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Member Coronavirus Information

What you need to know about COVID-19

Updated 3/20/20

Coronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. People of all ages can be infected. Older adults and people with pre-existing medical conditions like asthma, diabetes and heart disease may be more likely to become severely ill if infected. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness

What Is The Coronavirus?
COVID-19 is a respiratory disease that is caused by a new virus called a coronavirus, which has become a public health emergency. The number of cases continue to increase nationally and globally.

What Are The Symptoms?
The symptoms of coronavirus include mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. COVID-19 can be contagious before a person begins showing symptoms.

What Else Causes Similar Symptoms?
Influenza (the flu), a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the United States at this time. Everyone 6 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 the virus or flu, contact your healthcare provider or health department immediately.

How Else Can I Get Healthcare Services?
If you have the symptoms noted above, you can also access our Nurse Advice Line. To learn more, please call us at 1-877-658-0305 (TTY: 711). We can also answer general questions you may have about Coronavirus.

Protect yourself and your community.
We all have a role to play in protecting our communities and families from the spread of coronavirus. It is similar to other communicable viruses. You can also follow these tips to prevent infection:

  • Wash your hands thoroughly and frequently. Use soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizing rub (must contain at least 60 percent alcohol).
  • Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow.
  • Promptly dispose of tissues in a wastebasket after use.
  • Clean public surfaces thoroughly.
  • Stay home when you are sick.
  • Avoid shaking hands.
  • Avoid close contact with people who are sick.
  • Get a flu vaccine.

Does My Plan Cover COVID-19 Testing/Screening Services?
Yes. When medically necessary diagnostic testing or medical screening services are ordered and/or referred by a licensed health care provider, we will cover the cost of medically necessary COVID-19 tests and the associated physician’s visit. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing and/or medical screening services.

Is Prior Authorization Required For COVID-19 Testing/Screening Services Under My Plan Coverage?
No. We will not require prior authorization, prior certification, prior notification and/or step therapy protocols for medically necessary COVID-19 diagnostic testing and medical screening services, when medically necessary services are ordered and/or referred by a licensed health care provider.

Where May I Receive COVID-19 Testing/Screening Services Under My Plan Coverage?
Medically necessary COVID-19 diagnostic testing and/or medical screening services and the associated physician’s visit will be covered when ordered, referred and/or performed in the following In-Network locations:

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

Are you unsure if you have been exposed to or at-risk of being infected with COVID-19? Schedule a virtual care visit with a provider. It is a good option for non-urgent care to limit potential exposure in a physician’s office or other healthcare facility.

Will I Be Responsible For Any Out-Of-Pocket Costs For COVID-19 Testing/Screening Services?
No. We will cover medically necessary COVID-19 diagnostic testing and/or medical screening services at no charge to you, when such services are ordered and/or referred by a licensed health care provider. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing and/or medical screening services along with the associated physician’s visit.

If I Need Treatment For Coronavirus, Is That Covered By My Plan?
Any medically necessary treatment related to COVID-19 would be considered a covered benefit. We are committed to ensuring access to COVID-19 treatment services in accordance with federal and state law.

Will I Be Able To Refill My Prescriptions Before The Refill Date?
Yes, members will be able to refill prescriptions prior to the refill date.

Are There Strategies For Coping With The COVID-19 Outbreak?
Worry and anxiety can rise about the spread of COVID-19. Concern for friends and family who live in places where COVID-19 is spreading or the progression of the disease is natural.

  • 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 actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.
  • For more information, see the CDC’s suggestions for mental health and coping during COVID-19

For more information, including travel advisories, please visit cdc.gov.

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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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