Looking For a Doctor or Facility?

Find a Doctor

COVID-19 Updates

Go to our COVID-19 resource webpage for up-to-date information.

Update from MedCost on the Coronavirus (COVID-19)

At MedCost, our key objective is to protect and improve the health of our members. As the government, health and nonprofit communities work together to stop the spread of Coronavirus disease 2019 (COVID-19), we at MedCost want to provide you with recommendations, in alignment with the Centers for Disease Control (CDC), to keep you healthy. MedCost remains fully operational, with the vast majority of employees working from home; however, our offices are closed to the public due to the COVID-19 pandemic.

Coronavirus (COVID-19)

Members

For up-to-date information on the Coronavirus (COVID-19), or to assess symptoms for COVID-19 online, visit the Centers for Disease Control. If you have benefits questions, you can call the number shown on your health plan ID card during regular business hours, (8:30 a.m. to 5:00 p.m. ET, Monday through Friday) or access Live Chat on www.MedCost.com to get real-time answers and support from MedCost Customer Service. Your company’s HR professional or company benefits administrator is also a good source of information.

  • Accessing Your Benefits
    • You can access information about your benefits 24/7 by logging in to your member account at MedCost.com/MyMedCost. The My MedCost mobile app (available for download from the App Store or Google Play) also allows you to access web features.
  • COVID-19 Vaccine

    In the race to protect people from the coronavirus, the Food and Drug Administration (FDA) has fast tracked approval of several vaccines. Vaccinations are being given in phases, with healthcare personnel, residents and staff of long-term care facilities, frontline essential workers, and those over the age of 75 taking priority. The rest of the general population of the U.S. should have the opportunity to be vaccinated against COVID-19 within the next several months.  

    If your health plan is non-grandfathered (as most now are), coverage for COVID-19 vaccine(s) is automatic, as required by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The vaccine is included under preventive care and covered in-network at 100% with no cost-sharing. 

    Grandfathered health plans, on the other hand, are not required to cover the vaccine, but many already cover preventive vaccinations (which now includes COVID-19) in-network at 100% with no cost-sharing. Log in and check your plan’s benefits summary for coverage information.

  • Deadline Extensions for Special Enrollment Periods, COBRA, Claim Filing and Appeals

    The U.S. Department of Labor and Internal Revenue Service have issued a new regulation that requires health plans to extend certain deadlines related to special enrollment periods, COBRA continuation coverage, claims filing, and appeals, due to the COVID-19 National Emergency. Below is a more detailed overview of the deadlines impacted.  

     

    Extension Period 

    Each of the impacted deadlines described in more detail below will be extended by disregarding the duration of the “Outbreak Period” when calculating the deadline. The Outbreak Period is defined as the period of time that began on March 1, 2020, and extends until 60 days following the announced end of the COVID-19 National Emergency (as declared by the President). Note that this time period may be adjusted by regulators, particularly if the emergency declaration is lifted on a more localized basis. In addition, pursuant to ERISA, this time period cannot exceed one year without congressional action. 

     

    Deadlines Impacted 
     

    Special Enrollment Periods  

    • The 30-day special enrollment periods that may be triggered when eligible employees or dependents lose eligibility for other health plan coverage in which they were previously enrolled, and when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption; and  
    • The 60-day special enrollment periods that may be triggered by changes in eligibility for state premium assistance under the Children’s Health Insurance Program. 

     

    COBRA  

    • The 30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event;  
    • The 60-day deadline for individuals to notify the plan of a determination of disability;
    • The 14-day deadline for plan administrators to furnish COBRA election notices;  
    • The 60-day deadline for participants to elect COBRA; and  
    • The 45-day deadline in which to make a first premium payment and 30-day deadline for subsequent premium payments. 

     

    Claims Procedures and Appeals for ERISA Plans  

    • Deadlines for filing claims for benefits and for initial disposition of claims; and 
    • Deadlines for providing claimants a reasonable opportunity to appeal adverse benefit determinations under ERISA plans and non-grandfathered group health plans.  

     

    External Review Process  

    • Non-grandfathered group health plan deadlines for providing the required state or federal external review process following exhaustion of the plan’s internal appeals procedures; and  
    • Other deadlines that apply for perfecting an incomplete request for review. 
  • Expansion of HSA/FSA Eligible Products

    The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) expanded the list of products eligible for reimbursement under a Health Savings Account or Flexible Spending Account to include menstrual products and over-the-counter (OTC) medications, including those needed in quarantine and social distancing, without a prescription from a physician. This change is effective retroactive January 1, 2020.
     
    For FSA plans administered by MedCost, MedCost is implementing this change immediately. However, we expect a delay in FSA Debit Card acceptance for these newly eligible items while each individual merchant updates their systems. Because each merchant will adhere to their own timeline, this may result in inconsistencies in shopping experiences for the member (i.e. OTCs may be allowable at one merchant, but not another).

