Updated Health Insurance COVID-19 Benefits
COVID-19 cases are on the rise in America. Many states, including California, recently instituted new orders in several counties to help reverse this trend. In addition, health insurers support their members with a variety of health insurance COVID-19 benefits. Since many of the insurers altered their original coverage, this article updates our earlier article about health insurance COVID-19 benefits. Because it changes, we recommend contacting your health insurer for the most up-to-date information on your specific plan. California companies covered here include: Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, Health Net, Kaiser Permanente and United Healthcare. Later in the article, we discuss updated health insurance COVID-19 benefits and testing requirements for group health insurance plans.
INDIVIDUAL INSURANCE COMPANY BENEFITS
Aetna extended most of its COVID-19 benefits until September 30, 2020. It waives cost-sharing and copays for COVID-19 inpatient treatments. COVID-19 doctor visits are also free. Aetna offers virtual care with telemedicine options including Teladoc® services. For specific plans, it provides free mental health counseling using telemedicine and a $0 copay for outpatient mental health visits. Aetna also provides free delivery on CVS Pharmacy® prescriptions. You can find resources to reduce stress and manage emotional health and other benefits on its website.
Anthem Blue Cross
Anthem’s website provides information on COVID-19 benefits. The benefits outlined here may not apply to all members so it is important to check your specific plan. Anthem covers COVID-19 testing and treatment without copays and cost-sharing until December 31, 2020. Note that providers and facilities must be in network. Anthem waives telehealth costs for doctors (including non-COVID-19 visits) through September 30, 2020. (Another area of the site says, “until further notice.”) There are several options listed for emotional and mental health support. Anthem encourages members to speak with their practitioners about moving from 30-day to 90-day medication supply prescriptions. It will also mail you prescriptions from Anthem Home Delivery for free. COBRA plans are now more flexible. Anthem extended the time to enroll in a COBRA plan, pay a past-due COBRA premium, and file and appeal claims.
Blue Shield of California
Blue Shield waives prior approvals as well as out-of-pocket costs for copays, coinsurance, and deductibles for COVID-19 screenings and testing recommended by a doctor. The company waives copays, coinsurance, and deductibles for COVID-19 treatment until September 30, 2020 for specific plans. The company suggests using one of its virtual care options prior to in-person care for COVID-19 symptoms. The costs of these services vary by the service and the specific plan. Depending on the plan, Blue Shield covers out-of-network providers for COVID-19 only in a medical emergency. Many members can order a 90-day supply of medications through the mail service pharmacy with no delivery fee. Members can see mental health providers virtually with the same coverage costs as in-person visits. Additional coverage from Blue Shield is outlined here.
Cigna waives out-of-pocket costs for COVID-19 diagnostic visits with in-network providers through July 31, 2020. It also waives out-of-pocket costs for FDA approved COVID-19 testing. And it waives out-of-pocket costs for all COVID-19 treatment through July 31, 2020. Virtual care for non-COVID-19 issues is covered at normal out-of-pocket costs through July 31, 2020. Cigna delivers 90-day supply medications for free from Cigna Home Delivery Pharmacy and Express Scripts PharmacySM. For additional details, visit Cigna’s Resource Center.
COVID-19 FAQs appear on Health Net’s website. Health Net waives copays, coinsurance and/or deductibles for medically necessary COVID-19 testing and screening when ordered by a licensed health care provider. Prior authorization for these services is not required. These services must be ordered, referred, and/or performed at in-network locations. Health Net covers medically necessary COVID-19 treatments.
When referred by a Kaiser doctor, you won’t pay for COVID-19 screening or testing. Kaiser waives most COVID-19 out-of-pocket costs for inpatient and outpatient COVID-19 treatment services until December 31, 2020. Kaiser encourages members to use mail order for non-urgent prescriptions and refills. Members get a 3-month supply when doing so for the price of 2 months. Kaiser has an “emotional wellness center” that offers self-care tips, tools and guided meditations. Learn more about Kaiser and COVID-19 on its website.
United Healthcare waives cost-sharing (copayments, coinsurance, or deductibles) for medically necessary COVID-19 testing when ordered by a physician. Tests must be FDA-authorized for coverage without cost-sharing. The company also waives member cost-sharing for COVID-19 treatment through July 24, 2020. United Healthcare expanded access to telehealth services and offers it for both COVID-19 and non-COVID-19 visits. Optimum Home Delivery mails prescriptions to members. United Healthcare offers a variety of emotional health services. Learn more about United Healthcare’s COVID-19 benefits here.
