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Information from your health plan about COVID-19 (coronavirus disease)

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Information for providers

CMS and Wisconsin ForwardHealth have provided waivers and updates that allow medical providers to focus on treating patients with COVID-19 more efficiently. In line with these waivers and updates, Security Health Plan’s COVID-19 Provider FAQ  details our revised processes. This Provider FAQ will be updated continuously as new information is received from CMS and Wisconsin DHS.

We’ve got you covered

Please find your patient’s plan in the left column of the table below to see the COVID-19 benefits and services included with their plan. If your patient has any questions they should call the phone number on the back of their ID card or our general Customer Service line at 1-800-472-2363.

Security Health Plan members other than  Medicare Advantage HMO-POS members who need to get care from an out-of-network provider during the COVID-19 health emergency should contact a Security Health Plan Nurse Navigator at 1-800-472-2363.

 
  Active COVID-19 testing and testing-related services Serological or antibody testing and testing-related services COVID vaccines, preventive service/items Inpatient and observation treatment related to COVID-19 Out-of-network coverage (does not apply to Supplemental Benefits after Oct. 23, 2020) Telehealth
Medicare Advantage HMO-POS
Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will be subject to plan cost sharing.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will be subject to plan cost sharing.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

For calendar years 2020 and 2021, Medicare will be responsible to pay for the COVID-19 vaccine and its administration. Claims should be submitted directly to Medicare.

Effective for dates of service on or after Jan. 1, 2022, Security Health Plan will be responsible to pay for the COVID-19 vaccine and its administration.

Covered at 100%

Covered at 100% for dates of service on or before Dec. 31, 2021.

For dates of service on or after Jan. 1, 2022, services will be subject to applicable plan cost sharing.

Members can use an out-of-network doctor, hospital or service provider that accepts Medicare and pay the same costs they would pay to see an in-network provider for Medicare-covered services. This coverage is not affected by COVID-19 guidelines.

Effective for dates of service on or after Jan. 1, 2022, all out-of- network authorization requirements will be reinstated.
 

All Medicare-covered, medically-necessary telehealth services will be covered the same as if the visit was in the office. Members have free, unlimited coverage for Care My Way services.
Secure Saver MSA
Covered subject to plan deductible Covered subject to plan deductible

For calendar years 2020 and 2021, Medicare will be responsible to pay for the COVID-19 vaccine and its administration. Claims should be submitted directly to Medicare.

Effective for dates of service on or after Jan. 1, 2022, Security Health Plan will be responsible for processing the COVID-19 vaccine and its administration.

Covered subject to plan deductible

Covered subject to plan deductible Secure Saver MSA plan members may use any provider that accepts Medicare.

All Medicare-covered, medically-necessary telehealth services will be covered the same as if the visit was in the office.  have free, unlimited coverage for Care My Way services.

 
Ally Rx D-SNP

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will be subject to plan cost sharing.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will be subject to plan cost sharing.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

For calendar years 2020 and 2021, Medicare will be responsible to pay for the COVID-19 vaccine and its administration. Claims should be submitted directly to Medicare.

Effective for dates of service on or after Jan. 1, 2022, Security Health Plan will be responsible to pay for the COVID-19 vaccine and its administration.

Covered at 100%

Your Security Health Plan and Medicaid coverage will coordinate to cover at 100%.

Effective for dates of service on or after Jan. 1, 2022, all out-of-network authorizations will be reinstated. This includes authorizations to see out-of-network providers. Please refer to your Evidence of Coverage for services that require authorization.

All Medicare-covered, medically-necessary telehealth services will be covered. Your Security Health Plan and Medicaid coverage will coordinate to cover at 100% without member cost share. Members have free, unlimited coverage for Care My Way services.
Medicare Supplement

COVID-19 testing and testing-related services will be covered supplemental to Medicare.

COVID-19 testing and testing-related services will be covered supplemental to Medicare.

Covered by CMS at 100%

Covered supplemental to Medicare

Medicare Supplement members may use any provider that accepts Medicare.

All Medicare-covered, medically-necessary telehealth services will be covered the same as if the visit was in the office. Members have free, unlimited coverage for Care My Way services.

Until the end of the National Public Health Emergency 

Medicare Select: Senior Security

Covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, COVID-19 testing and testing-related services will be paid supplemental to Medicare when performed by an in-network provider unless considered urgent/emergent.

Covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, COVID-19 testing and testing-related services will be paid supplemental to Medicare when performed by an in-network provider unless considered urgent/emergent.

Covered by CMS at 100%

Covered supplemental to Medicare when performed by an in-network provider unless considered urgent/emergent.

 Services must be received from Security Health Plan affiliated providers unless services are urgent/emergent.

All Medicare-covered, medically-necessary telehealth services will be covered the same as if the visit was in the office. Members have free, unlimited coverage for Care My Way services.


Large employer group

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will not be covered and all costs will be denied as member responsibility.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing. 

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will not be covered and all costs will be denied as member responsibility.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

The COVID-19 vaccine and its administration will be covered with no cost sharing in and out of network.2 

Covered at 100% for dates of service on or before Dec. 31, 2021.

For dates of service on or after Jan. 1, 2022, services will be subject to applicable plan cost sharing.

Contact Customer Service for specific plan benefits.

An expanded list of services1 may be provided via telehealth and will be subject to the same copay or coinsurance as if the visit were in office. Includes free, unlimited coverage for Care My Way services.


Small employer group

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will not be covered and all costs will be denied as member responsibility.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will not be covered and all costs will be denied as member responsibility.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

The COVID-19 vaccine and its administration will be covered with no cost sharing in and out of network.2

Covered at 100% for dates of service on or before Dec. 31, 2021.