  • Finding Care
    • If you’re experiencing cough, cold, flu, fever or other respiratory symptoms, and have reason to believe you may have come in contact with COVID-19, contact your Primary Care Physician right away. Identify your concern. Testing can only be requested by a physician who will advise you of a testing facility and next steps. To find a doctor in your network, visit MedCost.com
    • Telehealth visits may be another option for evaluation if you are experiencing the symptoms mentioned above. Telehealth providers can assess your symptoms and determine if further testing and treatment are warranted. The coverage for telehealth visits (COVID-19 and non-COVID-19), if any, and applicable cost-sharing (co-pays, co-insurance, deductibles) varies for each health plan. Log in for coverage information. If your health plan covers telehealth through Teladoc, visit Teladoc’s website for information on how to schedule a Teladoc visit and for more helpful information on COVID-19. 
  • Pharmacy (PBM) Services
    Note: Only available to members with pharmacy benefits through OptumRx. If your pharmacy benefits are not provided by OptumRx, please contact the PBM shown on your ID card for more information. 
     
    OptumRx Formulary Changes for Albuterol Inhalers

    Due to manufacturing challenges resulting in a limited supply of generic ProAir®, OptumRx is temporarily holding formulary changes of select albuterol products that were scheduled for January 1, 2021. The following temporary formulary changes are effective January 1, 2021:

    • Brand name ProAir® and Ventolin® remain in tier 2 with a quantity limit
    • Generic albuterol products continue to be covered.
  • Recommendations to Prevent Transmission
    • Avoid close contact with people who are sick.
    • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
    • Avoid touching your eyes, nose and mouth with unwashed hands.
    • Stay home when you are sick and seek appropriate care.
    • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
    • Clean and disinfect frequently touched objects and surfaces.
    • Avoid outings and gatherings with large amounts of people in close contact and maintain a distance of approximately 6 feet from others when possible.
  • Well-Being Support Services
    Free On-Demand Wellness Webinars 

    MedCost, Carolina Behavioral Health Alliance and Mood Treatment Center are pleased to offer a free on-demand wellness webinar series to help you cope during these turbulent times. Topics include better sleep, managing anxiety and worry, and guidance from expert child therapists on talking with children about the pandemic.

Employers

We are closely monitoring the COVID-19 situation and have deployed our business continuity plan to protect the health of our employees while safeguarding our ability to perform the services our clients and their health plan members rely on. To help you and your members, we want to share some specific plan-related considerations:

  • Continuation of Health Coverage for Furloughed Employees

    MedCost encourages clients who are considering a furlough or other employment action to consult with their legal counsel. Our legal department is available, through your Account Manager, to coordinate with your legal counsel regarding these topics.

    If a furlough results in a loss of coverage under the Plan, the employee becomes eligible for COBRA. The determination of when a loss of coverage occurs has not changed. Employers should review their Plan’s provisions regarding coverage, eligibility, and leaves, as well as any applicable company policies for further details. 

    If a furloughed employee does lose coverage and elects COBRA, an Employer may decide to continue to cover its portion of the premium, thus keeping the employee’s premium cost the same, even while they are on COBRA. For clients utilizing MedCost for COBRA Administration, our team is prepared to assist. Please contact your Account Manager for further information.

  • Coronavirus Aid, Relief and Economic Security Act (CARES Act)

    The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed and took effect on Friday, March 27, 2020. We have updated this website to reflect several changes relevant to self-insured health plans. Specifically, the Act clarifies the amounts payable for required COVID-19 testing, expands the list of products eligible for reimbursement from HSA and FSA accounts, authorizes (but does not require) High Deductible Health Plans to cover all telehealth services without cost sharing, and requires coverage for COVID-19 vaccines within 15 days of availability of an approved vaccine. 

  • Coverage for COVID-19 Vaccine

    If a health plan is non-grandfathered (as most now are), coverage for COVID-19 vaccine(s) is automatic, as required by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). No further action is required; the vaccine will be added to the preventive care list for the health plan and covered in-network at 100% with no cost-sharing.
     
    Grandfathered health plans, on the other hand, are not required to cover the vaccine. However, many grandfathered plans already cover preventive vaccinations (now including COVID-19) in-network at 100% with no cost-sharing. If your health plan does not, please contact your MedCost Account Manager to discuss recommendations and options. Note: If your plan chooses to add coverage for the vaccine, a Plan Amendment may be required. 

  • Coverage for Testing/Treatment

    All Plans – The Families First Coronavirus Response Act (FFCRA) requires all group health plans and health insurers, including grandfathered health plans under the ACA, to cover testing for COVID-19 without any cost sharing (co-pays, co-insurance, deductibles). The Coronavirus Aid, Relief, and Economic Security Act (CARES ACT) confirmed that this requirement applies to both in- and out-of-network services. Out-of-network services will be payable at the cash price of the service, which is required to be posted by the provider on a publicly available internet site. On April 11, 2020, several federal agencies clarified that this requirement extends to serological (antibody) tests that otherwise meet the requirements for coverage. On June 23, 2020, several federal agencies clarified that testing conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance, or for any other purpose not primarily intended for individualized diagnosis or treatment is beyond the scope of the FFCRA and CARES ACT requirements.

