Learn what COVID-19 vaccinations may mean for the business community and how you can encourage your employees to get a vaccination.
Hosted by Dr. Joon Lee, Senior Vice President, UPMC, and President, UPMC Physician Services, UPMC Health Services Division and Ellen Beckjord, PhD, MPH, Associate Vice President, Population Health and Clinical Transformation, UPMC Health Plan
The Coronavirus Aid, Relief, and Economic Stimulus (CARES) Act is intended to protect Americans from the public health and economic impact of COVID-19. Under the CARES Act, member cost sharing will be waived for services including:
- COVID-19 diagnostic testing. All tests are subject to current standards of medical practice, including but not limited to CDC guidance on the appropriate use of testing.
- Emergency department, office, and urgent care visits that result in necessary COVID-19 diagnostic testing.
- Labs or chest imaging that are used to evaluate a possible COVID-19 diagnosis or determine the need for diagnostic testing.
- Vaccinations for COVID-19.c
UPMC Health Plan Enhanced Benefits
COVID-19 is a Public Health Emergency (PHE). In light of this unprecedented challenge, we are providing enhanced benefits to help our members. For example, UPMC Health Plan is waiving all member cost sharing (such as deductibles, copays, and coinsurance, unless otherwise noted below) for:
- In-network inpatient treatment of COVID-19 through Jan. 20, 2022.e
- In-network monoclonal antibody treatment for COVID-19 through Jan. 20, 2022.e,g
- The costs of necessary emergency and inpatient treatment without the application of deductibles, copays, or coinsurance for patients who experience a severe immediate (within 4 hours) adverse reaction and requires emergency medical care immediately following vaccine administration.h
- Members who receive a screening mammogram shortly after receipt of a COVID-19 vaccine AND have an abnormal screening result due to swollen lymph nodes. UPMC Health Plan will waive member cost-sharing for a follow-up screening mammogram or ultrasound with their network provider. Only one follow-up screening will be permitted per benefit year. Coverage is retroactive effective Jan. 1, 2021 through Jan. 20, 2022, so long as permitted under the current state and federal emergency declarations and associated guidance.i
- Telemedicine visits, including UPMC AnywhereCare, for the diagnosis of suspected COVID-19. f
aThese recordings may not have the most up-to-date information. Recording dates are provided for each.
bOnly the Pfizer vaccine is available to patients as young as 12 years old. The Moderna and Johnson & Johnson vaccines are approved for patients who are 18 and older.
cCoverage applies to FDA-authorized vaccines administered by the United States in 2021.
dUPMC Health Plan will cover these services with no member cost share for fully insured plans until Aug. 31, 2021, so long as permitted under the current State and Federal emergency declarations. Traditional ASO groups may opt out of these enhancements.
eUPMC Health Plan will cover these services with no member cost share for fully insured plans until Jan. 20, 2022, so long as permitted under the current State and Federal emergency declarations and associated guidance. Traditional ASO groups may opt out of these enhancements.
fUPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II, P.C. (OCN), subject to availability. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.
gFor more information on monoclonal antibody treatments, visit UPMC.com/AntibodyTreatment or call 1-866-804-5251.
hProviders are responsible for indicating which patient conditions are attributable to an adverse vaccine reaction. Standard network, authorization, and other coverage rules will still apply. Our self-insured or ASO employer groups can opt out of this coverage. Coverage for out-of-network providers and facilities will follow standard rules under a member’s benefit plan, which may include higher cost-sharing or non-coverage of non-emergency services. This coverage is effective through Jan. 20, 2022, so long as permitted under the current state and federal emergency declarations and associated guidance.
iOur self-insured or ASO employer groups can opt out of this coverage. Coverage for out-of-network providers and facilities will follow standard rules under a member’s benefit plan, which may include higher cost-sharing or non-coverage.