During these unprecedented times, EMI Health has made important decisions about how we will cover COVID-19 related tests and treatments.
Since this pandemic began, we made the decision to cover medically-necessary COVID-19 (coronavirus) testing, when ordered and administered by a healthcare provider following a clinical assessment, at 100% up to the plan's maximum allowable charge (MAC). This includes one Serology test, a test used to determine the presence of COVID-19 antibodies. To be covered, the testing must be requested by a physician and performed by an accredited laboratory or medical facility. EMI Health does not cover tests performed for surveillance, employment, school, or travel purposes.
In accordance with recent federal guidance, beginning January 15, 2022, EMI Health plans will also cover up to eight over-the-counter home tests per covered person per month. If EMI Health administers the pharmacy benefit for those plans, eligible tests will be covered upfront with no out-of-pocket expense to the member when they are obtained at a participating pharmacy.
President Biden announced that the federal government is purchasing 500 million at-home COVID-19 testing kits, to be sent free of charge to Americans who request them through https://www.covidtests.gov/.
EMI Health has also decided to cover costs for treatment of an active COVID-19 infection at 100% up to the plan's MAC for covered members who receive treatment between April 1, 2020 and September 30, 2021. This does not apply to Minimum Essential Coverage (MEC) plans.
During this period, members will not have any cost sharing (including copays, coinsurance, or deductibles) for COVID-19 testing or treatment for an active COVID-19 infection, as EMI Health will cover these costs 100%. Ongoing treatment due to complications of COVID-19 are subject to the normal benefits of the plan.
It is important to note that, while EMI Health will pay nonparticipating providers as if they were participating for COVID-19 testing and treatment rendered through September 30, 2021, nonparticipating providers may choose to balance bill the patient for amounts that exceed the plan's MAC. Participating providers have agreed to write off that amount and will not balance bill the patient.
Beginning October 1, 2021, treatment for COVID-19 will be covered as any other condition, according to the terms of the member's health plan, and normal cost sharing will apply. Testing and vaccinations will continue to be covered at 100% up to MAC.
We are committed to serving our members when times are good, as well as when we find ourselves in challenging times like now.
It is critical that we all work to combat this pandemic and act responsibly in accordance with national and state guidelines. The EMI Health customer service team is here for you if you have if any questions about your health plan.
Stay safe. Stay well. Look out for each other and we will make it through this together.
Thank you for your partnership.