In response to the COVID-19 pandemic, HMSA expanded some health care benefits and medical policies to help ensure that our members have access to care during a critical time. Expanded COVID-19 benefits applied to all of HMSA’s fully insured commercial plans (including group, individual, and student plans), EUTF, HMSA Federal Plan 87, Medicare Advantage, and QUEST members. HMSA also worked with self-funded customers who wanted to implement a similar approach.

These benefits were effective March 1, 2020.

• Tests and testing-related services for COVID-19: HMSA is waiving the cost share for diagnostic lab tests and testing-related services that are consistent with CDC guidance related to COVID-19 for HMSA’s commercial, HMSA Federal Plan 87, EUTF, and Medicare Advantage plan members. This applies to COVID-19 testing and the related provider visit and is effective through May 11, 2023.

  COVID-19 diagnostic tests are covered if they’re related to clearance for surgery or other medical procedures (i.e., colonoscopy), when you have symptoms of COVID-19 or have been exposed to COVID-19. Starting May 12, 2023, regular cost shares and deductibles will apply.

  QUEST members will continue to have no copayment as part of their health plan benefits for COVID-19 services.

  HMSA does not cover diagnostic testing for COVID-19 for travel purposes, such as to avoid quarantines associated with business or leisure travel. COVID-19 testing for surveillance or employment purposes are also not covered.

• Over-the-counter at-home COVID-19 tests: From Jan. 15, 2022, through May 11, 2023, HMSA will cover the cost for FDA-approved over-the-counter COVID-19 diagnostic test kits for HMSA commercial plan members Learn more about over-the-counter at-home COVID-19 tests¹.
• Antibody testing: Following guidance issued by the U.S. Centers for Disease Control and Prevention², HMSA will cover antibody tests only if one of the following conditions is met to support the diagnosis of COVID-19 illness or complications of COVID-19 in the following situations:
  • A positive antibody test at least seven days following acute illness onset in persons who had a previous negative antibody test (e.g., seroconversion) but did not receive a positive viral test might indicate SARS-CoV-2 infection between the dates of the negative and positive antibody tests.
  • A positive antibody test can help support a diagnosis when patients develop complications of COVID-19, such as multisystem inflammatory syndrome or “long COVID.”

  Starting May 12, 2023, regular cost shares and deductibles will apply.

  HMSA will not cover antibody testing if the test is being used to indicate immunity to COVID-19. HMSA fully supports clinical advancements that improve the diagnosis, treatment, and prevention of COVID-19. However, antibody testing is not currently recognized by the CDC as a valid diagnostic test for COVID-19 (except in the situations listed above) or a reliable test to demonstrate immunity.

  Visit the CDC website² for more information.

• Preoperative COVID-19 testing: HMSA is providing coverage for COVID-19 diagnostic tests with no cost share for patients with no COVID-19 symptoms who will undergo surgery and other procedures through May 11, 2023. This applies to commercial, Medicare Advantage, HMSA Federal Plan 87, and FEP plans. Starting May 12, 2023, regular cost shares and deductibles will apply. For EUTF members, regular cost shares and deductibles will apply starting June 1, 2023.

  QUEST members will continue to have no copayment as part of their health plan benefits for COVID-19 services.

• Treatment for COVID-19: If a diagnostic test confirmed that a member has COVID-19, HMSA waived the cost share for all medically necessary treatment and services administered at a doctor’s office, urgent care facility, and emergency room, as well as inpatient hospital stays.

  This cost-share waiver applied to fully insured commercial plan members for dates of service from March 1, 2020, through Dec. 31, 2022, when rendered by a participating provider or Hawaii-based nonparticipating provider.

  As of Jan. 1, 2023, regular cost shares and deductibles apply for treatment of COVID-19, including hospital and office visits, for fully insured commercial members and some self-insured plans, except as otherwise required by law.

  Medicare Advantage members will continue to have no copayment for those treatments where the law so requires, which includes COVID-19 monoclonal antibodies treatment through Dec. 31, 2023, or COVID-19 oral antivirals until it becomes commercially available.

  QUEST members will continue to have no copayment as part of their health plan benefits for COVID-19 services.

• Telehealth: Regular cost share and deductibles apply for telehealth visits for fully insured commercial members and some self-insured plans. Medicare Advantage and QUEST members will continue to have no copayment as part of their 2023 plan benefits for all telehealth visits, including e-visits.
  • Audio-only (phone) visits: Audio-only (phone) visits will be temporarily covered for commercial plan members, EUTF, HMSA Federal Plan 87, and some self-insured plan members through May 11, 2023. HMSA will continue to cover audio-only visits for certain mental health conditions until Dec. 31, 2023. For Medicare Advantage members, phone visits are temporarily covered for some services through Dec. 31, 2024.
    
    

    Continued coverage of phone visits for QUEST members is pending guidance from the Med-QUEST Division. We will update this guidance when available.

    Check with your doctor about what telehealth and audio-only options are available for you.

    View a list of FAQs about our expanded telehealth benefits.³
• Teledentistry: For members with an HMSA dental plan, emergency teledentistry visits will be covered 100% for visits with a participating dentist. Emergency teledentistry is not a benefit for HMSA Medicare Advantage plans in 2023. Starting Jan. 1, 2021, teledentistry became a benefit for all fully insured HMSA commercial plan members and individual plan members who have an HMSA dental plan. There are no copayments, coinsurances, or deductibles for this service when seeing a participating dentist. View a list of FAQs about our expanded teledentistry benefits [PDF]⁴.

Out-of-network providers: Depending on your plan benefits, HMSA may also cover services from nonparticipating providers. However, it’s important to remember that HMSA does not contract with providers outside of our network, so members may be responsible for paying the difference between HMSA’s rate for the service and what a nonparticipating provider charges for that service. For help finding a participating provider, use HMSA’s Find a doctor tool.⁵