Looking For a Doctor or Facility?

Find a Doctor

COVID-19 Updates

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

MedCost

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 Testing/Treatment

    Testing

    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.

    Effective January 15, 2022, the federal government expanded this coverage by requiring health plans and insurers to cover FDA-authorized at-home over the counter (OTC) COVID-19 diagnostic tests without cost-sharing and issued guidance to help clarify how plan participants may seek reimbursement for the tests during the remainder of the ongoing public health emergency. 

    Many pharmacy benefit managers (PBM) are allowing health plan members to purchase FDA-authorized OTC COVID-19 test kits as part of their pharmacy benefit at retail pharmacies with no upfront cost to the member and no need to submit for reimbursement. Although the PBMs are implementing this change immediately, there may be a transitional period while each individual merchant (pharmacy) updates their systems. Because each merchant will adhere to their own timeline, this may result in inconsistencies in shopping experiences (i.e., test kits may be purchased at no upfront cost at one location but require payment at another). You may want to contact your pharmacy to see if they are prepared to submit the test kit to your pharmacy plan for coverage. If you are asked to pay upfront for an OTC test, please save your receipt and contact the PBM shown on your health plan ID card for reimbursement.  

    The following provides a general overview of how to get your OTC COVID-19 test for free.* To ensure you have the most current and accurate information, we encourage you to contact or visit the website of the PBM shown on your health plan ID card. 

    1. Visit a pharmacy as designated by your assigned PBM.  
    2. Choose an FDA-authorized OTC antigen test kit. This list is continually being updated as testing products receive Emergency Use Authorization (EUA) clearance. Some of the most common tests include, but are not limited to, BinaxNOW™, Flowflex™, InteliSwab™, On/Go™, Ellume™, and QuickVue®.
    3. Present your health plan ID card at the pharmacy counter and ask to have your test kit submitted to your pharmacy plan for coverage. A prescription is not required to obtain test kits, but there is a quantity limit of 8 units/tests per covered member per calendar month/30-day period if purchased without a prescription. 
    4. If your doctor gave you a prescription for an OTC at-home COVID-19 test kit, submit it to your in-network pharmacy just as you would any other prescription. This also should be available at no cost. Quantity limits do not apply to at-home test kits prescribed by your doctor.
    5. If you are charged for an FDA-authorized OTC test kit at a pharmacy, or you purchased a test kit online or at a non-pharmacy retail location, SAVE YOUR RECEIPT. You will need it to file a claim for reimbursement. To submit a claim for reimbursement, contact or visit the website of the PBM shown on your health plan ID card (see below for a list of PBMs commonly used by MedCost employer groups). 

     

    *If you pay upfront for a test kit, you will be reimbursed up to $12 per test/unit (or the cost of the test, if less than $12). To be eligible for reimbursement, an at-home test must have a purchase date of 1/15/22 or later and must be FDA-authorized. If you plan to seek reimbursement under your pharmacy benefit as described above, you cannot use your FSA/HSA card to purchase these tests. You will be asked to pay for shipping if you place orders for home delivery of kits. The cost of test kits will not apply to member deductibles. No additional utilization management edits (i.e., prior authorization or other limits) will be applied.

    Some PBMs have information regarding reimbursement for at-home COVID test kits available online:

     

    Also, every home in the U.S. is eligible to order 4 free at-⁠home COVID-⁠19 tests from the federal government. You will find details on how to order at https://www.covidtests.gov/

    Note: 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 excluded from these requirements.

    Treatment 

    Treatment for COVID-19 was not addressed by FFCRA or the CARES Act. All medical plans administered by MedCost include coverage for treatment (in office and, if covered, virtual) of COVID-19. Treatment is generally subject to normal cost-sharing (co-pays, co-insurance, deductibles), but a small number of MedCost administered plans offer enhanced benefits for COVID-19 treatment. Log in to check your plan’s summary plan description for coverage information.

    Further details are available in MedCost Medical Policy #101 – COVID 19 Testing and Treatment.

  • COVID-19 Vaccine

    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 the Internal Revenue Service have issued a 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 implemented this change immediately. 

  • 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. 
  • 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. 

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

    The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) took effect on Friday, March 27, 2020. This website reflects several changes that are 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 approved COVID-19 vaccines. 

  • 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. Regulators have extended this requirement to out-of-network providers for the duration of the COVID-19 public health emergency.
     
    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 and may choose to extend coverage to include out-of-network providers. If your health plan does not cover preventive vaccinations, 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

    Testing

    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. 

    Effective January 15, 2022, the federal government expanded this coverage by requiring health plans and insurers to cover FDA-authorized at-home over the counter (OTC) COVID-19 diagnostic tests without cost-sharing and issued guidance to help clarify how plan participants may seek reimbursement for the tests during the remainder of the ongoing public health emergency. 

    Many pharmacy benefit managers (PBMs), including those commonly used by MedCost employer groups, are allowing health plan members to purchase FDA-authorized OTC COVID-19 test kits at retail pharmacies as part of their pharmacy benefit with no upfront cost to the member and no need to submit for reimbursement. As a result of the widespread availability of this “direct coverage” option, MedCost recommends that your health plan members purchase OTC COVID-19 home test kits using their pharmacy benefit rather than seeking reimbursement through the medical plan. 

