To help limit the spread of COVID-19, National General will waive 100% of customers’ out-of-pocket costs for COVID-19 diagnostic tests and will ease access for customers seeking diagnostic testing. This waiver will extend to all National General Short Term Medical customers and will be made available to employers in the National General Benefits Solutions Program. As part of the effort regarding COVID-19 diagnostic testing, National General will:Waive all member cost sharing for COVID-19 diagnostic tests and related services, including the associated office visit, emergency room, or urgent care charges. The waiver applies any out-of-pocket costs, including deductibles, copays, and co-insurance for diagnostic testing related to COVID-19.Waive all prior authorization requirements as it relates to COVID-19 diagnostic testing.Allow early refills and up to a 90-day supply of a member’s prescription drugs in the event of hardship related to COVID-19.For limited medical or hospital expense policies, if your policy has office visits or lab benefits, testing may be covered under your policy. Please view your plan documents on your member portal for further details.
Customers concerned about exposure to COVID-19 should contact their healthcare provider or state health department. National General’s customer service call center will be available to assist if customers have any questions about COVID-19 testing-related services.
Decisions about testing are at the discretion of state and local health departments and/or individual clinicians. The Centers for Disease Control (CDC) had previously recommended that anyone with symptoms of COVID-19, returning from a Centers for Disease Control-designated “Level 2” or “Level 3” advisory area, or who has been in contact with someone who is suspected or confirmed of having the coronavirus within the last 14 days, should be tested. Any individual who suspects that they may have been exposed to the coronavirus or is exhibiting symptoms such as fever, cough, or difficulty breathing should consult with their health care provider to make the appropriate testing recommendation.
The CDC has outlined clinical criteria to qualify as a candidate which may be approved by a doctor. The CDC clinical criteria for a COVID-19 Person Under Investigation (PUI) have been developed based on what is known about COVID-19 and are subject to change as additional information becomes available.
Decisions about testing are at the discretion of state and local health departments and/or individual clinicians. The Centers for Disease Control (CDC) had previously recommended that anyone with symptoms of COVID-19, returning from a Centers for Disease Control-designated “Level 2” or “Level 3” advisory area, or who has been in contact with someone who is suspected or confirmed of having the coronavirus within the last 14 days, should be tested. Any individual who suspects that they may have been exposed to the coronavirus or is exhibiting symptoms such as fever, cough, or difficulty breathing should consult with their health care provider to make the appropriate testing recommendation.
Members who have concerns that they may have been exposed to COVID-19 or may have symptoms of COVID-19 should contact their health care practitioner or state Department of Health for testing.
No vaccine or specific treatment for COVID-19 is available at this time; care for a person who tests positive for the virus is supportive in nature.
Here are some resources to learn more about COVID-19:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html
For National General Short-Term Medical and National General Benefits Solutions Self-Funded Program members, cost-sharing will be waived for COVID-19 diagnostic testing-related services. This means the member will not be subject to deductibles, copays, or coinsurance.
Contact our Customer Service Teams by calling:
Contact our Customer Service teams by calling the number on the back of your Medical ID card
National General Benefits Solutions Self-Funded Program members should call the number on the back of their Medical ID card
National General would like to ensure that our network partners understand how we are addressing the COVID-19 crisis and we are committed to working with you and our claims administrators during this unprecedented period. We understand these are difficult times, and we appreciate what our dedicated providers are doing to help protect our members.
This document will address the following key areas on how National General is adjudicating its Short Term Medical plans:
- Waiving cost sharing for COVID-19 testing
- General billing guidelines for COVID-19 related services.
- General Telehealth Guidelines
- Utilization Review
- Prescription Drugs
National General has been working closely with our claims administrator on how our Short Term Medical plans are to be adjudicated. If you have any questions after reviewing this document, please contact our Third Party Administrator Meritain Health at 866-596-5817. They will be able to assist you with any detailed questions you may have. As the COVID-19 crisis evolves, we will be updating this document and notifying our claims administrators of any changes on how to adjudicate our plans.
