With all that is happening, we felt it important to give you some quick answers to some Frequently Asked Questions pertaining to the COVID-19 virus itself, how this pandemic affects individuals, questions that relate to us as a medical carrier, and questions about stop-loss/reinsurance.
Frequently Asked Questions:
- What are the symptoms of Coronavirus?
The most common symptoms of COVID-19 are fever, tiredness, shortness of breath, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention.
- How soon after exposure will symptoms occur?
2-14 days after exposure.
- How is the disease spread?
- Between people in close contact with one another (6 feet).
- Through respiratory droplets produce when an infected person coughs or sneezes.
- These droplets can land in mouths and noses of people who are nearby or possible inhales into the lungs.
- Can someone spread the virus without being sick?
- People are thought to be most contagious when they are most symptomatic (the sickest).
- Some spread might be possible before people show symptoms, but this is not thought to be the main way the virus spreads.
- What to do if you are sick?
- If you think you have been exposed to COVID-19 and develop a fever and symptoms call your healthcare provider.
- Stay home except to get medical care.
- Separate yourself from other people.
- Call ahead before visiting your doctor and tell them you have or may have COVID-19. This will help the healthcare provider take steps to keep other people from getting infected.
- Wear a face mask.
- Follow the steps to protect yourself above.
- Stay home until instructed to leave if infected.
- Can the virus that causes COVID-19 be transmitted through the air?
Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air.
- Can COVID-19 be caught from a person who has no symptoms?
The main way the disease spreads is through respiratory droplets expelled by someone who is coughing. The risk of catching COVID-19 from someone with no symptoms at all is very low. However, many people with COVID-19 experience only mild symptoms. This is particularly true at the early stages of the disease. It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill. WHO is assessing ongoing research on the period of transmission of COVID-19 and will continue to share updated findings.
- Is there a vaccine for the virus?
There is no vaccine currently available. They are being worked on but there is no time frame.
For Individuals & Families
- Steps to protect yourselves
- Wash your hands often.
- Use hand sanitizer that contains at least 60% alcohol.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Avoid contact with people who are sick.
- Put distance between yourself and other people.
- Stay home if you are sick.
- Cover coughs and sneezes.
- Wear face mask if you are sick.
- Clean and disinfect.
- How is EMI Health covering COVID-19?
EMI Health will waive member co-pays, deductibles, and other cost sharing for Coronavirus (COVID-19) diagnostic testing, up to the plan's maximum allowable charges, when ordered by a physician and performed by an accredited lab or medical facility. EMI Health will also cover Serology testing, which is a test looking for the presence of COVID-19 antibodies, one time.
EMI Health will cover member co-pays, deductibles, and other cost sharing for Coronavirus (COVID-19) related treatment, up to the plan's maximum allowable charges, received between April 1, 2020 and September 30, 2020. This does not apply to Minimum Essential Coverage (MEC) plans.
Treatment will be covered at 100%, up to the plan's maximum allowable charges. When services are received from in-network providers and facilities within the coverage window, the provider will not balance bill you. If services are received from out-of-network providers and facilities, the provider is encouraged to write off amounts above the plan's maximum allowable charge, but may not be legally obligated to do so.
EMI Health will re-evaluate this coverage window in August to determine if it will be extended.
- Who can get tested?
As testing becomes more widely available, there are increased options available to the public. Remember, to be covered by your health plan, the test must be requested by a physician and performed by an accredited lab or medical facility.
- What do I need to do to get tested?
- If you live in Utah, visit testutah.com to see if you qualify for a free test.
- See your healthcare provider either in person or through Telemed.
- Have your provider order a test at an authorized testing facility.
- Where can I get tested?
- Qualified Urgent Care facilities.
- Qualified local hospitals.
- Qualified physician offices.
- State Health Department.
- testutah.com (Utah only).
- U of U Hospital (Utah only).
- Approved facilities from Intermountain Healthcare (Utah Only).
- National testing location search provided by Cigna
- If you are covered through our BCBSAZ partnership, COVID-19 testing sites in Arizona can be found here. Once you have identified a site location near you, use the provider search to verify contract status.
- What are the rules for getting the COVID-19 test?
- Symptoms of COVID-19 or close contact with a person diagnosed with COVID-19.
- Test will need to be done at an approved laboratory location.