For dates of service on or after Jan. 1, 2022, services will be subject to applicable plan cost sharing.

Contact Customer Service for specific plan benefits.

An expanded list of services1 may be provided via telehealth and will be subject to the same copay or coinsurance as if the visit were in office. Includes free, unlimited coverage for Care My Way services.


Individual and Family Plan (IFP)

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will not be covered and all costs will be denied as member responsibility.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

Effective for dates of service on or after Jan. 1, 2022, COVID-19 testing done for travel, employment or other not medically-necessary reasons will not be covered and all costs will be denied as member responsibility.

Medically-necessary COVID-19 testing will continue to be covered at 100% until the end of the National Public Health Emergency.

For dates of service after the National Public Health Emergency, medically-necessary COVID-19 testing and testing-related services will be subject to applicable plan cost sharing.

The COVID-19 vaccine and its administration will be covered with no cost sharing in and out of network.2

Covered at 100% for dates of service on or before Dec. 31, 2021.

For dates of service on or after Jan. 1, 2022, services will be subject to applicable plan cost sharing.

Contact Customer Service for specific plan benefits. An expanded list of services1 may be provided via telehealth and will be subject to the same copay or coinsurance as if the visit were in office. Includes free, unlimited coverage for Care My Way services.
BadgerCare Plus (Medicaid) Covered at 100%3 Covered at 100% The COVID-19 vaccine and its administration will follow all coverage requirements as outlined by ForwardHealth when made available.2 Covered at 100% COVID-19 testing and treatment received at out-of-network facilities will be considered emergent and covered the same as in network indefinitely.

All covered services may be provided via telehealth at no cost to you. You have free, unlimited coverage for Care My Way services.

Marshfield Clinic Health System employees (self-funded non-governmental employer)

Covered at 100%  until the end of the National Public Health Emergency 3

Covered at 100%  until the end of the National Public Health Emergency

The COVID-19 vaccine and its administration will be covered with no cost sharing in and out of network.2

Covered at 100%  until the end of the National Public Health Emergency

Please call Security Administrative Services at 1-800-570-8760 for details. An expanded list of services1 may be provided via telehealth and will be subject to the same copay or coinsurance as if the visit were in office. Includes free, unlimited coverage for Care My Way services.
Marshfield Clinic Health System-Beaver Dam employees (self-funded non-governmental employer)

Covered at 100%  until the end of the National Public Health Emergency3

Covered at 100%  until the end of the National Public Health Emergency

The COVID-19 vaccine and its administration will be covered with no cost sharing in and out of network.2

Covered at 100%  until the end of the National Public Health Emergency

Please call Security Administrative Services at 1-800-570-8760 for details. An expanded list of services1 may be provided via telehealth and will be subject to the same copay or coinsurance as if the visit were in office. Includes free, unlimited coverage for Care My Way services.
Governmental self-funded groups

Covered at 100%  until the end of the National Public Health Emergency3

Covered at 100%  until the end of the National Public Health Emergency

The COVID-19 vaccine and its administration will be covered with no cost sharing in and out of network.2 Please call Security Administrative Services at 1-800-570-8760 for details. Please call Security Administrative Services at 1-800-570-8760 for details. Please call Security Administrative Services at 1-800-570-8760 for details.
Non-governmental self-funded groups

Covered at 100%  until the end of the National Public Health Emergency3

Covered at 100%  until the end of the National Public Health Emergency

The COVID-19 vaccine and its administration will be covered with no cost sharing in and out of network.2 Please call Security Administrative Services at 1-800-570-8760 for details. Please call Security Administrative Services at 1-800-570-8760 for details. Please call Security Administrative Services at 1-800-570-8760 for details.

1The expanded list of services available via telehealth includes but is not limited to behavioral health, office visits/consultations, care management and outpatient therapy.

2The cost of the COVID-19 vaccine is covered by the federal government. The cost to administer the vaccine will be paid by Security Health Plan. 

COVID-19 services not received on the same day as a COVID-19 test (unless admitted to inpatient/observation) will apply to the plan’s normal cost sharing.

Providers working at additional locations to help with altered workflow during COVID-19

Security Health Plan understands the situations that may arise during the COVID-19 pandemic that may require providers to work at health care locations where they normally do not practice. Security Health Plan created guidelines for our provider affiliates to report health care facility changes to Security Health Plan to facilitate payment for services during this time and into the future. Please check this page for any updates as COVID-19 evolves.

To report provider location changes please fill in the Excel spreadsheet    “COVID-19 Additional Provider Locations”  and email it to both of the following addresses shp.dsc.netmgmt@securityhealth.org and shpprd@securityhealth.org.

COVID-19 interim policy coverage for telehealth services

Security Health Plan covers telehealth services as outlined in its updated Telehealth Medical Policy. View Telehealth Medical Policy

Security Health Plan updates this policy as necessary as situations change during the COVID-19 pandemic.

The coverage outlined in the Telehealth Medical Policy covers providers who are credentialed and affiliated with Security Health Plan. Telehealth visits are reimbursed according to the provider’s current Security Health Plan contracted rate, and the member’s plan cost sharing applies.

Commercial and Security Administrative Services products: Providers should bill telehealth services with POS 02 and modifiers GQ, GT, or 95 if applicable.
BadgerCare/Medicaid plans:  Providers should follow ForwardHealth guidance for billing telehealth services.
Medicare plans:  Providers should follow CMS guidance for billing telehealth services.

 

Last updated:  Nov. 26, 2021