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A Message from the Health Options Program

04/07/2020 —

The Health Options Program is committed to ensuring your benefits continue to support you and your loved ones during the coronavirus (COVID-19) health emergency. This includes working with our health care administrators to implement plan changes based on newly-passed federal laws related to this crisis. It also means keeping you up-to-date on what these changes mean to you.

The latest piece of legislation is the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act). It clarifies how plans are required to cover COVID-19-related testing.

What the CARES Act means to you

  • Any test used to detect the virus is covered 100%. This includes tests authorized by the Federal Food Drug and Cosmetic Act; tests for which the developer has requested, or intends to request, emergency use authorization under the Drug Act; and those authorized by a state that has notified the U.S. Department of Health and Human Services (HHS) of its intention to review the tests; and tests determined appropriate by HHS
  •  Administration of the test is covered 100%
  • Provider visits—in person, telehealth, urgent care or emergency room visits—that result in an order for testing for COVID-19 are covered 100%
  • There are no prior authorization requirements for testing-related services

In addition, Medicare covers all medically necessary hospitalizations. This includes if you are diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.

The insurance providers for the Medicare Advantage plans available under the Health Options Program may make other plan design changes. If you are enrolled in a Medicare Advantage plan, contact the insurance provider with questions about how your benefits work.

Frequently Asked Questions

  • Do I have to worry about staying in my network for COVID-19 testing? No. COVID-19 testing must be available to you at no cost whether the provider doing the testing is in-network or out-of-network.
  • What if I am charged for COVID-19 testing, including deductibles, copayments, and coinsurance? You will be reimbursed and/or your deductibles adjusted by your health plan. This applies to telemedicine services as well.
  • Will there be additional laws passed regarding COVID-19 and my health benefits? Potentially. We’re keeping a close eye on all the federal and state announcements to make sure we’re up-to-date.

We encourage you to follow all local, state and national COVID-19 regulations, and the advice and practical tips offered by medical professionals. Should you have additional questions about using your benefits during this time, contact the applicable plan administrator.

Benefit

Plan

Contact information

Medical benefits

HOP Medical Plan, Value Medical Plan or Pre-65 Medical Plan

HOP Administration Unit
1-800-773-7725

Medicare Advantage plans available under the Health Options Program

Click here for applicable contact information.

Prescription drugs

Enhanced, Basic or Value Medicare Rx Options

OptumRx
1-888-239-1301

Dental

MetLife Dental Plan

1-855-700-7997

Wellness

SilverSneakers (available to members enrolled in the HOP Medical Plan, the Pre-65 Medical Plan and certain Medicare Advantage plans)

HOP Administration Unit
1-800-773-7725

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