Throughout the COVID-19 pandemic, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (AmeriHealth) have remained committed to helping members access the care they need.
Now that the Public Health Emergency (PHE) is set to end on May 11, 2023, AmeriHealth will be updating the following policies:
- Timely filing of claims: Effective July 11, 2023, AmeriHealth will no longer waive the timely filing requirements. Claims incurred on or after July 11, 2023 must be submitted within 365 days.
- COVID-19 testing: Effective May 12, 2023, standard cost-sharing will be applied, in accordance with an AmeriHealth member's benefits, for FDA-authorized COVID-19 tests, including diagnostic tests (RT-PCR and Antigen tests). When medically necessary, testing will continue to be covered when prescribed by health care providers for individuals who have signs and symptoms of COVID-19 and/or who may have been exposed to the COVID-19 virus.
- Any COVID-19 testing done for screening or public health surveillance purposes, or tests without FDA authorization, will continue to be excluded from coverage. AmeriHealth will no longer reimburse for nonprescription, over-the-counter (OTC) COVID-19 tests. If an AmeriHealth member has a Health Savings Account (HSA) or a Flexible Spending Account (FSA), they can submit for reimbursement through those programs. Testing should continue to be conducted when medically necessary.
- COVID-19 vaccination: The administration of the COVID-19 vaccine will continue to be covered at no cost to AmeriHealth members when obtained from an in-network provider. If the vaccine is administered by an out-of-network provider, standard cost-sharing will apply. Members should check their benefits to confirm whether they have out-of-network coverage.
- At the present time, the COVID-19 vaccine product will continue to be provided by the Federal government. Once the Federal government supply ends, AmeriHealth will cover the cost of the COVID-19 vaccine product as it is considered preventative.
- COVID-19 treatments: Effective May 12, 2023, AmeriHealth will no longer waive cost-sharing for drugs/biologics for the treatment of COVID-19.
- Telemedicine visits: Effective May 12, 2023, standard telemedicine cost-sharing will apply for all telemedicine visits with an AmeriHealth member's primary care provider (PCP) and specialists. Standard telemedicine cost-sharing will also apply for all virtual visits with a behavioral health provider. AmeriHealth will no longer waive cost-sharing for a COVID-19 diagnosis for members residing in Pennsylvania.
Providers should communicate these COVID-19 coverage updates to their office staff and patients. We will follow up this article with additional communications that include links to these updated policies.
For more information on COVID-19, visit the COVID-19 resources page on the AmeriHealth Provider News Center.