    Treatment for COVID-19 was not addressed by FFCRA or the CARES Act. All medical plans for MedCost clients include coverage for treatment (in office and, if covered, virtual) of COVID-19, which is covered subject to normal cost-sharing. Health plan sponsors who choose to do so may waive applicable cost-sharing (co-pays, co-insurance, deductibles) for the treatment of COVID-19 as well. Clients wishing to add this coverage should contact their Account Manager for assistance. Please note that this change will require a plan amendment that may be subject to review and approval by stop loss carriers.

    For HSA-Eligible High Deductible Health Plans – On March 11, 2020, the IRS issued a notice declaring that HSA-eligible High Deductible Health Plans are permitted to cover coronavirus treatment (in person and, if covered, virtual) before cost-sharing (similar to preventive coverage). See IRS Notice 2020-15. As a result, employers who chose to do so may pay for treatment for COVID-19 under HDHPs without requiring that members first meet their deductibles, and it will not interfere with members’ ability to contribute to HSA accounts. On May 12, 2020, the IRS issued a notice clarifying that these coverage changes may be applied retroactively to January 1, 2020. See IRS Notice 2020-29.

  • Deadline Extensions for Special Enrollment Periods, COBRA, Claim Filing and Appeals

    The U.S. Department of Labor and Internal Revenue Service have issued a new regulation that requires health plans to extend certain deadlines related to special enrollment periods, COBRA continuation coverage, claims filing, and appeals, due to the COVID-19 National Emergency. Below is a brief outline of MedCost’s plan for implementing these changes and a more detailed overview of the deadlines impacted.  

     

    Implementation 

    MedCost will implement the changes required by this regulation without requiring any further action from employers or plan sponsors. Plans that have not elected MedCost’s COBRA Administration Services should ensure that the COBRA-related changes are implemented by their COBRA administrator(s). Both ERISA and the Internal Revenue Code permit plans to implement these deadline extensions without a formal plan amendment.   

     

    Extension Period 

    Each of the impacted deadlines described in more detail below will be extended by disregarding the duration of the “Outbreak Period” when calculating the deadline. The Outbreak Period is defined as the period of time that began on March 1, 2020, and extends until 60 days following the announced end of the COVID-19 National Emergency (as declared by the President). Note that this time period may be adjusted by regulators, particularly if the emergency declaration is lifted on a more localized basis. In addition, pursuant to ERISA, this time period cannot exceed one year without congressional action. 

     

    Deadlines Impacted 
     

    Special Enrollment Periods  

    • The 30-day special enrollment periods that may be triggered when eligible employees or dependents lose eligibility for other health plan coverage in which they were previously enrolled, and when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption; and  
    • The 60-day special enrollment periods that may be triggered by changes in eligibility for state premium assistance under the Children’s Health Insurance Program. 

     

    COBRA  

    • The 30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event;  
    • The 60-day deadline for individuals to notify the plan of a determination of disability;
    • The 14-day deadline for plan administrators to furnish COBRA election notices;  
    • The 60-day deadline for participants to elect COBRA; and  
    • The 45-day deadline in which to make a first premium payment and 30-day deadline for subsequent premium payments. 

     

    Claims Procedures and Appeals for ERISA Plans  

    • Deadlines for filing claims for benefits and for initial disposition of claims; and 
    • Deadlines for providing claimants a reasonable opportunity to appeal adverse benefit determinations under ERISA plans and non-grandfathered group health plans.  

     

    External Review Process  

    • Non-grandfathered group health plan deadlines for providing the required state or federal external review process following exhaustion of the plan’s internal appeals procedures; and  
    • Other deadlines that apply for perfecting an incomplete request for review. 

     

    Please do not hesitate to contact your Account Manager with any questions. 

  • Emergency FMLA Leave

    The Families First Coronavirus Response Act created a new category of emergency FMLA leave for some employees who are unable to work due to a need for leave to care for their son or daughter (under 18) whose school or place of care is unavailable due to COVID-19. On April 6, 2020, the U.S. Department of Labor published a regulation clarifying that health plans must continue coverage for employees taking Emergency FMLA for the duration of this leave, on the same conditions as coverage would have been provided if the Employee had been continuously employed. MedCost’s standard plan language addresses health coverage for employees on FMLA leaves, which also applies to this new category of leave. Specifically: “During an FMLA qualified leave of absence, the Employee’s benefits under the Plan may continue as if he or she were actively at work. The Employee must continue to pay any part of the cost he or she was required to pay before the leave began.” This new category of FMLA does not apply to all employers or employees; other limitations also apply. Employers should consult their HR advisers and/or employment law counsel on the specifics of this new FMLA category.

  • Employer Paid Sick Leave Act

    The Families First Coronavirus Response Act included an Employer Paid Sick Leave Act (EPSLA) that entitles some employees to paid time off for specific COVID-19 related reasons. On April 6, 2020, the U.S. Department of Labor published a regulation requiring health plans to continue coverage for employees taking EPSLA leave for the duration of this leave, on the same conditions as coverage would have been provided if the Employee had been continuously employed. MedCost’s standard plan language includes coverage for employees on an “Employer-Approved, non-FMLA Leave of Absence” that will automatically apply here to continue coverage. Employers who are covered by this law should review their plan to ensure this language is included. If you are a covered employer but unsure if the appropriate language is included, please contact your Account Manager for assistance.The EPSLA does not apply to all employers or employees; other limitations also apply. Employers should consult their HR advisers and/or employment law counsel to determine if or how the EPSLA applies to their business.