GROUP HEALTH INSURANCE PLANS AND TESTING REQUIREMENTS
Group health insurance plans are health plans offered by employers or employee organizations. Health and Human Services (HHS), the Department of the Treasury, and the Department of Labor dictated new testing requirements for group health insurance plans. This update is based on the CARES Act (Coronavirus Aid, Relief, and Economic Security Act). It is also based on the FFCRA (Families First Coronavirus Response Act).
New testing requirements for group health insurance plans include the following:
- Plans must provide coverage for at-home COVID-19 tests. Tests must be ordered by a medical provider and meet the FFCRA and CARES Act testing requirements.
- Plans must cover multiple COVID-19 tests on the same person. A medical provider must say the test is appropriate for this person.
- Tests must fall into one of four categories. 1) Test must be approved by the FDA. 2) Test where the developer intends to submit or has submitted a request for emergency use authorization from the FDA. 3) Test is developed in and authorized by a state that is reviewing COVID-19 tests. 4) Test is approved by HHS in other guidance.
Go here to learn more about testing requirements for group health insurance plans.
The Tragic Situation in Nursing Homes and COVID-19 Whistleblower Protections
Coronavirus is ripping through nursing homes and decimating its vulnerable residents. The government and nursing homes themselves have restricted outside visitors for fear of infection spread. These restrictions mean there is no longer any threat from the outside to nursing homes who put their financial interests ahead of their residents. Nursing home employees are some of the few witnesses to the neglect and mistreatment of residents. This article reviews the current situation in nursing homes and COVID-19 whistleblower protections for nursing home staff who speak out.
Resident and Staff Deaths in California Nursing Homes
Skilled nursing facility deaths in California more than doubled in May 2020. As of June 16, 2,176 residents and 85 health care workers died in California from COVID-19.
Lack of Oversight While Vulnerable Residents are Cut Off from Advocates
With a few exceptions, family and friends can no longer make in-person visits to nursing home residents. Family and friends not only provide emotional, mental, and physical support, they also scrutinize resident care.
On March 16, long-term care ombudsmen were instructed to stop entering nursing homes. Ombudsmen advocate for residents and file complaints against nursing homes.
On March 23, the federal government told state inspectors to stop in-depth annual inspections. In-depth inspections involve multiple inspectors spending days inspecting facilities and interviewing residents, family, and staff. The inspections since March 23 are “infection control visits” that focus on handwashing, personal protective equipment, and isolation programs that separate residents who are COVID-19 positive. Even though 95% of California facilities have been inspected since March 1, the inspections are much less rigorous and have often not led to enforcement.
Many nursing homes pay low wages and struggle to retain employees. Several nursing homes are taking advantage of a California state waiver to exempt them from staffing requirements. Thus they are operating understaffed.
Our most vulnerable elderly population at risk and also has less social interaction. Aside from fewer visitors, many facilities have ceased activity programs and communal dining. Consequently, there is an increase in social isolation and loneliness. Many residents have suffered psychologically and with a decline in cognitive function.
At the onset of the pandemic and often still today, there is insufficient personal protective equipment for staff. In addition, there is inadequate testing. On May 11, California sent a letter to skilled nursing facilities outlining mitigation plan implementation and submission requirements. Unfortunately, even though the state and LA County assured it, there is still not 100% testing.
Health Care Worker Dangers
In May 2020, COVID-19 cases among health care workers in nursing homes more than doubled and COVID-19-related deaths quadrupled. Contributing to this problem is the fact that social distancing in nursing homes is nearly impossible. How can a health care worker socially distance when assisting with bathing, clothing, and feeding residents?
In addition, many staff work in multiple facilities for financial necessity reasons.
California COVID-19 Whistleblower Protections for Nursing Home Employees
Nursing home certified nursing assistants, nurses, and other employees see negligent acts. These employees can report these acts to appropriate regulators, media, or the public. However, to do so the employees would be putting their jobs at risk. Many of these employees are bound in tough situations. On one hand they care for the well-being of the residents. On the other hand, they cannot jeopardize their jobs. Many nursing home employees are paid at or just above minimum wage and are living from paycheck to paycheck. They cannot lose their jobs without potentially losing their homes, apartments, child care, or potentially going hungry.
The good news is that California law already contains safeguards which cover COVID-19 whistleblower protections. These safeguards protect such employees and minimize their personal risks in reporting dangerous and illegal situations.
