We’re prepared for the Coronavirus. And we’re here to make sure you’re prepared, too.

If you are concerned about how the Coronavirus pandemic will impact your business, your health plan, and your employees, know Highmark is working round the clock to remove barriers so your employees have access to testing, treatment, and reliable information as this crisis unfolds.

Stay Connected

Help your employees take advantage of all their health plan has to offer, including our member portal, online tools, and member discounts.

What actions is Highmark taking?

We’ve temporarily removed cost-sharing (deductibles, coinsurance and copayments) on COVID-19 diagnostic testing and virtual care, including network telemedicine and virtual visits. We have given our self-insured customers the option to separately opt out of the testing waiver and the virtual care waiver. 

We’re also increasing member communications to address questions about available benefits, as well as access points such as telemedicine and nurse lines that can help them get initial guidance while minimizing exposure to others.

What cost-sharing will be waived?

Effective immediately, Highmark is implementing the following cost-sharing relief for insured and self-insured customers, including HDHP members. This is effective until June 13, 2020.

Federal & State Resources

Are now available to help business owners during the Coronavirus crisis.

COVID-19 testing

Under this program, COVID-19 lab charges by a network provider will be covered at 100%. Cost sharing (deductibles, coinsurance, and copayments) associated with physician-ordered diagnostic testing for novel Coronavirus will be waived when it is provided by a network provider.  

Most plans will cover testing performed by an out-of-network provider; however, out-of-network cost-sharing will apply.  HMO and EPO plans will not cover out-of-network care unless it is considered an emergency.  The medical visit charge will follow your benefit schedule. 

This relief impacts all markets (large group, small group, ACA), funding arrangements (insured and self-funded), products (PPO, EPO, HDHP, HMO, student products, Signature 65, traditional, comprehensive, and Medicare Advantage) and all markets (PA, WV, DE and National). 

Self-insured customers had to opt-out of this waiver by March 13, 2020.

Telemedicine and virtual visits

All member cost-sharing (deductibles, coinsurance and copays) for 24/7 telemedicine visits provided by American Well (www.amwell.com) and Doctor On Demand (www.doctorondemand.com) and Teladoc (www.teladoc.com) will be waived regardless of medical diagnosis, including behavioral health services for those feeling high levels of stress or anxiety. This applies to all fully insured commercial groups and individual products that cover this service under the telemedicine service benefit — both QHDHP and non-QHDHP plans.  

Cost-sharing for virtual PCP visits (including AHN MyChart video visits) will also be waived for all plans and all diagnoses.  

Self-insured customers had to opt out of this waiver by March 20, 2020.

Frequently Asked Questions

 

What are the cost implications of cost-sharing relief for employers?

Premiums for insured businesses will not be adjusted to account for the elimination of cost-sharing on COVID-19 testing. 

Self-funded clients that do not opt-out of the temporary relief will be billed for the waived member cost-sharing. 

Are there any impacts to prescription drug coverage?

Many plans do allow 90-day fills for certain medications; however, others may limit to a 30- or 34-day supply. Members interested in receiving a 90-day supply of medication should check their benefits and then have a conversation with their primary care physician to determine if this is appropriate. Medication quantity limits may also apply. 

Is telemedicine an alternative to conventional face-to-face care?

Yes. Telemedicine and virtual visits are effective ways for members experiencing mild symptoms to see a physician quickly and safely, without exposing or being exposed to others. For this reason, we are encouraging and promoting the use of telemedicine as an early line of defense. 

If an individual meets CDC criteria for COVID-19 testing, the telemedicine clinician will refer the patient to a local urgent care or emergency center for immediate testing and management.  We are waiving the cost-sharing for these visits to encourage members to seek care in the most effective way. 

For our fully insured customers

What are my options to continue coverage for employees/members who are losing hours or being furloughed?

For coverage periods through June 1, 2020, we will waive “active at work” eligibility requirements for coverage for a period of up to 90 days from the date of furlough or reduction in hours. This enables coverage for employees/members transitioned to part-time or furlough status. The only requirements are that:

a. the affected employees/members be currently covered on the plan,

b. coverage be offered on a uniform, non-discriminatory basis,

c. the premium is paid for the coverage with the same level of employer subsidies previously offered, and

d. at least one employee/member remains in active full-time employment.

What if I have to furlough employees/members partway through the month?

Any employees/members who were enrolled and eligible for coverage because they were actively working at the first of the month will be covered through the end of the month. We won’t be offering partial refunds of premiums for employees/members whose coverage would have ended by their employer partway through the month. This applies to March, April, and May.