  • Expansion of HSA/FSA Eligible Products

    The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) expanded the list of products eligible for reimbursement under a Health Savings Account or Flexible Spending Account to include menstrual products and over-the-counter (OTC) medications, including those needed in quarantine and social distancing, without a prescription from a physician. This change is effective retroactive January 1, 2020.

    For FSA plans administered by MedCost, MedCost is implementing this change immediately. Please note that we expect a delay in FSA Debit Card acceptance for these newly eligible items while each individual merchant updates their systems. Because each merchant will adhere to their own timeline, this may result in inconsistencies in shopping experiences for members (i.e. OTCs may be allowable at one merchant, but not another). 

  • Families First Coronavirus Response Act

    The Families First Coronavirus Response Act was signed March 18, 2020. The health plan related provisions took effect the same day. This website reflects the provisions of this Act that are applicable to self-insured health plans. Specifically, the Act requires all group health plans and health insurers, including grandfathered health plans under the ACA, to cover testing for COVID-19 without any cost sharing (co-pays, co-insurance, deductibles). 

  • FSA Changes – Health, Dependent Care Assistance Program, and Limited Purpose

    On December 27, 2020, the President signed into law another wide-ranging COVID-19 relief bill, the Consolidated Appropriations Act, 2021. The most immediate impact for MedCost administered plans is the loosening of certain requirements for Health Flexible Spending Accounts (FSAs) and Dependent Care Assistance Program (DCAP) FSAs offered under Section 125 Plans (“Cafeteria Plans”).  
     
    The law does not require employers to adopt these changes but permits significant flexibility in response to the COVID-19 Public Health Emergency (PHE). This flexibility is not limited to individuals affected by the pandemic. These optional changes are described in further detail below.  
     

    Election Changes for Health and DCAP FSAs 

    For plan years ending in 2021, Cafeteria Plans may permit plan participants to modify their elections for Health or DCAP FSA contributions during the plan year on a prospective basis (i.e., not retroactively). An employer is not required to provide unlimited election changes and may determine the extent to which such election changes are permitted and applied, so long as any applicable requirements comply with the nondiscrimination rules.  
     

    Carryover and Grace Period Changes for Health and DCAP FSAs 

    For plan years ending in 2020 and 2021, Cafeteria Plans may carryover (or “rollover”) unused Health and DCAP FSA funds to the next plan year with no dollar limit. Alternatively, Cafeteria Plans may offer a “grace period” for participants to use Health and DCAP FSA funds remaining after the end of those plan years for up to 12 months. Only one of these options may be selected.  
     

    Dependent Age Limit for DCAP FSAs   

    For plan years with a regular enrollment period ending on or before January 31, 2020, the maximum age for DCAP FSA dependent eligibility may be increased by one year (from ‘under 13’ to ‘under 14’). Cafeteria Plans may also apply this rule in the following plan year but only for unused balances from the prior plan year. 
     

    Former Plan Participants for Health FSAs

    Cafeteria Plans may allow employees who ceased participation in Health FSAs during the 2020 or 2021 calendar year to receive reimbursements from unused benefits through the end of the plan year in which participation ceased (including any grace period).  
     

    Implementation with MedCost 

    As a reminder, the changes listed above are optional and should be considered carefully. To adopt any of these changes, Plans must be amended by the end of the first calendar year beginning after the end of the plan year in which the change took effect. As a practical matter, if you wish to make changes, those changes should be made as soon as possible for effective administration. Please contact your Account Manager if you are considering making any of these changes.  
     
     

  • Health Plan Election Changes

    On May 12, 2020, the IRS issued a notice that allow Section 125 Plans (“Cafeteria Plans”) to permit certain additional mid-year election changes for health plans, Health FSAs (including limited purpose FSAs), and Dependent Care Assistance Program FSAs (“DCAPs”). See IRS Notice 2020-29.

    This IRS notice does not require employers to adopt these changes but permits significant flexibility in response to the COVID-19 Public Health Emergency (PHE). This flexibility is not limited to individuals affected by the pandemic. Employers should think carefully, in consultation with their broker(s) and/or MedCost Account Manager, before adopting any of these changes due to the potential for significant downstream impacts. These optional changes are described in further detail below. 

    Health Plan Changes

    For calendar year 2020 (only), employees may be permitted to:

    • Make a new election, if the employee initially declined to elect employer-sponsored health coverage; 
    • Revoke an existing election and make a new election to enroll in different health coverage sponsored by the same employer; or
    • Revoke an existing election, provided that the employee attests in writing that the employee is enrolled, or immediately will enroll, in other health coverage not sponsored by the employer. (A sample written attestation is included in Notice 2020-29, page 8.) 

