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Health Net Broker Alerts

Special Enrollment Period for Individual and Family Plans

Now through 6/30/20

Due to the COVID-19 virus, a Special Enrollment Period has been created and is open now through June 30 for those who need 2020 health care coverage. Proof of this qualifying event is not needed.

Consumers must:

  • Enroll by the last day of the month in order to start coverage on the first day of the following month.
  • Pay their first premium payment to begin coverage.

Updated 4/24/20 – The following sections were added and/or updated with additional guidance and information:

  • Benefits, Eligibility and Products – 1 new Q&A
  • COVID-19 Testing/Screening Cost-Shares and Prior-Authorizations – 1 new Q&A
  • General Questions – 1 new Q&A
  • Grace Periods and Billing – 1 new Q&A
  • Pharmacy and Prescriptions – Refills and Emergency Supply – 15 new Q&As
  • Telehealth – 2 new Q&As

What is Health Net doing to reach vulnerable populations to ensure these individuals continue to receive needed health care services, while practicing appropriate social distancing?

Health Net is waiving all COVID-19 related prior authorizations and member cost sharing for screenings, tests and treatment. This specifically applies to all Commercial employer group business and Individual and Family Plan members. In addition, Health Net covers all telehealth services that are associated with COVID-19 for its members, as well as all covered healthcare services that can be administered virtually during the COVID-19 crisis.

Also, Health Net assembled a COVID-19 taskforce to identify, and is reaching out to members who are at high risk for COVID-19. The purpose of the outreach is to connect with identified high-risk members and confirm they have access to the support and services they need. The taskforce began making outbound calls to this membership at the beginning of April.

In addition to the above, our parent company, Centene Corporation is:

  • Facilitating the sourcing, ordering, and shipping of personal protective equipment (PPEs) to our provider partners that enable them to meet the urgent needs of patients. Centene is already in the process of expediting the distribution of approximately 2 million pieces of PPE including safety goggles, facemasks, hand sanitizers and disaster kits, and will continue these efforts in coming weeks.
  • Partnering with our providers to deploy resources to service areas that have been most impacted by newly created quarantine and isolation centers.
  • Providing data and support that enable providers to reallocate resources based upon utilization changes caused by the COVID-19 pandemic.
  • Working to ensure that our community Safety Net providers and organizations have long-term sustainability beyond the immediate crisis.
  • Providing assistance in securing small business loans to specifically help behavioral health providers and community-based behavioral health organizations, long-term service support organizations and other Safety Net providers gain access to government-sponsored small business loans, and telehealth technology.

Added 4/24/20

What happens if my client’s income changes?

Members should report their income changes to Covered California so their eligibility for increased subsidies or new eligibility for subsidies can be determined. This can potentially help reduce their payment responsibility going forward. Off-exchange members are permitted to enroll into a Covered California plan if they become eligible for subsidies.

In some cases, members can qualify for Medi-Cal, which offers low-cost or free health coverage to eligible Californian residents with limited income.

Does the Special Enrollment Period also apply to Grandfathered SBG plans?

Yes. The COVID-19 special enrollment period applies to groups with grandfathered plans and does not impact the grandfathered plan's status.

When employees are rehired, will Deductibles and Out-Of-Pocket Max (OOPM) accruals start over?

So long as the employee remains on the same plan with the same member ID, the deductible and OOPM will pick up where it left off when the employee re-enrolls later in the year.

Can Individual and Family Plan members use the COVID-19 Special Enrollment Period (SEP) to change plans?

The new COVID-19 SEP is created for the uninsured to easily get coverage. Plan changes are not allowed on Off-Exchange plans. Covered California offers an SEP for those whose income changed and are now eligible for APTC. Members can use the income change SEP to switch from an Off-Exchange plan to a Covered California exchange plan. Deductibles and Out-of-Pocket Max accumulator will carry over to the new plan provided that it’s within the same legal entity (Health Net of California or Health Net Life Insurance). For example, HMO to HMO, HSP to HMO, EPO to EC PPO, PPO to PPO, or PPO to EC PPO.

Will Covered California offer an extension for enrollments in the Individual marketplace or offer retroactive enrollment coverage back to the true date of Qualifying Event?

