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COVID-19 Questions

How we're responding to Covid-19

Overview

National General Accident & Health is committed to keeping you informed with updates regarding the COVID-19 outbreak and your health coverage. Maintaining the health of our members and easing the financial burden is our No. 1 priority. As of Friday, December 18, 2020, the FDA has granted Emergency Use Authorization (EUA) for two COVID-19 vaccines. The FDA is also in the process of reviewing other manufacturers’ vaccines for EUA approval. As a member of National General Accident & Health Short Term Medical plans and National General Benefits Solutions Program, National General will waive member cost sharing of deductibles, copays, or coinsurance for physician- recommended COVID-19 diagnostic testing, an FDA-approved COVID-19 vaccine, or for any costs applied for administering an FDA-approved COVID-19 vaccine. Initially the cost of the vaccine itself will be paid in full by the government under the CARES Act.

Charges for administering the vaccine will be paid by this plan. Prior authorization requirements will be waived for plan members seeking COVID-19 diagnostic testing, treatment for COVID-19, or medically necessary supportive care for COVID-19. Early refills and up to a 90-day supply (if prescribed) for those who are facing COVID-19-related hardships will be allowed. You should call the Pharmacy Benefits number on the back of your Medical Plan ID card to discuss your options.

For limited medical or hospital expense policies, if your policy has office visits or lab benefits, testing and costs applied for administering an FDA-approved COVID-19 vaccine 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 or vaccine-related services.

For questions regarding your coverage, please call the number on the back of your Medical Plan ID Card.

Frequently Asked Questions about the Vaccine

Is there a vaccine available?

As of Friday, December 18, 2020, the FDA has granted Emergency Use Authorization (EUA) for two COVID-19 vaccines. Additional COVID-19 vaccines are under FDA review and approvals are pending.

Who is eligible to receive the COVID-19 vaccine?

Due to limited supply of the COVID-19 vaccine, FDA -approved COVID-19 vaccines will be available in a phased approach to different populations based on the Centers for Disease Control’s (CDC) Advisory Committee on Immunization Practices (ACIP) guidance. The first phase of vaccine distribution will be allocated to health care personnel and long-term care facility residents. To find out more visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations.html

Where can I get a COVID-19 vaccine?

When COVID-19 vaccines become more widely available, it will be distributed through CDC-approved medical providers and pharmacies. Additional information will be released when the vaccine becomes more widely available.

How do I know that a COVID-19 vaccine is safe and effective?

To learn more about how the CDC ensures safety of COVID-19 vaccines in the United States visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html

Frequently Asked Questions about testing

Can anyone get tested for COVID-19?

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.

Who should be tested for COVID-19?

Decisions about testing are at the discretion of state and local health departments and/or individual clinicians. The CDC provides guidelines for who and when someone should get 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 their health care provider for a testing recommendation.

How can members access COVID-19 testing?

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.

How can I learn more about COVID-19?

Here are some resources to learn more about COVID-19:

National General Accident & Health Response to COVID-19

National General is addressing the COVID-19 pandemic and we are committed to working with you and our claims administrators to ensure our members receive the care they need.

This document will address the following key areas on how National General is adjudicating its Short Term Medical plans:

  • Waive cost-sharing for COVID-19 testing
  • Costs associated with administrating the COVID-19 vaccine
  • 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. The Meritain team will be able to assist you with any detailed questions you may have. As the COVID-19 crisis evolves, we will update this document and notify our claims administrators of any changes on how to adjudicate our plans.

Waiving cost sharing for COVID-19 testing

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 coinsurance for diagnostic testing related to COVID-19.

Processing costs for the administration of the COVID-19 vaccine

Our members will not be required to pay for any costs associated with the administration of an FDA-approved vaccine for COVID-19. While the government is covering the costs of all vaccines, our Short Term Medical plans will pay first dollar for administering the vaccine.

General billing guidelines for COVID-19 related services

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 Centers for Disease Control (CDC) and AMA. In order to properly adjudicate claims for COVID-19 diagnostic tests and administration of the vaccine, we are encouraging all providers to utilize the following websites:

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 Meritain at 866-596-5817.

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).

General Telehealth Guidelines

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.
Customer cost-sharing will apply. For any state-specific differences, please contact Meritain at 866-596-5817.

Utilization Reviews

National General will be waiving 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).

Prescription Drugs

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 for members who are quarantined or facing 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.

NATIONCARE Group Plans
Notice to Participating Providers regarding COVID-19

To help limit the spread of COVID-19, National General has made the following benefit enhancements to all Nationcare plans.

Waived member cost-sharing for physician-recommended COVID-19 diagnostic tests and related charges.

  • Nationcare members will not be subject to deductibles, copays, or coinsurance for physician-recommended 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.1
    • For members who obtain physician-recommended COVID-19 diagnostic tests from in-network providers, the Plan will pay 100% of the network-contracted rate.
    • For members who obtain physician-recommended 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.2

1Cost-sharing for treatment of COVID-19 will also be waived for Nationcare members who are residents of the District of Columbia.
2Cost-sharing for treatment of COVID-19 will also be waived for members of Texas-domiciled Nationcare groups.

General billing guidelines for COVID-19 related services

In order to properly adjudicate claims for COVID-19 diagnostic tests, we are encouraging all providers to utilize the following websites:

Note that the above links provide general guidelines for paying COVID-19-related claims. State-specific requirements may vary. These websites are subject to change.