     

    These options for election changes only apply to group health plans and only for changes elected on a prospective basis (i.e., not retroactively). An employer is not required to provide unlimited election changes and may determine the extent to which such election changes are permitted, so long as any applicable requirements comply with the nondiscrimination rules for cafeteria plans.

    There is a real possibility of adverse selection with permitting these election changes (e.g., an employee who realizes they are likely to incur significant medical expenses may decide to enroll in the plan for the first time or decide to switch from a HDHP to a more traditional offering). As such, before implementing new election change options, MedCost advises employers to carefully consider the impact in consultation with their broker(s) and/or MedCost Account Manager. 

    If an employer desires to implement these election changes:

    • The applicable Cafeteria Plan document must be amended to support the change. 
    • The health plan’s SPD must be amended to reflect the change. Such amendments will be subject to stop loss approval. We anticipate some carriers may require specific plan language or even premium increases to offset the adverse selection issue noted above.
    • Employers must also inform all employees eligible to participate in the Cafeteria Plan of the changes to the plan. 
     
    Implementation with MedCost

    As a reminder, all the changes listed above are optional and should be considered carefully. Please contact your Account Manager if you are considering making any of these changes. 

    For plans that decide to make any of these changes, MedCost’s compliance department is prepared to draft any necessary health plan SPD amendments upon request. If MedCost is administering an FSA or DCAP for the employer, MedCost will also assist with any required Cafeteria Plan changes. If MedCost is not administering an FSA or DCAP for the employer, MedCost’s compliance department is unable to assist with Cafeteria Plan changes. In such cases, employers should contact their broker(s) or legal counsel for further assistance. Your Account Manager can also assist with a referral to outside legal counsel, if needed.

  • Mental Well-Being Services
    MyStrength

    For clients with MedCost Behavioral Health, online emotional support is available for your members. myStrength has multiple resources available for participants regarding coping skills and management of fear and anxiety related to COVID-19. Members can access myStrength from the secure member portal on MedCost.com/MyMedCost, under the Healthy & Whole option.

    Free On-Demand Wellness Webinars 

    MedCost, Carolina Behavioral Health Alliance and Mood Treatment Center are pleased to offer a free on-demand wellness webinar series for employees and their families and friends to help them cope during these turbulent times. Topics include better sleep, managing anxiety and worry, and guidance from expert child therapists on talking with children about the pandemic. 

  • Pharmacy (PBM) Services
    OptumRx Formulary Changes for Albuterol Inhalers

    Due to manufacturing challenges resulting in a limited supply of generic ProAir®, OptumRx is temporarily holding formulary changes of select albuterol products that were scheduled for January 1, 2021. The following temporary formulary changes are effective January 1, 2021: 

    • Brand name ProAir® and Ventolin® remain in tier 2 with a quantity limit
    • Generic albuterol products continue to be covered.

     

    Optum Perks Prescription Relief Program (PRP)

    The Optum Perks Prescription Relief Program is a free pharmacy discount service that offers prescription savings on brand-name, generic, and doctor-prescribed over-the-counter drugs, as well as continued access to home delivery (where applicable), to your employees who have lost coverage. Unless you choose to opt out by notifying your MedCost Account Manager, you are automatically enrolled in this program at no additional cost.

    This program is not insurance, but it utilizes your employee’s current benefits ID card. Your employee takes their prescription to the pharmacy and presents their ID card as usual. The employee then has the choice to pay the full, out-of-pocket cash price or the discounted rate provided by the PRP.

    OptumRx will send a letter to your employees after they have lost coverage with information on this automatic savings program. If an employee has signed up for COBRA benefits, they should utilize the prescription benefit as explained in their COBRA benefit package.

  • Precertification of Testing Services

    MedCost does not require precertification on COVID-19 testing or treatment services (except in the event of a non-emergent inpatient admission).

  • Recommendation for Expansion of Telehealth Benefits

    MedCost has seen significant increases in the number of telehealth claims as government officials have encouraged the use of these services to allow for the delivery of medical care while maintaining social distancing. We have also noticed a shift in the types of services being delivered via telehealth. In order to meet this new demand for telehealth services, we recommend that clients consider adopting an amendment to expand the scope of telehealth benefits available under their health plans. Interested clients should contact their Account Manager for assistance with adopting a telehealth amendment.

  • Teladoc Services

    For clients with Teladoc, your members have convenient access to virtual doctor consultations. Teladoc physicians provide up-to-date, evidence-based supportive care to screen for possible COVID-19 cases and relieve symptoms for affected patients. Most cases of the virus are mild and can be safely managed via an at-home care plan. Health plan sponsors may choose to waive co-pays. 

    As the coronavirus pandemic evolves, members may experience extended wait times due to the high demand and need for Teladoc’s services. Teladoc has implemented the following strategies to address the increase in volume:

    Optimizing physician capacity: Teladoc has enhanced its technology to help doctors efficiently address COVID-19 cases and supply patients with home care information, automate suspected COVID-19 case reporting, and approve 30-day prescription refills and extend 90-day refills where appropriate. To serve escalating demand, Teladoc is rapidly onboarding more high-quality board-certified physicians and is activating its existing physician network to drive increased consult availability.

