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COVID-19 Updates

Go to our COVID-19 resource page 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 Testing/Treatment

    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. 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 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

    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:

  • COBRA Premium Subsidies

    The American Rescue Plan Act of 2021, signed by President Biden in March 2021, includes federal subsidies for eligible employees to obtain COBRA coverage. The subsidy pays for the full amount of the enrollee’s COBRA premium and applies to all employees who were involuntarily terminated or received a reduction in hours which resulted in their coverage terminating. The subsidy applies to enrollees who meet the qualifications and are eligible for COBRA at any point between April 1, 2021, and September 30, 2021. This is also the only time period eligible for a premium subsidy. Eligible individuals who did not previously elect COBRA, and those who elected but discontinued COBRA, must be given a second opportunity to elect COBRA effective April 1, 2021.

    Self-insured employers are required to “front” the money to pay the COBRA premiums for eligible individuals. Those employers will then be reimbursed by the federal government by claiming an advance-refundable tax credit on their quarterly payroll tax returns.

    The bill requires employers to send eligible individuals a notice explaining that they may now be eligible to receive COBRA subsidies by May 31, 2021. Individuals who first become eligible for COBRA between April 1 and September 30, 2021, must also receive a version of this notice. 

    Additionally, employers must send an “expiration notice” to COBRA participants at least 15 days (and no more than 45 days) prior to expiration of the subsidies. 

    The U. S. Department of Labor (DOL) recently issued initial regulatory guidance regarding the implementation of these subsidies, including model notices for eligible individuals. MedCost will send these notices on behalf of its COBRA Administration Clients. Employers administering COBRA internally or through another vendor should ensure these latest updates are implemented. 

    Below is additional information for employers utilizing MedCost’s COBRA  Administrative Services

    MedCost’s COBRA Administration Services
    MedCost is prepared to assist employers with the administration of these premium subsidies, including mailing required notices to individuals who may be eligible.
     
    Because the subsidy is only available to plan participants who are eligible for COBRA due to a reduction of hours or involuntary termination, MedCost will need to know whether terminations were voluntary or involuntary. Unfortunately, existing electronic eligibility data feeds (i.e., 834 EDI) omit this information.  Therefore, MedCost is standing up a new process to receive information regarding the nature of each termination. We will provide further details through your MedCost Account Manager once the process is in place. 
     
    In addition, the Act allows (but does not require) employers to offer individuals eligible for premium subsidies the opportunity to enroll in coverage that is different from the coverage they had at the time of the COBRA qualifying event. This option is subject to several caveats, additional notice requirements, and requires employers to offer an additional 30-day period to select new coverage options. For these reasons, MedCost is advising employers to follow the typical COBRA process that limits coverage to that which was in effect at the time of the COBRA qualifying event. Employers wishing to allow changes in coverage should contact the MedCost COBRA team (COBRA@medcost.com or 1-800-852-7040) as soon as possible to discuss further details, including feasibility and pricing.
     
    Frequently Asked Questions
    See the DOL’s FAQs for further information about the subsidies generally.
     

    How will the premium subsidy be provided to individuals?
    Eligible individuals will not have to pay the COBRA premium for the period of coverage from April 1, 2021, through September 30, 2021. Any payments that are received in error will be refunded. Eligible individuals who have enrolled in MedCost’s recurring electronic payment service will have those electronic premium payments suspended during this time period.  
     
    Are employers required to remit COBRA premiums to MedCost?
    No. Employers will continue to self-fund claims expenses (and premiums for stand-alone plans) but are not required to make COBRA premium payments to MedCost.
     
    How will employers be reimbursed for the COBRA premiums that are waived? Employers will claim a tax credit (on a dollar-for-dollar basis) on their quarterly payroll taxes for the COBRA premiums that are waived. We expect the IRS to issue further guidance on how such credits will work.
     
    How do I determine if an employee was voluntarily or involuntarily terminated? 
    We are hoping the IRS will issue further guidance on this topic (as they did for the 2009 COBRA subsidy). Until further guidance is issued, some employers are looking to the 2009 IRS Notice for help in answering this question. At a high level, that notice defined involuntary as “the independent exercise of the unilateral authority of the employer to terminate the employment, other than due to the employee’s implicit or explicit request, where the employee was willing and able to continue performing services. … The determination of whether a termination is involuntary is based on all the facts and circumstances. For example, if a termination is designated as voluntary or as a resignation, but the facts and circumstances indicate that, absent such voluntary termination, the employer would have terminated the employee’s services, and that the employee had knowledge that the employee would be terminated, the termination is involuntary.”
     
    What specific benefits are eligible for the premium subsidy?
    The COBRA subsidy is available for each health benefit which is subject to COBRA other than a health flexible spending account. This includes major medical, dental and vision plans. 

    Who should I contact with additional questions? 
    MedCost’s COBRA team (COBRA@medcost.com or 1-800-852-7040) and your Account Manager are available to assist with any additional questions. 

     

  • 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. 

    The American Rescue Plan Act of 2021 includes federal subsidies for eligible employees to obtain COBRA coverage. See COBRA Premium Subsidies section for more information.
     

  • 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

    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.

    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 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. 

  • 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. The mandate to offer this leave expired December 31, 2020.  However, the American Rescue Plan Act of 2021 gives employers the option to continue providing this leave on a voluntary basis through September 30, 2021. 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. The mandate to offer this leave expired December 31, 2020.  However, the American Rescue Plan Act of 2021 gives employers the option to continue providing this leave on a voluntary basis through September 30, 2021. 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. 

    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
    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. 

  • 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.