What if I’m not able to continue to offer the same level of employer subsidies to my furloughed employees/members?

In that case, employees/members have the right to elect COBRA under federal law (except for church-sponsored plans which may offer contractual COBRA) or mini-COBRA under Pennsylvania, West Virginia, or Delaware law if the employer is eligible. This coverage would be available at a cost of up to 102% of the fully insured rate. The decision to offer access to subsidized coverage versus COBRA coverage must be made on a uniform, non-discriminatory basis. Please share your group’s COBRA information with your employees/members.

a. If your group is not eligible for COBRA, Highmark has options available through the individual exchange market for continuous access to coverage. Your employees/members can reach out to a dedicated Highmark phone line for information on securing an approved ACA insurance plan at 1-855-329-7791. HM Plans and coverage vary by county and are available in WV, PA and DE.

b. If you have furloughed employees/members that are over 65 years old and older, they can sign up for Medicare Advantage and/or Medicare Supplemental plans from Highmark at 1-833-490-1668. Plans are available in all Highmark regional markets. (Individual MA, Medigap, and PDP are available in our PA footprint and much of our WV footprint. Only Medigap and PDP are available in DE.)

What happens if I temporarily close my business due to COVID-19?

If there is at least one active-at-work employee, the policy continues. If not, individual market plans are available to ensure continuous coverage. See information above. 

If I am able to re-hire furloughed employees/members in the future, will the re-hired employees/members have to undergo a new waiting period for coverage?

If an employee/member is laid off or furloughed prior to June 30, 2020, due to COVID-19 business disruption and rehired prior to June 30, 2021, Highmark will waive the waiting period for coverage.

If I have to reduce or eliminate contributions toward dependent coverage, can I restore that same level of support later? Will disenrolled dependents have to wait for a special enrollment period?

If you restore contributions by December 31, 2020, to the former level in effect prior to June 30, 2020, Highmark will permit affected dependents to re-enroll if that special enrollment is timely requested. Affected dependents will be given the appropriate effective date of coverage based on the special enrollment period rules.

If my group falls below participation requirements due to furloughs, will my coverage be canceled?

Highmark will not enforce participation requirements through June 30, 2020.

I’m a new Highmark customer. My eligible employee/member population has changed between when my quote was issued and the effective date of coverage. What happens to my rates and coverage?

If your Highmark coverage began prior to July 1, 2020, we’ll honor the quoted rates for 90 days. Employees/members who have had reductions in hours or been furloughed will have access to coverage regardless of their “actively at work” status for 90 days following the job status change. (This access to coverage is subject to the requirements mentioned in question one on page one.) After 90 days, we’ll reevaluate your employee/member population and make a rate adjustment if necessary.

I’m a new Highmark small group customer. If my employee population drops to one or two employees, what will happen to my coverage?

If your Highmark coverage began prior to July 1, 2020, we’ll honor the quotes rated until renewal. We’ll also permit furloughed or laid-off employees to be added back to the plan and we’ll waive the waiting period for coverage.

If my group’s enrollment changes by more than 10%, will my premium be subject to re-rating?

Highmark will not re-rate policies for reductions in enrollment through June 30, 2020.

I’m having trouble paying my premium bill, what options do I have?

Please contact your Highmark customer manager to discuss your situation.

If I need to decrease my benefit level to help reduce my premiums, can I do that sooner than the normal 60-day waiting period?

Unfortunately, no. Due to Affordable Care Act requirements, we’re not able to permit changes sooner than 60 days.

Employee Resources

Members and employers should visit www.highmarkanswers.com for guidance on where to go for care, prevention and preparation tips, plus general Coronavirus information. 

For the most up-to-date information, refer to the CDC website.  

If you have any questions, day or night, please reach out to your Highmark Representative. They’re your first, best resource for guiding you through this unprecedented event.

 

For our self-insured customers

What if I’m unable to offer the same level of employer subsidies to my furloughed employees/members?

If you need to terminate coverage due to a reduction in hours, then employees/members and their beneficiaries will have the right to elect COBRA under federal law (except for church-sponsored plans, which may offer contractual COBRA.) Talk to your COBRA administrator for more details.

a. If your group is not eligible for COBRA, Highmark has options available through the individual exchange market for continuous access to coverage. Your employees/members can reach out to a dedicated Highmark phone line for information on securing an approved ACA insurance plan at 1-855-329-7791. HM Plans and coverage vary by county and are available in WV, PA and DE.

b. If you have furloughed employees/members that are over 65 years old and older, they can sign up for Medicare Advantage and/or Medicare Supplemental plans from Highmark at 1-833-490-1668. Plans are available in all Highmark regional markets. (Individual MA, Medigap, and PDP are available in our PA footprint and much of our WV footprint. Only Medigap and PDP are available in DE.)