- Only the COVID-19 test will be covered at no cost share. Any other tests will have applicable cost sharing applied.
- EMI Health will cover the cost of physician-ordered testing for patients who meet CDC guidelines.
- Will EMI Health pay for the cost of the testing?
Yes, when ordered by a physician and the test is done at an accredited laboratory. This includes Serology testing used to determine if you have COVID-19 antibodies. Serology testing is covered one time only.
- Are Telehealth visits covered?
Yes, but any copays and deductibles will apply. WellVia TeleMedicine is available to most EMI Health members with no copay.
- How long will it take to get the test results?
Varies by test and location but estimates are 24-48 hours.
- What is EMI Health doing to address COVID-19?
EMI Health is working to provide information to providers, care managers and customer service professionals to ensure they have the latest information about the virus so we can work together to inform and support our members who have questions or concerns.
- What codes are being used for billing the test?
Current guidance is to use CPT 86328, 87635, 86769, G2023, G2024, U0001, U0002, U0003, or U0004.
- Is EMI Health allowing employers to lower their minimum hourly requirement from 30 to 20 HPW effective immediately to allow employees to stay on as “active” longer? And will this impact rates?
Yes, we will allow this on a temporary basis. Employers are responsible to have written eligibility policies in place and to provide eligibility information to EMI Health. Contribution levels must remain at least 50% of the single coverage. Coverage can NOT be voluntary. For a more detailed discussion of your group's situation, please contact your EMI Health account manager. EMI Health cannot give legal advice. For legal advice regarding eligibility requirements, please contact your legal counsel.
- If layoffs cause loss of coverage and then the employee is reinstated, will EMI Health allow employee to re-enroll in plan without a waiting period?
Yes, we will allow. Please have any employer let us know what their rehire policy is. We will want to make sure to limit this to no more than 6 months and ideally less (depending on how things go over the next few months).
- What are the rate/claims implications of decisions we make regarding paid/unpaid leave, shared work, partial work, reduced hours and furloughs?
Currently we are not making any changes to rates until the next renewal period. Claims will be paid for all members enrolled on the plan as long as premiums are paid.
- What are the costs of COVID-19 tests, and how will this impact rates? Will EMI Health be holding rates at the same level as current – how will this we be handled at the renewal?
Pricing for COVID-19 testing varies by vendor. There will be no change to existing rates. Renewals will be handled like they have in the past.
- Can EMI Health project the expected costs when someone contracts COVID-19 and requires hospitalization?
We do not currently have any projections available.
- What impact will temporary headcount reductions from laid-off (or furloughed) employees have on renewals for all lines of coverage?
We will review each group on a case by case basis and make projections based on the members expected to be on the plan going forward.
- With the ability to re-rate based upon changes in enrollment, will EMI Health deploy re-rate strategies midyear?
We don’t currently anticipate making adjustments but will review each group on a case by case basis.
- Has EMI Health made any assumptions around COBRA participation volumes if/when those layoffs/furloughs happen? If yes, how does EMI Health anticipate this impacting the rates? Will EMI Health wait to adjust until renewal?
We do not have any assumptions yet on COBRA volume or impact to rates.
- Does EMI Health expect to keep your timelines for renewal delivery? Has EMI Health had any discussions about extending rate periods or postponing renewals?
Yes we expect to keep timelines for renewal delivery. There will not be any change to renewal dates.
- If EMI Health has released a renewal, will those rate actions hold or is there a potential for adjustments?
Renewal rates already released will remain the same.
- Will EMI Health allow for continuation of benefits in the event of layoff and furlough? Will clients be required to change their eligibility policies to allow for that?
As long as the employer is paying the same level of premium, continuation of benefits can be allowed. This cannot become voluntary coverage.
- What approach is EMI Health taking in terms of client’s inability to pay for premium due to significant reductions in revenue/workforce?
We can discuss on a case by case basis.
- Do EMI Health dental plans cover infection control efforts?
Infection control, including personal protective equipment (PPE) and oral rinses, is an integral part of the dental treatment you receive—not an extra service—therefore, your EMI Health dental plan does not pay separately for infection control.
Of course, we recognize that dental offices are incurring additional expenses associated with the pandemic. In fact, all organizations are to some degree, including yours and ours. EMI Health is dedicated to controlling costs for our clients and members, especially during this time when so many are facing financial challenges.