​​COVID-19 (Coronavirus): Telemedicine services for AmeriHealth Pennsylvania members

March 30, 2021

This article was revised on March 30, 2021 to update the effective date range. To learn about the AmeriHealth New Jersey position, please read this article.

For more information about telemedicine services, please refer to Medical Policy #00.10.41h: Telemedicine Services (AmeriHealth Pennsylvania). It was posted as a Notification on December 31, 2020, and will go into effect July 1, 2021.

​​​​Expansion of telemedicine coverage​​

To encourage social distancing and increase access to care, AmeriHealth continues to expand its telemedicine services to our members. This chart provides details of the expanded coverage.

Fully insured groups and individual members Self-funded groups and members

Coverage timeline

Effective March 6, 2020, through June 30, 2021.*

Effective March 6, 2020, through June 30, 2021.*

Primary care provider (PCP) visits

  • As of January 1, 2021, member cost-sharing (i.e., copayment, deductible, and coinsurance) will be waived for COVID-19 related telemedicine PCP visits only.*

  • For high-deductible health plan (HDHP) members, cost-sharing will be waived for COVID-19 testing and PCP COVID-19 related telemedicine visits, which will be covered even if deductible has not been met.

  • Cost-sharing will be waived for all telemedicine visits for all PCP, specialist, and behavioral health visits related to COVID-19 beginning January 1, 2021.

  • Cost-sharing will be reinstated for all non-COVID related telemedicine visits with a network PCP beginning January 1, 2021, unless the group chooses to waive it.

Specialist visits

  • Cost-sharing will be waived for telehealth visits related to COVID-19 for specialist visits; nutrition counseling; urgent care; video-only visits for physical and occupational therapy; and audio or video for speech therapy.

  • Telehealth visits with specialists that are not related to COVID-19 are subject to the appropriate member cost-sharing.

  • Cost-sharing will be waived for telehealth visits related to COVID-19 for specialists; nutrition counseling; urgent care; video-only visits for physical and occupational therapy; and audio or video for speech therapy.

  • Telehealth visits with specialists that are not related to COVID-19 are subject to the appropriate member cost-sharing.

Behavioral health visits

  • Based on the member’s benefit plan, cost-sharing will be waived for all in-network and out-of-area telemedicine visits related to COVID-19 with behavioral health specialists.

  • Behavioral health telehealth visits that are not related to COVID-19 are subject to the appropriate member cost-sharing.

  • Based on benefit design, cost-sharing will be waived for all in-network and out-of-area telemedicine visits related to COVID-19 with behavioral health specialists.

  • Behavioral health telehealth visits that are not related to COVID-19 are subject to the appropriate member cost-sharing.

MDLive® visits

  • Cost-sharing for all MDLive telemedicine visits continue to be waived until 2021 renewal date for small and large fully insured group commercial members. Upon renewal, MDLive services and cost-sharing will vary based on the member's benefits plan. For standard plans, cost-sharing will remain at $0 post renewal. Large groups with custom plan designs will re-instate cost-sharing post renewal.

  • As of January 1, 2021, individual consumer plan members will have $0 cost-share based on their 2021 filed plan design.

  • Cost-sharing is waived for all MDLive telemedicine visits related to COVID-19 through June 30, 2021. Customers that have opted to waive cost-sharing on MDLive visits for any diagnosis may choose to continue this waiver through June 30, 2021, or until their 2021 renewal, whichever is first, at which time cost-sharing will be re-instated.

AmeriHealth is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all AmeriHealth members to visit our dedicated COVID-19 webpage for AmeriHealth Pennsylvania regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Learn more

Read more about coverage requirements, billing, reimbursement, and proper coding in the News Article, Telemedicine Services for AmeriHealth Pennsylvania Members (Updated March 19, 2021), which is posted on our Medical and Claim Payment Policy Portal.

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