If I’m having trouble paying my claims or invoice, what options do I have?

Please contact your Highmark Client Manager to discuss your situation.

I’m a new Highmark customer. My eligible employee/member population has changed between when my quote was issued and the effective date of coverage. What happens to my fees?

We’ll honor the quoted rates for 90 days. We’ll then reevaluate your employee/member population and fees.

Privacy Information For Self-Funded Plans 

As of today, there has been no change in federal requirements regarding the proper handling of protected health information (PHI). We are monitoring communications from the Department of Health and Human Services on this subject and will adjust our current practices as needed if deviations from current requirements are authorized. 

Can Highmark share the names of covered members who have been tested?

Yes. Highmark can provide group health plan administrators with the names of their members who have been tested, presuming we have received claims for the tests and can identify them. You will be invoiced for the claims and have the right to know the identities of individuals for whom you are paying claims in order to properly administer their plans. 

Can Highmark share test results?

No. Highmark cannot provide any test results, positive or negative. If we receive corresponding claims for any COVID-19 hospitalizations or other treatments we cannot provide anything more than what you would receive in the course of your usual invoicing process.

Business Preparedness for COVID-19

FIRST, KNOW THAT WE’VE BEEN PREPARED FOR THIS.

Highmark has a corporate policy that governs our Business Continuity and Disaster Recovery Planning processes so that we can respond quickly and decisively to potentially disruptive events and continue to meet the needs of the communities we serve. Here’s how some of those processes have been put into action in the past weeks.

HOW ARE YOU PROTECTING THE HEALTH OF YOUR EMPLOYEES?

Starting Thursday, March 19, 2020, all Highmark employees have been granted approval to work-from-home full-time, and issued the equipment they need to do their jobs easily outside of our corporate offices. This provides some necessary social distancing for them, and a seamless service experience for you.

WILL YOUR CALL CENTERS BE ABLE TO HANDLE THE INCREASED VOLUME OF CALLS?

During this time, it’s essential that all member questions are promptly answered — so we’ve moved all non-business-critical personnel to off-hour shifts to accommodate the anticipated increase in call volumes. Our call centers are a top priority.

DO YOU HAVE THE NETWORK BANDWIDTH TO DO THIS FOR AN EXTENDED PERIOD OF TIME?

Yes, we have confirmed with our internet service provider that we have thecapacity to support long-term remote work. We are continuously monitoring our network bandwidth and will make adjustments as needed. Our network is secure and requires two-factor authentication to gain access. 

IS YOUR DATA CENTER SECURE?

Yes. Our Tier III data center is certified for service continuity by the Health Insurance Trust Alliance (HITRUST) and ISO20000-1. We use a nationally recognized recovery services vendor to recover critical systems and services, and we exercise our corporate disaster recovery plans on an annual basis.

WHAT ARE YOU DOING TO SUPPORT PROVIDERS DURING THIS TIME?

To relieve pressure on Emergency Departments, private practices, and urgent care facilities, we’ve increased access to telemedicine and to testing via driveup COVID-19 testing sites.

SHOULD I OR MY EMPLOYEES FOLLOW ANY DIFFERENT PROCEDURES WITH QUESTIONS DURING THIS TIME?

Please continue to use the normal channels to get answers to your questions. For you that means contacting your Highmark account rep. Your employees can access their member portal or call the Member Services number on the back of their Highmark ID card.

WHERE SHOULD I GO FOR THE LATEST INFORMATIONON COVID-19?

Please visit the following sites, updated regularly.

highmarkanswers.com

cdc.gov

Important Legal Information:

Health benefits or health benefit administration may be provided by or through Highmark Blue Shield or one of its affiliated Blue companies, which are independent licensees of the Blue Cross Blue Shield Association.  Highmark Inc. d/b/a Highmark Blue Shield and certain of its affiliated Blue companies serve Blue Shield members in the 21 counties of central Pennsylvania. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania.  Highmark Inc. or certain of its affiliated Blue companies serve Blue Cross Blue Shield members in the 29 counties of western Pennsylvania, 13 counties in northeast Pennsylvania, the state of West Virginia plus Washington County, Ohio, and the entire state of Delaware. Information on this website is issued by Highmark Blue Shield on behalf of its affiliated Blue companies.