The COVID-19 Special Enrollment Period allows consumers to apply for health care coverage up to the last day of the month and to be effective the following month. For example, consumers can apply by 4/30/2020 to be effective 5/1/2020. Retroactive enrollments are not being allowed.

Will employers be able to continue benefits if the entire workforce is laid off?

Standard Policy COBRA and state continuation protocols apply if one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.

Can health benefits be extended through the end of the month if a significant portion, or all, of an employer's workforce is laid off?

If premiums have been remitted for the month the employee is laid off, coverage will continue through the end of that same month.

For employees that enroll in an Individual & Family plan, how quickly will their coverage be effective?

Covered California is offering a Special Enrollment Period (SEP) through June 30, 2020, to help uninsured consumers get 2020 health care coverage. Health Net will allow this SEP for Individual & Family Plans available through both Covered California as well as enrollment on our off-exchange plans. Effective dates of coverage are:

Enroll by Effective date
April 30 May 1, 2020
May 31 June 1, 2020
June 30 July 1, 2020

Questions about IFP coverage should be directed to Health Net Direct Sales at 1-877-878-7983. Our representatives will assist your clients to determine their eligibility for subsidies, as well as provide information for IFP plans through Covered California, off-exchange IFP plans, and Medi-Cal.

If employees enroll in a short-term plan, how quickly will their coverage be effective?

Health Net does not offer short term coverage.

Can employers open up a Special Open Enrollment period to employees who waived health coverage?

Health Net will allow a special COVID-19 enrollment period for both large group and small group clients for employees who previously did not elect health benefit coverage for themselves, spouses or children. From April 1 to April 20, 2020, employers may hold a special enrollment for employees, spouses or children who waived coverage, with an effective date of April 1, 2020, provided they remit full premium for the month of special enrollment.

Can an employer reduce their current minimum hours threshold down to 20 hours off-anniversary?

Through May 31, 2020, Health Net is temporarily relaxing its requirement that employees be actively working to be eligible for coverage and will allow employers to cover their reduced-hour employees, as long as employers pay the monthly premium. Employers must offer this coverage on a uniform, non-discriminatory basis.

Will eligibility be closely monitored? If a client's workforce goes to less than 30 hours a week or below the hourly requirement, will flexibility be allowed?

Through May 31, 2020, Health Net is temporarily relaxing its requirement that employees be actively working to be eligible for coverage and will allow employers to cover their reduced-hour employees, as long as employers pay the monthly premium. Employers must offer this coverage on a uniform, non-discriminatory basis.

If an employee took a sabbatical or temporary leave of absence, can they keep their benefits intact for a few months without being paid a salary?

Through May 31, 2020, Health Net is temporarily relaxing its requirement that employees be actively working to be eligible for coverage and will allow employers to cover their reduced-hour employees, as long as employers pay the monthly premium. Employers must offer this coverage on a uniform, non-discriminatory basis.

If an employee is on furlough, and unable to pay their premium, and returns to work, will they be subject to the employer group's waiting period? How quickly will the employee be able to obtain coverage without a waiting period?

Health Net will waive the normal waiting period for rehired employees. Employees rehired by May 31, 2020 will not be subject to a waiting period.

What Benefit Enhancements has Health Net implemented for California Small Group Fully Insured Members related to COVID-19 services?

COVID-19 Testing and Screening:
Health Net covers screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Pharmacy:
To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.

Mental Health Resources:
Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.

Telehealth:
To limit members' risk of COVID-19 infection, Health Net encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for all services. During this state of emergency, member cost share is waived for telehealth services.

Is Health Net waiving cost-share requirements for COVID-19 related treatments?

Effective immediately, Health Net will waive member cost sharing for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members.

Is Health Net waiving prior authorizations for COVID-19 related treatments?

Effective immediately, Health Net and its delegated entities will waive prior authorizations for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members. Inpatient admission notification is still required as soon as possible to Health Net and the member's assigned delegated participating physician group (PPG) or IPA, if available.