COVID-19 vaccine administration fees

National General will pay first dollar for COVID-19 vaccine administration fees for our customers seeking to obtain a federally-approved COVID-19 vaccine.

Waived Penalty for Emergency Room COVID-19 diagnostic tests

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 physician-recommended COVID-19 diagnostic tests.

Waived Prior Authorization requirements/penalties for COVID-19 testing and treatment.

There will be no prior authorization requirements for Nationcare members seeking physician-recommended COVID-19 diagnostic tests, treatment for COVID-19, or medically necessary supportive care if tested positive for COVID-19.

Telehealth services conducted by a health care provider.

  • Claims submitted with the place of service code 02 (telehealth) will be considered according to the plan benefits.
  • Member cost-sharing will be waived for any claim with the place of service code 02 (telehealth) that is related to physician-recommended diagnostic testing for COVID-19 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.

Outpatient prescription drug support.

  • 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.
  • Formulary exceptions will be expedited as appropriate.
  • Members can use out-of-network pharmacies if they cannot get timely refills due to increased demand or drug shortages at in-network pharmacies.

National General Accident & Health Response to COVID-19

National General is addressing the COVID-19 pandemic and we are committed to working with you and our claims administrators to ensure our members receive the care they need.

This document will address the following key areas on how National General is adjudicating its Short Term Medical plans:

  • Waive cost-sharing for COVID-19 testing
  • COVID-19 vaccine administration fees
  • General billing guidelines for COVID-19 related services
  • General Telehealth Guidelines
  • Utilization Review
  • Prescription Drugs
National General will continue to work closely with our claims administrator on claim adjudication as it relates to our Short Term Medical plans. If you have questions after reviewing this document, please contact our third-party administrator, Allied Benefit Systems, Inc., (Allied) at 855-505-2355. The Allied team will be able to assist you with any detailed questions you may have. As the COVID-19 pandemic continues to evolve, we will update this document and notify our claims administrators of any changes on how to adjudicate our plans.

Waiving cost sharing for COVID-19 testing

National General will waive 100% of customers’ out-of-pocket costs for physician-recommended COVID-19 diagnostic tests and will ease access for customers seeking diagnostic testing. This waiver applies to any out-of-pocket costs, including deductibles, copays and co-insurance and will extend to all National General Short Term Medical customers.

Processing costs for the administration of the COVID-19 vaccine

Our members will not be required to pay for any costs associated with the administration of an FDA-approved vaccine for COVID-19. While the government is covering the costs of all vaccines, our Short Term Medical plans will pay first dollar for administering the vaccine.

General billing guidelines for COVID-19 related services

National General’s third-party administrator claims processing systems are able to accurately and timely process claims when health care providers follow the guidelines provided by the Centers for Disease Control (CDC) and AMA. In order to properly adjudicate claims for COVID-19 diagnostic tests and vaccinations, we are encouraging all providers to utilize the following websites:

Note that the above links provide general guidance for 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 Allied at 855-505-2355. Claims will be processed in accordance with these guidelines for dates of service on or after March 2, 2020.

General Telehealth Guidelines

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 modifiers, 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.
  • Customer cost-sharing will apply. For any state-specific differences, please contact Allied at 855-505-2355.

Utilization Reviews

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, pursuant to applicable state requirements.

Prescriptions

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 for members who are quarantined or facing 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 Accident & Health Response to COVID-19

National General is addressing the COVID-19 pandemic and we are committed to working with you and our claims administrators to ensure our members receive the care they need.

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
  • COVID-19 vaccine administration fees
  • General billing guidelines for COVID-19 related services
  • General Telehealth Guidelines
  • Utilization Review
  • Prescription Drugs
National General will continue to work closely with our claims administrator on claim adjudication as it relates to our Limited Medical plans. If you have 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 pandemic continues to evolve, we will update this document and notify our claims administrators of any changes on how to adjudicate our plans.

Coverage for COVID-19 diagnostic tests, vaccines, and related charges

National General’s Limited Medical plans provide a set-dollar amount for services like office visits, ER visits, urgent care, and lab tests. 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 or FDA-approved COVID-19 vaccine.

COVID-19 vaccine administration fees

National General will pay first dollar for COVID-19 vaccine administration fees for our customers seeking to obtain a federally-approved COVID-19 vaccine.

General billing guidelines for COVID-19 related services

National General’s third-party administrator’s claims processing system is able to accurately and timely process claims when health care providers follow the guidelines provided by the Centers for Disease Control (CDC) and AMA. In order to properly adjudicate claims for COVID-19 diagnostic tests and vaccinations, we are encouraging all providers to utilize the following websites:

Note that the above links provide general guidelines for paying COVID-19-related claims. State-specific requirements may vary. These websites are also subject to change. In order to get the most current coding and any state-specific differences, please contact Key Benefit Administrators at 855-212-5014.

Claims will be processed in accordance with these guidelines for dates of service on or after March 2, 2020.

General Telehealth Guidelines

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. Generally, we also will continue to pay for telehealth services for 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 later.

  • Providers may bill using a face-to-face code, append the GQ, GT or 95 modifiers, 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. Provider reimbursement will be consistent with typical face-to-face rates.

Utilization Reviews

National General will waive 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, pursuant to applicable state requirements.