The Department of Employee Trust Funds is working with state health officials and health plans participating in the State of Wisconsin Group Health Insurance Program to ensure you receive the care you and/or your covered dependents need during the COVID-19 outbreak.
We will provide updates on group health insurance benefits and coverage related to the COVID-19 outbreak as the situation continues to develop.
Below you will find answers to commonly asked questions about your health benefits in relation to COVID-19.
- International Coverage
- Well Wisconsin Health Screenings
If you and/or a covered dependent are showing symptoms of COVID-19, you should contact your health care provider and/or use telehealth to discuss your symptoms. According to the Centers for Disease Control and Prevention, symptoms typically appear 2-14 days after exposure and include fever, cough, and shortness of breath.
On March 18, 2020, President Trump signed the Families First Coronavirus Response Act. This bill requires all group health insurance plans to cover testing and any services or supplies provided as part of a testing visit at no cost to patients.
Members with an It's Your Choice (IYC) High Deductible Health Plan can also receive testing at no cost, following guidance provided by the IRS.
- As of March 11, 2020, doctors are no longer required to receive public health department approval before submitting test requests for COVID-19.
- Testing may be prioritized by laboratories for people who are considered high-risk.
If you and/or a covered dependent are diagnosed with COVID-19, follow your provider’s instructions following diagnosis. Most people isolate at home during their illness and limit contact with others. The current treatment protocol for COVID-19 is the same as the flu, including rest and fluids.
If you and/or a covered dependent require hospitalization because of COVID-19, treatment will be covered the same as it would for any other hospitalization.
Active Employees, COBRA Continuants, and Retirees without Medicare
State of Wisconsin Group Health Insurance Program plan designs for active employees, COBRA continuants, and retirees without Medicare only offer emergency coverage outside of the United States. Emergency coverage is generally limited to services for an immediate and life-threatening condition or illness.
- Health plans may determine on a case-by-case basis if care you receive out of the country is medically necessary and therefore covered by the plan. This includes emergency medical transport or medical evacuation.
- You must notify your health plan as soon as possible if you and/or a covered dependent receive care out of the country.
- Members who receive care out of the country will likely have to pay for services up-front and send paper claims to the health plan for reimbursement.
- The paper claim must include an itemized bill from the international service provider. The bill must be in English and indicate the appropriate currency exchange rate on the bill.
Retirees with Medicare
Coverage outside of the United States varies between the It’s Your Choice (IYC) Medicare plan designs:
- IYC Health Plan Medicare and IYC Medicare Advantage – See section above (same emergency-only coverage as active employees and retirees without Medicare).
- IYC Medicare Plus – Covers health services received outside the United States that are medically necessary.
- WEA Trust may determine on a case-by-case basis if medical transport or medical evacuation out of the country is medically necessary and therefore covered by the plan.
The public health emergency declaration has the following impacts on the pharmacy benefit:
- Removes the “refill too soon” (RTS) edits. Members will now be able to get medication refills sooner than they normally would.
- The RTS edits are also lifted for Schedule II controlled substances such as opioids. However, they will be monitored closely for fraud and abuse.
- Other claims processing edits will still apply. These include quantity limits, as well as prior authorization and step-therapy requirements.
- Allows for the maximum extended day supply (90 days) of a medication at the time of refill.
Members are encouraged to have at least a 30-day supply of prescription medications and frequently used health supplies, like allergy medications.
- Talk with your provider or pharmacist about getting a 90-day supply of your medications at your refill.
- You may also consider utilizing ServeYou Rx, the mail-order pharmacy available through Navitus, the State of Wisconsin Group Health Insurance Program pharmacy benefit manager, to have a 90-day supply delivered to your home. 90-day prescriptions filled through ServeYou are only subject to two copays instead of the usual three.
Navitus is monitoring for current and any future nationwide drug shortages and pharmacy supply chain issues due to COVID-19. They will work with members and pharmacies to make sure needed medications are available for members.
Most health plans offer telehealth services to diagnose and treat common illnesses or conditions. Telehealth is ideal if you have a common illness and wish to limit your interaction with others during the COVID-19 outbreak.
Not only is telehealth fast and affordable, it’s available to most members without any out of pocket costs. For more information, see Telehealth Options.
Many health plans also offer a 24-hour Nurseline. A Nurseline may be useful to determine what type of care is most appropriate for your symptoms. For more information, see Health Plan Contact Information.
All onsite health screenings scheduled between March 17 and May 11 are in the process of being canceled. StayWell is available to both employers and members for assistance.
You can learn more about COVID-19 from the Centers for Disease Control and Prevention, World Health Organization, or Wisconsin Department of Health Services. You may also receive information about COVID-19 from your health plan.
ETF will provide updates on group health insurance benefits and coverage related to the COVID-19 outbreak as the situation continues to develop.