CARES Act - H.R. 748

Sweeping legislation to respond to the COVID-19 pandemic was cleared by Congress and signed into law by President Trump on March 27, 2020. The Coronavirus Aid, Relief, and Economic Security Act ("the CARES Act" or "the Act") authorizes more than $2 trillion to battle COVID-19 and its economic effects, including immediate cash relief for individual citizens, loan programs for small business, support for hospitals and other medical providers, and various types of economic relief for impacted businesses and industries.

CARES Act summary and analysis (PDF)

Health Net Presents - Employer Hot Topics in Response to COVID-19 and Related Legislation (webinar)

Will there be any delays on processing claims?

Health Net intends to provide the same level of service and claim processing support as it does during normal circumstances.

Will Health Net be able to offer coverage options to employees that have been laid off and lose their work-based insurance? Will employers be able to offer continuation coverage to their employees at their own expense?

Standard Policy COBRA and state continuation protocols apply provided that one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.

Covered California is offering a Special Enrollment Period (SEP) through June 30, 2020, to help uninsured consumers get 2020 health care coverage. Health Net will allow this SEP for Individual & Family Plans available through both Covered California as well as enrollment on our off-exchange plans. Effective dates of coverage are:

Enroll by Effective date
April 30 May 1, 2020
May 31 June 1, 2020
June 30 July 1, 2020

If your clients are interested in IFP coverage, please instruct them to call Health Net Direct Sales at 1-877-878-7983. Our representatives will assist your clients to determine their eligibility for subsidies, as well as provide information for IFP plans through Covered California, off-exchange IFP plans, and Medi-Cal.

Testing can be ordered only by physicians or other authorized health care providers. Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.

Added 4/24/20

Who should members contact to be screened and tested for COVID-19 and where can members be tested?

For guidance on COVID-19 testing and screening, call your physician or other authorized health care provider. Health Net members can also access telehealth services through Teladoc.

If your physician or other health care provider determines that you meet COVID-19 testing criteria, your physician will direct you on where to obtain the test.  Is Health Net waiving cost-share requirements for screening and testing?

All member cost-share requirements (copayment, coinsurance and/or deductible amounts) related to the screening and testing for COVID-19 will be waived across all products.

Health Net covers screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law and Health Net's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Is Health Net requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Will there be a change in our contacts? Or contact phone numbers (cell phones)?

There will be no change in our contacts. Health Net has made all necessary arrangements for its employees to assure uninterrupted service.

How is Health Net addressing potential technical issues?

We have thorough Business Continuity Plans in place for our IT systems, Call Centers and other operations. Health Net and Centene offices remain open, with essential personnel in place. We have implemented appropriate technology, and work from home capabilities for the majority of our employees under HIPAA/PHI/PII compliance guidelines. There are no changes to business hours.

Will there be a change in Health Net's escalation process?

Our escalation process remains sound and there are no changes planned for our escalation process.

Added 4/24/20

How can employers access previous Health Net invoices to get information for a Paycheck Protection Program (PPP) loan?

Employers and brokers with delegated access are able to obtain this information through the self-service option on the employer portal (available for active groups) or by calling their Account Manager.

What if a Health Net member requires proof of insurance to re-enter the country?

Members may download proof of coverage or their ID card from our website. We encourage all members to register on our website and update their current contact information, including email and cell phone number.

If an employer is indefinitely closing their offices due to COVID-19 guidelines, how does this affect open enrollment?

Health Net will suspend all face-to-face open enrollment meetings until further notice, and will offer online/virtual open enrollment meetings.

Added 4/24/20

What is the payment grace period for Individual and Family Plans?

Members who receive Advanced Premium Tax Credits (ATPC), also referred to as subsidies, have a 90-day grace period. Members who do not receive APTC have a 30-day grace period.

Members should report their income changes to Covered California so their eligibility for increased subsidies or new eligibility for subsidies can be determined. This can potentially help reduce their payment responsibility going forward. Off-exchange members are permitted to enroll into a Covered California plan if they become eligible for subsidies.

How is Health Net handling late or partial premium payments from employer groups? Will there be extensions?

There will be no change to our 30-day grace period policy for employer groups. Health Net requires full payment of premium for employees covered.

If an employer lays off the bulk of their workforce, and are experiencing cash flow issues, can they remit payment for the "true" amount of their bill for the upcoming benefit month, to allow for 1-2 billing cycles to be trued up?