    Temporarily streamlining how people access and receive care: Teladoc is actively managing visit requests and accepting on-demand visits, scheduled visits, or both during specific periods of the day, so as best to serve peak demand. Video visit requests may be converted to phone visits for faster response. For the fastest support, members are encouraged to download the mobile app or use the website to request a doctor visit.

    For those who choose to call, Teladoc has implemented technology that enables a callback from a service representative rather than waiting on hold. And after a visit request is initiated, members are encouraged to be available and ready to promptly answer callbacks, as requests will be considered canceled after 1 unanswered callback attempt (which typically includes 3 outbound calls) by a doctor. 

    Managing member expectations and experience: Teladoc’s phone, website, and App messaging transparently shares that Teladoc is experiencing high visit volumes and provides useful information about COVID-19 while members wait to connect with a doctor. Service communications are deployed to assure waiting members that they remain in the queue and periodic outreach asks members to confirm that they still need to talk to a doctor, helping to efficiently allocate doctors’ time to active, unabandoned visits and requests.
     

  • Telehealth Services for High Deductible Plans

    High-deductible health plans (HDHP) may (but are not required to) pay for telehealth services before the deductible is met. Such coverage is not limited to COVID-19 and will not affect eligibility to make tax-free contributions to an HSA.  This exemption is only available for plan years that begin on or before December 31, 2021. Clients wishing to add this coverage should contact their Account Manager for assistance. Please note that this change will require a plan amendment that may be subject to review and approval by stop loss carriers. 

    On May 12, 2020, the IRS issued a notice clarifying that these coverage changes may be applied retroactively to January 1, 2020. See IRS Notice 2020-29.

Providers

As you read through the topics below, please be aware of the following terms:
MedCost, LLC refers to our entire organization.
MedCost Network in NC and SC and MedCost Virginia in VA refer to our provider networks which are leased by various payers/administrators.
MedCost Benefit Services refers to our own TPA which administers self-funded health plans sponsored by employers.

MedCost, LLC continues to closely monitor the ongoing COVID-19 situation. We successfully deployed our business continuity plan to protect the health of our employees while safeguarding our ability to perform the services our providers, clients, and health plan members rely on. Our systems are able to accept claims related to COVID-19 testing and treatment, as well as expanded telehealth services.
 
We understand that you have questions, and the topics below are being reviewed and continually updated to provide answers as this national health emergency evolves. For questions related to COVID-19 that are not addressed on this page or in the provider resources on this website, email COVID19inquiries@medcost.com.

Please be aware that MedCost, LLC is in a unique position since we are both a leased provider network (MedCost Network in NC and SC, and MedCost Virginia in VA) and a payer/administrator for employers with self-funded health plans through our TPA, MedCost Benefit Services. 

Many of our provider partners have requested changes to existing requirements during this time. Whenever possible, we will try to accommodate those requests as they pertain to our leased networks (MedCost Network and MedCost Virginia) and our own TPA processes (MedCost Benefit Services). Some requirements are dictated by the individual health plans, over which we have no control. Also, other payers/administrators accessing MedCost Network or MedCost Virginia as leased networks will have their own procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. MedCost, LLC will make every effort to communicate changes to our network providers via email, but this web page is your most up-to-date source for information. Please continue to check it regularly.
 

  • Business Continuity

    As an organization, MedCost, LLC is committed to maintaining a safe workplace and doing whatever we can to mitigate the spread of the virus. MedCost, LLC has a comprehensive business continuity plan that involves every aspect of our organization and contemplates how we will respond in an emergency to assure our organization is able to continue to provide normal services for our clients, providers, payers, and members. To that end, we have instituted our business continuity plan, and successfully transitioned our workforce to a remote environment for the foreseeable future. 

    MedCost, LLC has a dedicated team reviewing all applicable local, state and national regulatory updates that may impact authorization processes and clinical procedures. Currently, there are no updates that materially change or delay our existing processes or require us to expand or limit our normal business hours.  

  • Claims Filing
    Claims Filing Deadlines

    Claims filing deadlines can vary by payer/administrator and can also be dictated by requirements within individual health plans, ranging from 90 days to 18 months. The majority of payers/administrators leasing our networks (MedCost Network and MedCost Virginia) offer a generous 180-day claims filing deadline. Plans administered by MedCost Benefit Services, our own TPA, also offer a claims filing deadline of at least 180 days. Certain deadlines affecting filing claims for benefits, appeals of denied claims, and external review of certain claims are automatically extended during the COVID-19 outbreak. Please see Deadline Extensions for Special Enrollment Periods, COBRA, Claim Filing and Appeals for details. As always, MedCost Benefit Services will work closely with providers, clients and health plan members to evaluate additional flexibility and special considerations as needed during the COVID-19 health emergency. Other payers/administrators accessing MedCost Network and MedCost Virginia as leased networks will have their own procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. 

    Claim Filing Recommendations

    Diagnosis or Treatment

    To ensure appropriate flagging of COVID-19 related care, and in accordance with CMS guidelines, we recommend institutional claims for COVID-19 diagnosis or treatment include condition code “DR.”