    Although PBMs are implementing this change immediately, there may be a transitional period while each individual merchant (pharmacy) updates their systems. Because each merchant will adhere to their own timeline, this may result in inconsistencies in shopping experiences for members (i.e., test kits may be purchased at no upfront cost at one location but require payment at another). Members may want to contact their usual pharmacy to see if they are prepared to submit the test kit to the pharmacy plan for coverage. If members are asked to pay upfront for an OTC test, they should save their receipts and contact their PBM for reimbursement.  

    The following provides a general overview of how members can get their OTC COVID-19 test for free.* Members should contact or visit the website of the PBM shown on their health plan ID card to ensure they have the most current and accurate information. 

    1. Visit a pharmacy as designated by the assigned PBM.  
    2. Choose an FDA-authorized OTC antigen test kit. This list is continually being updated as testing products receive Emergency Use Authorization (EUA) clearance. Some of the most common tests include, but are not limited to, BinaxNOW™, Flowflex™, InteliSwab™, On/Go™, Ellume™, and QuickVue®.
    3. Present a health plan ID card at the pharmacy counter and ask to have the test kit submitted to the pharmacy plan for coverage. A prescription is not required to obtain test kits, but there is a quantity limit of 8 units/tests per covered member per calendar month/30-day period if purchased without a prescription. 
    4. If a doctor gave the member a prescription for an OTC at-home COVID-19 test kit, the member should submit it to an in-network pharmacy just as they would any other prescription. This also should be available at no cost. Quantity limits do not apply to at-home test kits prescribed by a doctor.
    5. If a member is charged for an FDA-authorized OTC test kit at a pharmacy, or if the member purchased a test kit online or at a non-pharmacy retail location, they should SAVE THEIR RECEIPT. The member will need it to file a claim for reimbursement. To submit a claim for reimbursement, the member should contact or visit the website of the PBM shown on the health plan ID card (see below for a list of PBMs commonly used by MedCost employer groups). 

     

    *If the member pays upfront for a test kit, they will be reimbursed up to $12 per test/unit (or the cost of the test, if less than $12). To be eligible for reimbursement, an at-home test must have a purchase date of 1/15/22 or later and must be FDA-authorized. If member plans to seek reimbursement under the pharmacy benefit as described above, they cannot use an FSA/HSA card to purchase these tests. Member will be asked to pay for shipping if they place orders for home delivery of kits. The cost of test kits will not apply to member deductibles. No additional utilization management edits (i.e., prior authorization or other limits) will be applied.

    Some PBMs have information regarding reimbursement for at-home COVID test kits available online:

     

    Also, every home in the U.S. is eligible to order 4 free at-⁠home COVID-⁠19 tests from the federal government. You will find details on how to order at https://www.covidtests.gov/

    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 

    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.
     

    Further details are available in MedCost Medical Policy #101 – COVID 19 Testing and Treatment.

     

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

    The U.S. Department of Labor and the Internal Revenue Service have issued a regulation requiring 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). However, in no event will the Outbreak Period be longer than one year with respect to a particular deadline that applies to an individual.  This means that any deadline that applies to you will not be extended for longer than one year but could be  shorter. 

     

    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. 

  • 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 implemented this change immediately. 

  • 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. 

    Dependent Care FSA Maximum

    The American Rescue Plan Act of 2021 included a provision temporarily increasing the Dependent Care FSA maximum from $5,000 to $10,500 (from $2,500 to $5,250 for taxpayers who are married filing separately) for taxable years beginning in 2021. Employers opting to make this change must amend their plan by the last day of the plan year in which the amendment is effective. 

    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.  
     
     

  • 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
    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. 

  • 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
    Testing

    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. Effective January 15, 2022, the federal government expanded this coverage by requiring health plans and insurers to cover FDA-authorized at-home over the counter (OTC) COVID-19 diagnostic tests without cost-sharing during the remainder of the ongoing public health emergency. Many pharmacy benefit managers (PBMs), including those commonly used by MedCost employer groups, are allowing health plan members to purchase FDA-authorized OTC COVID-19 test kits at retail pharmacies as part of their pharmacy benefit with no upfront cost to the member and no need to submit for reimbursement. Although PBMs are implementing this change immediately, there may be a transitional period while each individual merchant (pharmacy) updates their systems. Members should contact their PBM for questions about reimbursement. (To be eligible for reimbursement, an at-home test must have a purchase date of 1/15/22 or later and must be FDA-authorized.) A prescription is not required to obtain test kits, but there is a quantity limit of 8 units/tests per covered member per calendar month/30-day period if purchased without a prescription. Prescriptions for OTC at-home COVID-19 test kits should be submitted to an in-network pharmacy just as any other prescription. Quantity limits do not apply to at-home test kits prescribed by a provider.

    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 

    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 the Internal Revenue Service have issued a 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.
     

  • 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.