Yes, employers may choose to adjust their premium remittance for current terminations as long as they:

  1. do not terminate employees retroactive to the current invoice remittance, and
  2. clearly identify on their remittance, the employees who will remain active on their payroll, so we can appropriately and timely process any terminations.
  3. Remit the "true" amount which is Current Due total less terminated employees

Employers should submit their remittance with appropriate updates to the "Current Membership" and "Membership Changes" sections of their Group bill. Members on the current invoice have coverage until the end of the invoice month.

How will Voluntary premiums be impacted?

Current requirements continue to apply to voluntary premium/products.

What is Health Net doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans Health Net has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Health Net regularly reviews and updates its emergency business continuity protocols.

As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations.

How is mental health covered as related and unrelated, to COVID-19? If done through telemedicine, is it at a $0 copay?

During this state of emergency, Health Net will waive member cost share for all telehealth services (including behavioral telehealth services), whether COVID-19 related or not. Behavioral health services provided in person will be covered in accordance with the member's plan benefits, and applicable cost sharing will be applied.

Is coping assistance offered to members impacted by COVID-19?

Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.

Where can I obtain the latest information and guidance on COVID-19?

For more information about COVID-19 and the latest guidance from public health officials visit any of these websites:

Added 4/24/20

What is Health Net doing to address possible drug shortages related to coronavirus?

First, we are closely monitoring the spread of the coronavirus to prepare for any impact. We are also actively monitoring for news of any drug shortages. Second, if needed, we may send prescriptions from another one of our pharmacy locations. This will help ensure our members have continued access to medications. Finally, we always encourage members to refill maintenance medications in a timely manner.

Added 4/24/20

Are medications safe? Could they be contaminated or at risk? Are medications from China?

The US Food and Drug Administration (FDA) monitors drug safety. It sends alerts in case of any safety or contamination issues. We check all prescriptions for safety and quality, and will let our members know of any safety concerns. Members should continue to take their prescription medications as advised by their doctor.

Added 4/24/20

Is there a drug to prevent Coronavirus?

Not at this time, but our pharmacists are monitoring the new drug pipeline for any medication or vaccine that may become available.

Added 4/24/20

Where can I get credible information?

You can visit these websites that provide the most current information available:

Added 4/24/20

If a state of emergency is issued, will Refill Too Soon on member prescriptions be lifted?

We will work with our members on a case by case basis to ensure they have access to their medications.

Added 4/24/20

How much medication should members have on hand during this crisis?

Members should have at least a one-month supply of the prescription medications they need to manage their medical conditions.

Added 4/24/20

If members don't have a one-month supply can they get more medication before its refill date?

Yes, Health Net has relaxed the refill limits so members can have more of their medications. Members should contact their pharmacy to get an added supply. Also, members should be sure to request a refill several days in advance of when their current supply runs out. This will allow extra time for the pharmacy to prepare it.

Added 4/24/20

Can members get more than one prescription refilled early?

Yes. As a matter of fact it's best for members to arrange for all their prescriptions to either be picked up or delivered all at the same time. If they have more than one prescription, they should try to have them refilled on the same date. Health Net has been working with pharmacies to allow them to fill most prescriptions sooner than normal. This helps when trying to get prescriptions filled that have different refill dates.

Added 4/24/20

What is a good way to limit being exposed to other people at the pharmacy?

Use the pharmacy drive-thru. Many pharmacies now have drive-thru windows. If your pharmacy has one, it may be a good option to use. A drive-thru limits coming in contact with other people picking up their medications.

Members can also wait in the car for their prescription. If their pharmacy doesn’t have a drive-thru and they need to wait for a prescription to be ready, they might want to sit in their car rather than the pharmacy waiting area. By waiting in their car, members reduce the time they are exposed to other people. Some pharmacies will bring medications to the car. Note: Because of COVID-19 many pharmacies are changing the hours they are open. Members should contact their pharmacy to confirm business hours.

Added 4/24/20

My client doesn’t want to go out unless they really need to – is there a way to avoid going to the pharmacy?