    Claims processing procedures for COVID-19 testing related services have been amended for plans administered by MedCost Benefit Services. Effective for dates of service on or after September 1, 2020, providers must submit appropriate coding for COVID-19 testing related services for any claim submission. This requires the use of modifier CS in the first position on any COVID-19 related services that result in an order or administration of a COVID test. This may include but is not limited to physician office visits, labs, or diagnostic imaging, as described in the MedCost Benefit Services Medical Policy. The actual COVID-19 test does not require the use of the modifier. The modifier should only be used for services when determining if a COVID-19 test is required. Using the appropriate modifier ensures that correct benefits, with no member cost sharing, are applied.  If the CS modifier is not present in the first position, benefits will be applied based on the patient’s plan design which might cause patient responsibility. Please refer to the MedCost Benefit Services Medical Policy for more detailed information. 

    Vaccinations

    MedCost encourages providers to file COVID vaccination claims based on the American Medical Association (AMA) recommendations. Claims for COVID vaccines will process under a specific employer group plan based on their benefits, as any other vaccine would. Claims filed with incorrect codes will be denied.

    Filing a Telehealth Claim

    It is up to the plan sponsor (employer or insurance carrier) to elect to cover telehealth visits (COVID-19 and non-COVID-19) under their health plan and also whether to waive applicable cost-sharing (co-pays, co-insurance, deductibles). To verify coverage and/or any applicable cost sharing for telehealth services or for other specific questions, please contact the payer/administrator indicated on the back of the member’s ID card.

    MedCost Network and MedCost Virginia have allowables established for telehealth services. To ensure accurate pricing and payment consideration, telehealth services should be accurately coded to reflect the means of delivery ensuring medically necessary services are appropriately filed following these guidelines: 

    Professional services (HCFA filers): File with place of service “02” to signify telehealth using applicable telehealth service codes. Modifier “95” is accepted if filed but is not required, and it is recommended that audio and telephonic services (when secure video function cannot be used) are filed with modifier “CR” appended (catastrophe/disaster related). 

    Facility services (UB filers): File with the corresponding revenue code for the services being performed. Modifier “95” is required to be appended to all telehealth CPT and HCPCS codes. 

    For COVID-19 related services, please ensure your claim is filed with the appropriate COVID-19 diagnosis code(s). 

    Services delivered via telemedicine should not be billed as though the service was provided in person. MedCost reserves the right to audit for coding accuracy and may deny claims or seek reimbursement for improperly coded claims.

  • Coverage for COVID-19 Vaccine

    Non-grandfathered health plans under the ACA are required to cover COVID-19 vaccine(s) in-network at 100% with no cost-sharing. Grandfathered health plans are not required to cover the vaccine, but many already cover preventive vaccinations (now including COVID-19) in-network at 100% with no cost-sharing. 

    If you have specific questions regarding a health plan’s coverage for COVID-19 vaccination, please direct them to the payer/administrator indicated on the back of the member’s ID card. Claims for COVID-19 vaccination should be filed as any other preventive vaccination using the appropriate service code(s). 

    See Claims Filing section of this webpage for vaccine filing information based on AMA recommendations.

  • Coverage for Testing and Treatment

    All medical plans for MedCost Benefit Services clients include coverage for testing and treatment of COVID-19. The Families First Coronavirus Response Act requires all group health plans and health insurers, including self-funded and grandfathered health plans under the ACA, to cover testing for COVID-19 without any cost sharing (co-pays, co-insurance, deductibles). The language of the bill does not limit this requirement to in-network services. On April 11, 2020, several federal agencies clarified that this requirement extends to serological (antibody) tests that otherwise meet the requirements for coverage. On June 23, 2020, several federal agencies clarified that testing conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance, or for any other purpose not primarily intended for individualized diagnosis or treatment is beyond the scope of the FFCRA and CARES ACT requirements.

    The Families First Coronavirus Response Act does not address treatment for COVID-19. However, all medical plans for MedCost Benefit Services clients include coverage for treatment of COVID-19, which is covered subject to normal cost-sharing. Health plan sponsors who choose to do so may waive applicable cost-sharing (co-pays, co-insurance, deductibles) for the treatment of COVID-19.

    The IRS has declared that HSA-eligible High Deductible Health Plans are permitted (but not required) to cover COVID-19 testing and treatment before cost-sharing without impacting HSA status. 

  • Deadline Extensions for Special Enrollment Periods, COBRA, Claim Filing and Appeals

    The U.S. Department of Labor and Internal Revenue Service have issued a new regulation that requires health plans to extend certain deadlines related to special enrollment periods, COBRA continuation coverage, claims filing, and appeals, due to the COVID-19 National Emergency. Below is a more detailed overview of the deadlines impacted.  

     

    Extension Period 

    Each of the impacted deadlines described in more detail below will be extended by disregarding the duration of the “Outbreak Period” when calculating the deadline. The Outbreak Period is defined as the period of time that began on March 1, 2020, and extends until 60 days following the announced end of the COVID-19 National Emergency (as declared by the President). Note that this time period may be adjusted by regulators, particularly if the emergency declaration is lifted on a more localized basis. In addition, pursuant to ERISA, this time period cannot exceed one year without congressional action. 