California Health & Safety Code
One of the strongest protections is found in the California Health & Safety Code. In July 2019, California’s governor Gavin Newsom signed Senate Bill 233. This statute amended the Health & Safety Code to add section 1278.5. In passing the bill, California determined “that it is the public policy of the State of California to encourage patients, nurses, members of the medical staff, and other health care workers to notify government entities of suspected unsafe patient care and conditions.” It passed the bill to encourage “reporting in order to protect patients and in order to assist those accreditation and government entities charged with ensuring that health care is safe.”
The bill specifically prohibits a health care facility from discriminating or retaliating against an employee for making a report to any regulatory agency. It also prohibits discrimination or retaliation for participating in an investigation. Any employer who does so is subject to a criminal misdemeanor. The employee against whom the health care facility retaliated can also file a lawsuit. In this lawsuit, s/he can seek reinstatement, reimbursement for lost wages, a civil penalty, work benefits, and other compensatory damages. S/he can also seek the legal costs associated with pursuing the case.
California Labor Code
Nursing home employees in California also have the protection of the California Labor Code. Labor Code section 1102.5 is a general whistleblower statute which forbids all types of employers from retaliating against an employee who discloses any violation of state or federal statute or regulation to certain government or the company’s HR department, among others. Between these two statutes, nursing home employees have significant avenues to protect themselves against employers who retaliate against them for taking steps to keep their residents safe.
The situation in nursing homes does not appear to be improving. In fact, the number of deaths is rising. Hopefully attention to this issue will drive increased scrutiny and safeguards.
About the Law Offices of Scott Glovsky
The Law Offices of Scott Glovsky has represented injured consumers and victims of wrongful business practices for more than the past two decades. The firm focuses on health insurance bad faith, catastrophic personal injury, sexual abuse and consumer-related litigation. We get justice for our clients and hold the wrongdoers accountable.
If you have loved ones in nursing homes who have been mistreated, contact us and we can help.
FFCRA Requires 14 Days Paid Leave Due to Coronavirus
Coronavirus can devastate a person’s health and lead to financial ruin during the time it takes to recover. There are many people who cannot afford to miss a paycheck. To address this issue, the federal government passed a new law called “FFCRA,” or the “Families First Coronavirus Response Act.” FFCRA is an Act of Congress that helps workers impacted by coronavirus. FFCRA increases food stamp funding and allows workers affected in all 50 states to take 14 paid days off work. The act provides this leave for any time until December 31, 2020. FFCRA also requires employers to provide payment for leave if a doctor tells an employee to self-quarantine. FFCRA also covers leave that employees take while they wait for a medical diagnosis.
Paid Leave to Care for a Family Member or for Childcare
The act also allows employees to take 14 days of sick leave to take care of a sick family member or a child who cannot go to school or daycare because of a government order. Employees can take this type of leave at two thirds pay. Under FFCRA, employees can also seek an additional 10 weeks of family and medical leave at the same pay rate. They can take such additional leave if they are unable to work because coronavirus forces them to provide childcare.
Businesses Who Must Adhere to FFCRA
FFCRA only applies to businesses that have fewer than 500 employees and to certain public employers. It excludes federal government employees because Title II of the Family and Medical Leave Act already provides them with paid sick leave. Employers with less than 50 employees can seek an exemption from the childcare leave. That said, such employers can only seek the exemption if providing the leave would jeopardize their business. Generally, this law requires that employers allow all employees to take such leave if the employee worked for the employer for at least 30 days. However, hospitals and other healthcare providers can decide not to allow their employees to take the additional leave.
The act makes sure though not to leave employers high and dry. Employers who pay out additional leave under FFCRA can seek a tax credit for the full amount that they paid. Employers cannot fire or discipline an employee who takes this sick leave. Nor can employers fire or discipline an employee who files a complaint that is related to the act. Employers must also display a notice of the act’s requirements on their premises where people can see it.
The law not only requires additional leave, it also creates penalties if employers do not comply with its requirements. Of course, many employers may be confused or not learn of the act for a while. The government therefore will not enforce the act for 30 days after it was signed into law (March 18, 2020). However, if an employer violates the act and is not acting reasonably or in good faith, then the government will subject that employer to penalties even during the first 30-day period. This means that if an employer refuses to provide the sick leave but does not know of the law in the first 30 days, then the government will not punish that employer. However, if an employee takes off sick leave and informs the employer of the law but the employer still refuses to pay during the leave, then the government can subject them to penalties.
The Law Offices of Scott Glovsky is here to help you during this time. We specialize in insurance law and catastrophic personal injury. Please give us a call with any questions you have.
We’re Here for You
The Law Offices of Scott Glovsky specializes in insurance law and would like to help in any way we can. We can advise you about your individual policy and applicable coverage and will help address other questions you may have.