Yes, the member should ask the pharmacy if they will deliver medications. During this pandemic, many pharmacies have offered to have medication delivered for free or at a low cost. CVS and Walgreens will deliver for free. Members should make sure to talk to their pharmacist to confirm their prescriptions qualify for delivery and if there is a delivery charge.

Added 4/24/20

Are there other options besides going to the pharmacy?

Yes, members can use their mail-order option. Mail order will fill 30-day medication supplies. Or, members may be able to receive a larger amount – up to a 90-day supply for maintenance medications.

Added 4/24/20

How can my clientchange my prescription from a 30-day supply to a 90-day supply?

If you have a maintenance prescription, ask your pharmacist if you are able to get a 90-day supply. Mail order is also an option for filling a 90-day supply.

Added 4/24/20

My client has never used a mail-order pharmacy. Is this the right time to start? If so, how does it work?

Yes! Using a mail-order pharmacy or getting prescription delivered helps with social distancing. It lowers the risk of being exposed to COVID-19 and can reduce chances of getting sick. Benefits of mail-order pharmacies include:

  1. Simple, fast, and free delivery: Many mail-order pharmacies offer free shipping and can deliver prescriptions usually within five business days.
  2. Time and money saved: Some benefits offer discounts on medications if members get them through a mail-order pharmacy. Members can also save on time and transportation costs since they don’t have to make a trip to a pharmacy.

How it works:

  • Option 1: Members should ask their doctor to send an electronic prescription (eRx) to CVS Caremark Mail Service Pharmacy. It should be for a prescription of up to a 90-day supply of your maintenance medication.
  • Option 2: Members can sign up or sign in at Caremark.com. Select Prescriptions from the navigation bar. From the drop-down menu, select Request a New Prescription. Search for the drug name and strength. Add it to the cart by choosing Request a New Prescription, and complete the order.
  • Option 3: If a member cannot contact their doctor or they are not able to sign up at Caremark.com, CVS Caremark Mail Service Pharmacy can contact their doctor. To start this process, complete the Start Mail Service request form.
  • Option 4: Members can call Caremark mail order at the toll-free number 1-888-624-1139 (TTY 711), 24 hours a day, 7 days a week.

Members can also contact Health Net Customer Service toll-free at 1-800-522-0088 for help. Please allow 14 days for shipment to arrive from mail order.

Added 4/24/20

What if my client's medication comes from a specialty pharmacy?

Specialty pharmacies ship medications straight to a member’s home or office. Members can have their specialty prescription drug shipped most likely within a few days. Members should contact the specialty pharmacy for their refills.

Added 4/24/20

What about medications that need prior approval?

Health Net has extended prior approvals scheduled to end in the next couple of months. This helps to ensure that you will get your medications without delay of getting a new approval. Many doctors are sending requests online from their homes. Health Net has waived the need for a signature to make it easier for doctors.

How do members obtain an emergency supply of a prescription?

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.

On March 19, 2020, the state of California launched a new coronavirus awareness website. According to this website:

  • California is expanding the coronavirus testing capacity daily.
  • Currently, testing is being prioritized for people who have the coronavirus symptoms AND have one of these risk factors:
    • Have had contact with a person who has tested positive for COVID-19, OR
    • Are health care providers or work with vulnerable populations (such as a long term care facility), OR
    • Traveled to an affected country in the past 14 days, OR
    • Are over age 60, have a compromised immune system or have serious chronic medical conditions

Added 4/24/20

What new communications have you issued regarding telehealth?

In addition to posting information on our Member portal, we released Member email campaigns for Teladoc in early April, and planning additional email communications in the coming weeks.

In terms of Provider communications, we are posting to the provider alerts pages. We have also distributed provider recruitment letters for our telehealth services via fax and mail (standard process). Our Provider Relations team is emailing the Provider FAQs to providers as they are updated.

Added 4/24/20

Are interpreter services available for a member on a telehealth call?

Health Net members can access Teladoc as a primary option of telehealth for COVID-19 question. Teladoc offers members to select a Language Preference via the web or mobile app.

Can employer groups add Telehealth immediately, or do they have to wait for the next renewal? What is the PMPM cost? Would Health Net waive the PMPM cost? If Health Net doesn't waive the PMPM cost, is there a way to add Telehealth immediately and add the 2020 cost onto the next renewal instead of changing rates mid-year? Can we add Telehealth to groups that don't have it today for a 60-90 day complimentary period?