     

    Deadlines Impacted 
     

    Special Enrollment Periods  

    • The 30-day special enrollment periods that may be triggered when eligible employees or dependents lose eligibility for other health plan coverage in which they were previously enrolled, and when an eligible employee acquires a dependent through birth, marriage, adoption, or placement for adoption; and  
    • The 60-day special enrollment periods that may be triggered by changes in eligibility for state premium assistance under the Children’s Health Insurance Program. 

     

    COBRA  

    • The 30- or 60-day deadline for employers or individuals to notify the plan of a qualifying event;  
    • The 60-day deadline for individuals to notify the plan of a determination of disability;
    • The 14-day deadline for plan administrators to furnish COBRA election notices;  
    • The 60-day deadline for participants to elect COBRA; and  
    • The 45-day deadline in which to make a first premium payment and 30-day deadline for subsequent premium payments. 

     

    Claims Procedures and Appeals for ERISA Plans  

    • Deadlines for filing claims for benefits and for initial disposition of claims; and 
    • Deadlines for providing claimants a reasonable opportunity to appeal adverse benefit determinations under ERISA plans and non-grandfathered group health plans.  

     

    External Review Process  

    • Non-grandfathered group health plan deadlines for providing the required state or federal external review process following exhaustion of the plan’s internal appeals procedures; and  
    • Other deadlines that apply for perfecting an incomplete request for review. 
  • Online Access

    Access to our secure provider portal is available 24/7 on MedCost.com. And, during our regular business hours of 8:30 a.m. – 5:00 p.m. ET Monday through Friday, you can call 1-800-795-1023 or access Live Chat on www.MedCost.com to get real-time answers and support from MedCost Customer Service.
     

  • Pharmacy (PBM) Services
    OptumRx Formulary Changes for Albuterol Inhalers

    Due to manufacturing challenges resulting in a limited supply of generic ProAir®, OptumRx is temporarily holding formulary changes of select albuterol products that were scheduled for January 1, 2021. The following temporary formulary changes are effective January 1, 2021: 

    • Brand name ProAir® and Ventolin® remain in tier 2 with a quantity limit
    • Generic albuterol products continue to be covered
  • Precertification/Authorization

    MedCost, LLC is closely monitoring the impact of COVID-19 within our MedCost Network and MedCost Virginia provider communities. We will continue to evaluate the dynamic needs of our network providers and consider any shifts in processes beneficial to meet the healthcare needs of the population. At this time, our standard business requirements for services and supplies remain in place.

    Testing/Treatment

    MedCost Benefit Services does not require precertification on COVID-19 testing or treatment services (except in the event of a non-emergent inpatient admission). Other payers/administrators accessing MedCost Network and MedCost Virginia as leased networks will have their own precertification/authorization procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. 

    Inpatient Admission (Non-Emergent)

    At this time, authorization requirements remain in place per MedCost Benefit Services standard business requirements. Hospital-to-hospital inpatient care transfers do not require authorization and would be reimbursed at the benefit specifications of the health plan. Note: Non-Emergent Air Transport does require prior authorization. Authorizations are valid for up to 6 months from the date issued. Beyond 6 months, a new authorization request would need to be made. Other payers/administrators accessing MedCost Network and MedCost Virginia as leased networks will have their own inpatient authorization procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. 

  • Telehealth

    It is up to the plan sponsor (employer or insurance carrier) to elect to cover telehealth visits (COVID-19 and non-COVID-19) under their health plan and also whether to waive applicable cost-sharing (co-pays, co-insurance, deductibles). To verify coverage and/or any applicable cost sharing for telehealth services or for other specific questions, please contact the payer/administrator indicated on the back of the member’s ID card.

    Filing a Telehealth Claim

    MedCost Network and MedCost Virginia have allowables established for telehealth services. To ensure accurate pricing and payment consideration, telehealth services should be accurately coded to reflect the means of delivery ensuring medically necessary services are appropriately filed following these guidelines: 

    Professional services (HCFA filers): File with place of service “02” to signify telehealth using applicable telehealth service codes. Modifier “95” is accepted if filed but is not required, and it is recommended that audio and telephonic services (when secure video function cannot be used) are filed with modifier “CR” appended (catastrophe/disaster related). 

    Facility services (UB filers): File with the corresponding revenue code for the services being performed. Modifier “95” is required to be appended to all telehealth CPT and HCPCS codes. 

    For COVID-19 related services, please ensure your claim is filed with the appropriate COVID-19 diagnosis code(s). 

    Services delivered via telemedicine should not be billed as though the service was provided in person. MedCost reserves the right to audit for coding accuracy and may deny claims or seek reimbursement for improperly coded claims.
     

What is COVID-19?

COVID-19 is a respiratory illness that can spread from person to person. The virus is thought to spread mainly between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs or sneezes. It also may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. Mild or severe symptoms may include fever, cough and/or shortness of breath.