National General will waive 100% of customers’ out-of-pocket costs for COVID-19 diagnostic tests and will ease access for customers seeking diagnostic testing. This waiver will extend to all National General Short Term Medical customers. As part of the effort regarding COVID-19 diagnostic testing, National General will:
- Waive all member cost sharing for COVID-19 diagnostic tests and related services, including the associated office visit, emergency room, or urgent care charges. The waiver applies to any out-of-pocket costs, including deductibles, copays, and co-insurance for diagnostic testing related to COVID-19.
National General’s third party administrator claims processing systems are able to accurately and timely administer claims when health care providers follow the guidelines provided by the CDC and AMA . In order to properly adjudicate claims for COVID-19 diagnostic tests, we are encouraging all providers to utilize the following websites:
AMA COVID-19 coding and guidance:
https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance
CDC – Healthcare Professionals:
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
Note that the above links indicate generally how we are paying COVID-19 related claims. State specific requirements may vary. These websites are subject to change. In order to get the most current coding and any state specific differences, please contact our third party administrator at the number provided above. Claims will be processed in accordance with these guidelines for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
In an effort to make it as easy as possible for our customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, National General will allow providers to bill a standard face-to-face visit for all virtual care services related to COVID-19. In addition, generally telehealth services will continue to be paid on non-COVID-19 related services if the member’s plan includes telehealth benefits.
- National General is waiving customer cost sharing for telehealth screenings for COVID-19 related services. This means that providers can perform services for National General Short Term Medical customers in a virtual setting and bill as though the services were performed face-to-face. Claims will be processed in accordance with these rules for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
- Providers may bill using a face-to-face code, append the GQ, GT or 95 modifier, and use the Place Of Service (“POS”) that would be typically billed if the service was delivered face-to-face (e.g., POS 11).
- Providers may also bill using POS 02. Providers will be reimbursed consistent with their typical face-to-face rates.
- For any state specific differences, please contact our third party administrator at the number provided above.
National General will be waiving any utilization review, prior authorization, care management, and emergency care policies and procedures as they relate to the testing and/or treatment of COVID-19 for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
In the event an insured’s plan includes prescription drug benefits, early refills and up to a 90-day supply (if prescribed) will be permitted upon request due to quarantine or other COVID-19 hardships. National General will also assist members who request expedited formulary exceptions as appropriate, and those who are unable to access in-network pharmacies due to increased demand or drug shortages. Members are being encouraged to contact the Pharmacy Benefits number on the back of their ID card to discuss options.
To help limit the spread of COVID-19, NationalGeneral has made the following benefit enhancements to all Nationcare plans.
Waived member cost sharing for COVID-19 diagnostic tests and related charges.
- Nationcare members will not be subject to deductibles, copays, or coinsurance for diagnostic testing charges related to COVID-19. This means 100%, first-dollar Plan payment for professional services, lab tests, and facility charges (e.g. office visit, ER visit, urgent care visit) incurred for a COVID-19 diagnostic test.*
- For members who obtain COVID-19 diagnostic tests from in-network providers, the Plan will pay 100% of the network-contracted rate.
- For members who obtain COVID-19 diagnostic tests from a non-network provider, and for members covered by plans that do not use provider networks, the Plan will pay 100% of the Maximum Allowable Amount or as otherwise required under applicable law.
- If a member tests positive for COVID-19, all additional services provided to the member for the treatment of and medically necessary supportive care for COVID-19 will be subject to the member’s deductible, copays, and coinsurance.+
*Nationcaremembers who are residents of the District of Columbia also receive waivedmember cost sharing for treatment of COVID-19.
+Members of Texas-domiciled Nationcare groups will also receive waived membercost sharing for treatment of COVID-19
National General’s third party administrator claims processing systems are able to accurately and timely administer claims when health care providers follow the guidelines provided by the CDC and AMA . In order to properly adjudicate claims for COVID-19 diagnostic tests, we are encouraging all providers to utilize the following websites:
AMA COVID-19 coding and guidance:
https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance
CDC – Healthcare Professionals: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
Note that the above links indicate generally how we are paying COVID-19 related claims. State specific requirements may vary. These websites are subject to change. In order to get the most current coding and any state specific differences, please contact our third party administrator Meritain Health, Inc. at 800-847-8361. Claims will be processed in accordance with these guidelines for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
Since some members seeking COVID-19 diagnostic tests may be directed to an emergency room for quarantine purposes, the standard penalty for emergency room use for non-emergencies will NOT be applied for COVID-19 diagnostic tests.
