Coronavirus Disease 2019 (COVID-19) Notification
In response to mandated orders regarding COVID-19, the disease caused by the novel coronavirus, Health Alliance Northwest Health Plan (Health Alliance) has made the following temporary changes to your coverage effective for the time periods noted below, which are based upon the Executive Orders of the Washington Insurance Commissioner and the Governor’s Proclamation. Please note that this notification does not apply to self-funded employer plans or to Medicare Advantage plans.
Effective from March 5 - May 23, 2020:
- Health Alliance will cover a healthcare provider visit and U.S. Food and Drug Administration (FDA) authorized COVID-19 testing if you meet the Centers for Disease Control and Prevention (CDC) criteria for testing, as determined by the your healthcare provider. There will be no cost-share or deductible applied for these services.
- You will be able obtain a one-time refill of your covered prescription medications prior to the expiration of the waiting period between refills. This allows you to maintain an adequate supply of necessary medication. Please note: this change may not apply to specialty drugs or drugs that are considered high-risk for addiction.
- Health Alliance will suspend prior authorization requirements that apply to covered diagnostic testing and treatment of COVID-19.
- If there is an insufficient number or type of providers in your network to provide testing and treatment for COVID-19, Health Alliance will allow you to obtain the covered service from an out-of-network provider or facility within reasonable proximity of you. These services will be of no greater cost to you than if the provider were in-network.
Effective from March 24 – May 23, 2020:
- Health Alliance will consider the use of audio-only telephone as telemedicine.
- Health Alliance will cover diagnostic test panels for influenza A & B, norovirus and other coronaviruses, and respiratory syncytial virus (RSV), when any of this testing is determined medically necessary by your healthcare provider, and when billed in conjunction with a COVID-19 related diagnosis code. There will be no cost-share or deductible applied for these services.
- Health Alliance will cover a drive-through site as an office visit without cost-sharing or deductible when associated with COVID-19 testing, services to assess COVID-19 symptoms and services to obtain biological samples for COVID-19. When testing is performed as part of such a visit, the testing shall be covered so long as such testing is:
- approved by either the FDA or the Washington State Department of Health,
- performed by in-network healthcare providers within their scope of practice, or under the supervision or direction of an in-network healthcare provider within their scope of practice, and
- provided as ordered by your healthcare provider.
- If you’re hospitalized and it’s determined that you’re ready for discharge, and insufficient time exists for long-term care facility or home health services that will follow discharge to receive approval prior to delivery of care, Health Alliance will treat this as an extenuating circumstance. This eliminates the requirement for prior authorization of services.
- Other covered services necessary for discharge to a long-term care facility or home, which are subject to prior authorization, will be treated as expedited prior authorization requests.
- Health Alliance is allowing a grace period for payment of premiums of sixty (60) days.
Please note, Health Alliance will honor the above coverage for dates beyond May 23rd, if mandated by local, state and federal health care regulators.
We are here to help you understand the guidance that public health officials are providing, and to answer all questions about your plan’s coverage during this ongoing situation. Should you have any questions about these changes please contact Health Alliance at (866) 247-3296 or by e-mail at CustomerService@HealthAlliance.org.
This is a rapidly evolving situation, and Health Alliance is working closely with local, state and federal health partners to keep you informed. In order to ensure you have the most current information regarding COVID-19, we encourage you to visit our website here.