This article was revised on October 1, 2021 to update the medical policy information. 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) effective as of July 1, 2021. This policy does not apply to those members enrolled in AmeriHealth New Jersey.
To encourage social distancing and increase access to care, AmeriHealth continues to offer telemedicine services to our members. This chart provides details about cost-sharing.
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Fully insured groups and individual members |
Self-funded groups and members |
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Primary care provider (PCP) visits
| As of January 1, 2021, member cost-sharing (i.e., copayment, deductible, and coinsurance) is only waived for COVID-19 related in-network and out-of-area telemedicine PCP visits.
| As of January 1, 2021, member cost-sharing (i.e., copayment, deductible, and coinsurance) is only waived for COVID-19 related in-network and out-of-area telemedicine PCP visits. As of January 1, 2021, member cost-sharing was reinstated for all non-COVID related telemedicine visits with PCPs, unless the self-funded group chooses to waive it.
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Specialist visits | Cost-sharing waived for all in-network and out-of-area telemedicine visits related to COVID-19 for: specialists; nutrition counseling; speech therapy. Telemedicine visits with specialists that are
not related to a COVID-19 diagnosis are subject to the appropriate member cost-sharing.
| Cost-sharing waived for all in-network and out-of-area telemedicine visits related to COVID-19 for: specialists; nutrition counseling; speech therapy. Telemedicine visits with specialists that are
not related to a COVID-19 diagnosis are subject to the appropriate member cost-sharing.
|
Behavioral health visits | Cost-sharing waived for all in-network and out-of-area telemedicine visits related to COVID-19 diagnosis with a behavioral health specialist.
Telemedicine visits
not related to COVID-19 diagnosis are subject to the appropriate member cost-sharing.
| Cost-sharing waived for all in-network and out-of-area telemedicine visits related to COVID-19 diagnosis with a behavioral health specialist. Telemedicine visits
not related to COVID-19 diagnosis 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 members’ 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 waived for all MDLive telemedicine visits related to COVID-19. Self-funded customers that have opted to waive cost-sharing on MDLive visits for any diagnosis may choose to continue this waiver through October 31, 2021, or until their 2021 renewal, whichever is first, at which time cost-sharing will be reinstated.
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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
For more informtaion, please visit our
Medical and Claim Payment Policy Portal.