8/1/2020

No Cost Share for COVID-19 Testing and Treatment Extended Through Dec. 31

The health and safety of our members, providers, employees, agents and employers during the coronavirus pandemic is our number one priority. It’s important for our members to get the care they need at a cost they can afford and to keep you informed of benefit changes as decisions are made.

McLaren Health Plan will continue to provide COVID-19 testing and related treatment with no cost sharing through Dec. 31, 2020.

If you go to an out-of-network provider for treatment, your out-of-network cost share will apply.

Members may have been incorrectly charged a copay after March 31 for COVID-19 related services. Please know we have fixed the error and are reprocessing claims.

We are encouraging members to schedule appointments with their doctor for services missed during the stay-at-home order. Telemedicine or in-person visits are available.

We appreciate your continued partnership with us. Call customer service or your McLaren Health Plan sales executive at 888-327-0671 (TTY: 711) if you have any questions.

TEMPORARY LAYOFFS/CLOSINGS/COBRA-click to expand  

How long can employees remain covered with McLaren Health Plan if an employer needs to close their business temporarily due to a virus outbreak or needs to temporarily layoff or furlough employees, but they want to keep their benefits?

McLaren Health Plan will temporarily continue to provide coverage if a business closes, temporarily lays off employees, or cuts hours for employees due to the COVID-19 outbreak. At this time, coverage may continue through Dec. 31, 2020*. It is the employer’s decision whether to continue to offer benefits – not McLaren Health Plan’s. Employers must continue to pay premiums according to current payment policy to maintain coverage.

*Contact your McLaren Health Plan sales executive if your business continues to experience layoffs and/or furloughs. We will evaluate your situation and determine if you are eligible for continued coverage and for how long on a case-by-case basis. Dates are subject to change.

Will McLaren Health Plan require employers to immediately move laid off employees to COBRA?

If an employer opts to provide coverage for employees on temporary layoff, the employer will not be required to move the employees to COBRA. At this time, coverage may continue through Dec. 31, 2020. It is the employer’s decision whether to continue to offer benefits – not McLaren Health Plan’s. Employers must continue to pay premiums according to current payment policy to maintain coverage. COBRA will apply upon loss of coverage.


Will McLaren Health Plan have a set time period for which employees who are laid off can remain on an active policy vs. being moved to COBRA?

The employer determines eligibility. If the employer chooses to provide coverage and continues to pay premiums according to current payment policy, the employees will be covered through Dec. 31, 2020.


Will McLaren Health Plan waive underwriting requirements to allow employers to pay for benefits while employees are receiving unemployment benefits? 

Yes. McLaren Health Plan will waive underwriting requirements through Dec. 31, 2020. We will continue to monitor the situation and adjust accordingly as needed.


Will McLaren Health Plan waive waiting periods for workers returning to work after furlough or layoff as a result of the COVID-19 pandemic?

Yes. McLaren Health Plan will waive the waiting period to reinstate employees if the employer did not elect to continue coverage during layoff or furlough.

If an employer is unable to make eligibility changes, i.e., add or remove employees and/or dependents due to qualifying life events within the 30 days required due to COVID-19, what can they do?

McLaren Health Plan will work with employer groups to allow changes past the 30-day timeframe through Dec. 31, 2020 for fully funded employers.

Is there a requirement to alter any group provisions/policies if it is a result of the COVID-19 emergency mandates?

No. At this time we will not require any changes to plan documents or policies due to the declared state of emergency. McLaren Health Plan will continue to assess as new information becomes available.

PREMIUM INFORMATION-click to expand  

Will McLaren Health Plan provide any grace period for premium payment for individuals or employer groups?

McLaren Health Plan is committed to supporting our groups and members. Premium is prepaid and we have extended our 30-day grace period for fully-insured customers by an additional 15 days, so customers will have 45 days to remit payment. This also applies to individuals insured with McLaren Health Plan off the Exchange. On-Exchange individuals will follow the normal process.

Will McLaren Health Plan permit any leniency related to premium payments if small businesses are forced to close part of their business due to the Governor’s orders?

McLaren Health Plan is committed to supporting our groups and members. Premium is prepaid and we have extended our 30-day grace period for customers by an additional 15 days, so customers will have 45 days to remit payment. This also applies to individuals insured with McLaren Health Plan off the Exchange. On-Exchange individuals will follow the normal process.

COVERAGE QUESTIONS-click to expand  

Will McLaren Health Plan waive copays, deductibles and coinsurance during the COVID-19 pandemic?

Yes. McLaren Health Plan will waive copays, deductibles and coinsurance for diagnoses related to COVID-19 for all lines of business through Dec. 31, 2020.* This may not apply to self-funded or high-deductible health plans.

*Or earlier, if businesses resume normal operations.

Will McLaren Health Plan cover virtual visits if a provider office is only doing online visits?

A telemedicine visit is a visit that can be done over the phone with a doctor. This is a good way to help prevent the spread of infections like COVID-19. COVID-19 testing related services received through telemedicine are a covered benefit for McLaren Health Plan members with no cost-sharing. The doctor will determine if the member needs the COVID-19 test and will tell the member what to do next.

Telemedicine visits are also covered with your doctor for healthcare needs not related to COVID-19. These visits are subject to your normal office visit cost-share responsibility.

Will McLaren Health Plan waive the online office visit copay through Virtuwell for someone who uses it for symptoms of the coronavirus? 

McLaren Health Plan’s online office visit option, www.virtuwell.com allows members to have a virtual office visit with a board-certified nurse practitioner. The office visit copay will be waived through Dec. 31, 2020* for services related to COVID-19.

*Or earlier, if businesses resume normal operations.

How will McLaren Health Plan cover testing for COVID-19?

McLaren Health Plan will cover the cost of medically necessary COVID-19 tests for all members with no member cost-sharing for both in-network and out-of-network providers, including those with high deductible health plans through Dec. 31, 2020.* The most recent IRS guidelines allow for this coverage. https://www.irs.gov/newsroom/irs-guidance  

For all members, McLaren Health Plan will cover the two codes released by the Centers for Medicare & Medicaid Services (CMS), U0001 and U0002 and 87635, for laboratory testing. We will cover these two codes at 100% of allowed charges with no member cost sharing through Dec. 31, 2020.* McLaren Health Plan will also waive the costs of items and services related to the furnishing or administration of the testing provided to an individual during a health care provider office visit, urgent care center, an emergency room visit, or through a telehealth visit through Dec. 31, 2020.*

*Or earlier, if businesses resume normal operations

How will McLaren Health Plan cover treatment of medically necessary services related to coronavirus or COVID-19?

McLaren Health Plan will waive all cost-sharing for treatment or medically necessary services related to coronavirus or COVID-19 through Dec. 31, 2020.*

*Or earlier, if businesses resume normal operations.

How will McLaren Health Plan cover treatment for COVID-19 at an out-of- network provider?

If a member goes to an out-of-network provider for treatment of COVID-19, out-of-network cost share will apply. 

Is McLaren Health Plan waiving other pre-authorizations related to COVID-19?

Yes. McLaren Health Plan is removing the requirement for prior authorizations for services related to COVID-19.

Is there a provision for early prescription refills during this time?

McLaren Health Plan will continue to allow early refills of all 30-day or 60-day covered prescription medications to allow for up to a 90-day supply for all lines of business for all medications (except for controlled substances and specialty medications) through Dec. 31, 2020.

*Or earlier, if businesses resume normal operations.