For plans that do not currently have a telehealth benefit, these services will be offered in support of members throughout the duration of this state of emergency. The group's rates will not be changed mid-year.

Is Telehealth a covered benefit for Medical and Behavioral Health issues, even if the plan design does not currently include that benefit? If so, then what provider network do members use (Teladoc®, Doctor on Demand, etc.)?

Yes, telehealth is a covered benefit for both medical and behavioral health issues for all plans during this time. Health Net currently uses Teladoc® for telehealth services. However, during this state of emergency, Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

Can Health Net implement AB 744 early (it is supposed to take effect 1/1/21) and apply a $0 copay for medical and behavioral telehealth visits?

During this state of emergency, Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

In accordance with legislative requirements, Health Net will implement CA AB 744 effective January 1, 2021.

Does CDI's telehealth guidance apply to DMHC regulated plans (HMO plans)? And/or is there any other guidance that requires Health Net to cover telehealth for all providers (non-Teladoc)?

Yes, both regulatory bodies have approved Health Net's coverage for telehealth services will be temporarily expanded for all DMHC and CDI regulated plans, in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition) through the duration of this state of emergency.

Will Health Net allow access to telehealth services to increase access to care? And what is the reimbursement rate?

To limit members' risk of COVID-19 infection, Health Net encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for all services.

During the course of this declaration of emergency for Commercial and Medi-Cal members, Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

During the course of this declaration of emergency for Medicare and MMP/Cal MediConnect members, Health Net's coverage for telehealth services will follow guidance released by CMS which includes telecommunications involving both audio and video technology (with the only exception being for "virtual check-ins," which is defined in the CMS fact sheet available in the online link immediately below).
Medicare Telemedicine Health Care Provider Fact Sheet

In addition to telehealth services offered through our network of providers, Health Net is diligently working to offer expanded access to telehealth services through third parties. We will provide updated information on vendor arrangements once available.

Will Health Net allow mid-year plan downgrades (employer and employee) due to financial hardship? If yes, what documentation is required?

Groups have a one-time opportunity to downgrade their existing plans without penalty.

  • The plan downgrade must be within the plan family (for example, HMO to HMO, or PPO to PPO)
  • HMO plan downgrades that include a change in provider network require Underwriting approval (for example, Full-network HMO to WholeCare HMO)
  • Plan upgrades are not available
  • The group's renewal date will not change

Will Health Net allow mid-year employer contribution changes? If yes, what documentation is required?

Health Net will allow contribution changes as long as the minimum contribution requirements are met.

Will Health Net waive the reinstatement fee for groups that experience COVID-19 financial issues?

Health Net will be waiving all reinstatement fees until June 30, 2020.

Is Health Net considering any other options for employees who are not able to provide wet signatures (pen ink signature on paper) on their applications?

In addition to wet signatures, Health Net accepts member enrollment forms with electronic signatures, provided that the forms are submitted to Health Net via the group administrator, contracted broker or third party administrator (TPA). The group, broker or TPA is responsible for ensuring that the information provided to Health Net is accurate and the form was e-signed by the individual applying for coverage.

Will Health Net extend renewal deadlines?

No, renewal deadlines will not be extended. Health Net continues to comply with the 60-day renewal notification requirement for Small group employers, and 120-day renewal requirements for Large group employers.

Will Health Net be flexible on new business submission requirements (proof of business, payroll, etc.)?

Yes, we will provide an extension for new group business through June 30, 2020.

Will an employer group's rates/premium be subject to change if enrollment drops by more than 10% as a result of COVID-19?

Both small group and large group rates will not adjust off-renewal cycle.

If an employer reduces staff to below 100 for either part of or for the entire plan year, how will this affect their renewal?

Health Net will continue to apply Standard Policy rules to determine the coverage applicable to each group. Health Net will continue to comply with Federal and State guidelines on group size and applicable determination.

Regarding marketing for groups that renew between 5/1 and 8/1, will Health Net accept a census that was pre-layoff/reduction of hours?

Health Net will use current policies and will require and use best information available at time of quote.