There will be no prior authorization requirements for Nationcare members seeking COVID-19 diagnostic tests, treatment for COVID-19, or medically necessary supportive care if tested positive for COVID-19.
- Claims submitted with the place-of-service code “02” (telehealth) will be considered according to the plan benefits.
- Any claim with the place-of-service code “02” (telehealth) that is related to diagnostic testing for COVID-19 will have member cost sharing waived. Nationcare members will not be subject to deductibles, copays, or coinsurance for telehealth virtual visits that are part of diagnostic testing for COVID-19.
- For members who obtain telehealth virtual visits for diagnostic testing of COVID-19 from in-network providers, the Plan will pay 100% of the network-contracted rate.
- For members who obtain telehealth virtual visits for diagnostic testing of COVID-19 from a non-network provider, the Plan will pay 100% of the Maximum Allowable Amount or as otherwise required under applicable law.
- Early refills and prescriptions for up to 90-day supplies (as prescribed) will be permitted upon request due to quarantine or other COVID-19 hardships.
- Expedited formulary exceptions, as appropriate.
- Access to out-of-network pharmacies due to increased demand or drug shortages at in-network pharmacies.
National General would like to ensure that our network partners understand how we are addressing the COVID-19 crisis and we are committed to working with you and our claims administrators during this unprecedented period. We understand these are difficult times, and we appreciate what our dedicated providers are doing to help protect our members.
This document will address the following key areas on how National General is adjudicating its Short Term Medical plans:
- Waiving cost sharing for COVID-19 testing
- General billing guidelines for COVID-19 related services.
- General Telehealth Guidelines
- Utilization Review
- Prescription Drugs
National General has been working closely with our claims administrator on how our Short Term Medical plans are to be adjudicated. If you have any questions after reviewing this document, please contact our Third Party Administrator Allied at 855-505-2355. They will be able to assist you with any detailed questions you may have. As the COVID-19 crisis evolves, we will be updating this document and notifying our claims administrators of any changes on how to adjudicate our plans.
National General will waive 100% of customers’ out-of-pocket costs for COVID-19 diagnostic tests and will ease access for customers seeking diagnostic testing. This waiver will extend to all National General Short Term Medical customers. As part of the effort regarding COVID-19 diagnostic testing, National General will:
- Waive all member cost sharing for COVID-19 diagnostic tests and related services, including the associated office visit, emergency room, or urgent care charges. The waiver applies to any out-of-pocket costs, including deductibles, copays, and co-insurance for diagnostic testing related to COVID-19.
National General’s third party administrator claims processing systems are able to accurately and timely administer claims when health care providers follow the guidelines provided by the CDC and AMA . In order to properly adjudicate claims for COVID-19 diagnostic tests, we are encouraging all providers to utilize the following websites:
AMA COVID-19 coding and guidance:
https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance
CDC – Healthcare Professionals:
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
Note that the above links indicate generally how we are paying COVID-19 related claims. State specific requirements may vary. These websites are subject to change. In order to get the most current coding and any state specific differences, please contact our third party administrator at the number provided above.
Claims will be processed in accordance with these guidelines for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
In an effort to make it as easy as possible for our customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, National General will allow providers to bill a standard face-to-face visit for all virtual care services related to COVID-19. In addition, generally telehealth services will continue to be paid on non-COVID-19 related services if the member’s plan includes telehealth benefits.
In an effort to make it as easy as possible for our customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, National General will allow providers to bill a standard face-to-face visit for all virtual care services related to COVID-19. In addition, generally telehealth services will continue to be paid on non-COVID-19 related services if the member’s plan includes telehealth benefits.
- National General is waiving customer cost sharing for telehealth screenings for COVID-19 related services. This means that providers can perform services for National General Short Term Medical customers in a virtual setting and bill as though the services were performed face-to-face. Claims will be processed in accordance with these rules for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
-Providers may bill using a face-to-face code, append the GQ, GT or 95 modifier, and use the Place Of Service (“POS”) that would be typically billed if the service was delivered face-to-face (e.g., POS 11).
