcare provider within a few minutes of your scheduled appointment time. You don't need to have the Babylon App open to receive the call.

If you haven't received a call after a few minutes, read what to do if your appointment is late. We recommend turning on notifications so we can send you appointment reminders. To turn on notifications, follow these steps in your phone's general settings:

  • Go to Notifications > Babylon
  • Make sure notifications are turned on

You will receive a push notification reminding you about your appointment five minutes before it starts.

How do I prepare for my telehealth appointment?

  • Go somewhere quiet where you feel comfortable discussing your health. This could be at home or work, just as long as you won't be disturbed.
  • Try to avoid:
    • Being in a public place.
    • Being on a bus or train.
    • Doing other things during the call.
    • The healthcare provider might ask you to move if there's a lot of background noise, so you may want to keep headphones handy.
    • The healthcare provider will end the call if they think it's unsafe or inappropriate to continue, like if you take the call while driving or you're not fully dressed.
  • Make note of the main points you want to discuss and any relevant details, like:
    • How long you've experienced these symptoms.
    • What makes you feel better or worse.
    • Any medication you take, whether for your current symptoms or another health condition.
    • Don't worry about taking notes. Your healthcare provider will write up a summary that you can view after the appointment.

Are interpreter services available on a telehealth call?

Health Net members can access Babylon as a primary option of telehealth for COVID-19 question. Babylon offers members to select a Language Preference via the mobile app.

Can employer groups add Telehealth immediately, or do they have to wait for the next renewal? What is the PMPM cost? Would Health Net waive the PMPM cost? If Health Net doesn't waive the PMPM cost, is there a way to add Telehealth immediately and add the 2020 cost onto the next renewal instead of changing rates mid-year? Can we add Telehealth to groups that don't have it today for a 60-90 day complimentary period?

For plans that do not currently have a telehealth benefit, these services will be offered in support of members throughout the duration of this state of emergency. The group's rates will not be changed mid-year.

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 (Babylon, 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 Babylon for telehealth services. 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). Member cost share is waived for telehealth services until further notice.

Will Health Net allow access to telehealth services to increase access to care? And what is the reimbursement rate?

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).

Will Health Net be making changes due to the new IRS guidance on Section 125 plans, FSAs and HSAs?

To align with recent IRS guidance on Section 125 plans, FSAs and HSAs (Notice 2020-29 and Notice 2020-33), Health Net will allow members to elect mid-year plan changes and allow FSA and HSA updates at the request of the employer group. Please contact your Account Manager for more details if you wish to make a change to your Section 125 plan. Please note that Health Net is not allowing another Special Enrollment period.

Will Health Net allow mid-year plan downgrades (employer and employee) due to financial hardship? If yes, what documentation is required?

Groups have a one-time opportunity to downgrade their existing plans without penalty.

  • The plan downgrade must be within the plan family (for example, HMO to HMO, or PPO to PPO)
  • HMO plan downgrades that include a change in provider network require Underwriting approval (for example, Full-network HMO to WholeCare HMO)
  • Plan upgrades are not available
  • The group's renewal date will not change

Will Health Net allow mid-year employer contribution changes? If yes, what documentation is required?

Health Net will allow contribution changes as long as the minimum contribution requirements are met.

Will Health Net waive the reinstatement fee for groups that experience COVID-19 financial issues?

Health Net will be waiving all reinstatement fees through the end of the public health emergency.

Is Health Net considering any other options for employees who are not able to provide wet signatures (pen ink signature on paper) on their applications?

In addition to wet signatures, Health Net accepts member enrollment forms with electronic signatures, provided that the forms are submitted to Health Net via the group administrator, contracted broker or third party administrator (TPA). The group, broker or TPA is responsible for ensuring that the information provided to Health Net is accurate and the form was e-signed by the individual applying for coverage.

Will Health Net extend renewal deadlines?

No, renewal deadlines will not be extended. Health Net continues to comply with the 60-day renewal notification requirement for Small group employers, and 120-day renewal requirements for Large group employers.

Will Health Net be flexible on new business submission requirements (proof of business, payroll, etc.)?

Yes, we will provide an extension for new group business through the end of the public health emergency.

Will Health Net provide a partial premium refund for PPO plans as requested by the Insurance Commissioner on October 7, 2020?

No, Health Net will not issue a partial premium refund for PPO plans. The Affordable Care Act’s medical loss ratio  (MLR) provision require plans to provide a credit or rebate if the plan does not spend a certain percentage of premiums on medical care and activities to improve the quality of care. IFP and SBG plans must spend at least 80% of premiums on care; the threshold for large group plans is 85%.  Health Net will provide a premium credit or refund next September if the plan does not meet the 2020 MLR threshold.

Health Net encourages members to seek care, and has waived member deductible, copays and coinsurance for telehealth visits and COVID-19 testing and treatment.

Will an employer group's rates/premium be subject to change if enrollment drops by more than 10% as a result of COVID-19?

Both small group and large group rates will not adjust off-renewal cycle.

If an employer reduces staff to below 100 for either part of or for the entire plan year, how will this affect their renewal?

Health Net will continue to apply Standard Policy rules to determine the coverage applicable to each group. Health Net will continue to comply with Federal and State guidelines on group size and applicable determination.

Last Updated: 04/01/2021