-Providers may also bill using POS 02. Providers will be reimbursed consistent with their typical face-to-face rates.
- For any state specific differences, please contact our third party administrator at the number provided above.
National General will be waiving any utilization review, prior authorization, care management, and emergency care policies and procedures as they relate to the testing and/or treatment of COVID-19 for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
In the event an insured’s plan includes prescription drug benefits, early refills and up to a 90-day supply (if prescribed) will be permitted upon request due to quarantine or other COVID-19 hardships. National General will also assist members who request expedited formulary exceptions as appropriate, and those who are unable to access in-network pharmacies due to increased demand or drug shortages. Members are being encouraged to contact the Pharmacy Benefits number on the back of their ID card to discuss options.
National General would like to ensure that our network partners understand how we are addressing the COVID-19 crisis and we are committed to working with you and our claims administrators during this unprecedented period. We understand these are difficult times, and we appreciate what our dedicated providers are doing to help protect our members.
This document will address the following key areas on how National General is adjudicating its Limited Medical plans:
- Coverage for COVID-19 diagnostic tests and related charges
- General billing guidelines for COVID-19 related services.
- General Telehealth Guidelines
- Utilization Review
National General has been working closely with our claims administrator on how our Limited Medial plans are to be adjudicated. If you have any questions after reviewing this document, please contact our Third Party Administrator Key Benefit Administrators at 855-212-5014. They will be able to assist you with any detailed questions you may have. As the COVID-19 crisis evolves, we will be updating this document and notifying our claims administrators of any changes on how to adjudicate our plans.
National General’s Limited Medical plans provide a set-dollar amount for services like office visits, ER visits, urgent care, and lab tests. So if your plan covers these services, the plan will provide 100% plan payment for the professional services, lab tests and facility charges (e.g. office visit, ER visit, urgent care visit) incurred for a physician-recommended COVID-19 diagnostic test.
National General’s third party administrator claims processing systems are able to accurately and timely administer claims when health care providers follow the guidelines provided by the CDC and AMA. In order to properly adjudicate claims for COVID-19 diagnostic tests, we are encouraging all providers to utilize the following websites:
AMA COVID-19 coding and guidance:
https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance
CDC – Healthcare Professionals:
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
Note that the above links indicate generally how we are paying COVID-19 related claims. State specific requirements may vary. These websites are subject to change. In order to get the most current coding and any state specific differences, please contact our third party administrator at the number provided above.
Claims will be processed in accordance with these guidelines for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
In an effort to make it as easy as possible for our customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, National General will allow providers to bill a standard face-to-face visit for all virtual care services related to COVID-19. In addition, generally telehealth services will continue to be paid on non-COVID-19 related services if the member’s plan includes telehealth benefits.
National General will provide 100% plan payment for telehealth screenings for COVID-19 related services. This means that providers can perform services for National General Limited Medical customers in a virtual setting and bill as though the services were performed face-to-face. Claims will be processed in accordance with these rules for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
- Providers may bill using a face-to-face code, append the GQ, GT or 95 modifier, and use the Place Of Service (“POS”) that would be typically billed if the service was delivered face-to-face (e.g., POS 11).
- Providers may also bill using POS 02. Providers will be reimbursed consistent with their typical face-to-face rates.
National General will be waiving any utilization review, prior authorization, care management, and emergency care policies and procedures as they relate to the testing and/or treatment of COVID-19 for dates of service on or after March 2, 2020 and until at least May 31, 2020 (or longer pursuant to applicable state requirements).
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TELEMEDICINE
The following is applicable to all National General Short Term Medical and Nation Care products
TELEMEDICINE MEDICAL SERVICE OR A TELEHEALTH SERVICE
We will pay those Covered Expenses incurred for telehealth services and telemedicine medical services provided by a Physician other Health Care Professional subject to your applicable deductible, copayment, or coinsurance. The telehealth services and telemedicine medical services do not require a face-to-face consultation.
Not available for use in New Mexico.