Coronavirus

As cases of the COVID-19 (Coronavirus) increase across the U.S., we are actively monitoring the outbreak and putting measures in place to ensure the health and safety of our members and prompt access to diagnostic testing and treatment. 

For more information about the virus, please visit the following websites dedicated to this issue:

• summahealth.org/coronavirus
• Public Health Emergency
• Ohio Department of Health
• Centers for Disease Control and Prevention
• World Health Organization

Summa Health also established a Coronavirus hotline available 24/7 at 234.867.6314.

COVID-19 Scams: Please be Aware

The U.S. Department of Health and Human Services Office of Inspector General (OIG) and The United States Department of Justice (DOJ) have web pages alerting the public about fraud schemes related to the novel coronavirus (COVID-19).

Scammers are offering unapproved and illegitimate services in exchange for personal details and/or money. People are being targeted through telemarketing calls, social media platforms, and even door-to-door visits. Remember never to freely give personal information to suspicious callers, respond to emails/texts asking you to click on unfamiliar links, give information about your pandemic relief funds, etc. Please visit the OIG’s web page, or the DOJ web page for more information on how to protect yourself and report suspected scams.

Notice of Extension of Claims & Appeals

Due to the Public Health Emergency caused by the COVID-19 pandemic, participants and beneficiaries of our self-funded plan (except grandfathered plans) will be provided additional time to file claims and appeals. Issued by the Department of Labor, this 60-day extension begins when the Public Health Emergency expires, which has not yet been released.

Testing and Treatment of COVID-19

Is testing for COVID-19 (Coronavirus) a covered benefit?
Yes. Any co-pays and deductibles related to provider-ordered testing of COVID-19 are waived for our self-insured members regardless of where the test is ordered and performed. 

Can anyone request to be tested for COVID-19 as a precaution, or do I need to be showing symptoms?
We will continue to follow the guidance and protocols issued by the U.S. Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), and state and local public health departments. Based on current CDC recommendations, call your physician if you believe you have been exposed to COVID-19 or have symptoms that may need testing. The majority of patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness such as cough or difficulty breathing. Your physician is strongly encouraged to test for other causes of respiratory illness, such as influenza.

How can I be tested for COVID-19?
If you are 65 or younger and have possible symptoms of COVID-19, please visit summahealth.zipnosis.com to start the FREE online screening process.

If you are over the age of 65 and have possible symptoms of COVID-19, contact your doctor’s office.  Do not travel to a medical facility unless you are instructed to do so. You can also call the Summa Health 24/7 COVID-19 hotline to speak with a trained nurse at 234.867.6314.

Please be aware of COVID-19 testing scammers who may be attempting to contact you via telemarketing phone calls, social media and home visits. Always protect your personal information. A COVID-19 test should only be ordered by a trusted medical provider. For more information, please read this important fraud alert from the U.S. Department of Health and Human Services Office of Inspector General.

Are e-visits covered for Coronavirus testing?
Yes. FREE online screenings and e-visits for COVID-19 (Coronavirus) are covered.  Visit summahealth.zipnosis.com/ to start the online screening process.

If I become infected with COVID-19, is treatment covered?
Symptom management for COVID-19 is subject to the same copays, co-insurance and/or deductibles that would apply to other tests and treatment (such as flu or other viral infection). No medication or vaccination currently exists for the treatment of COVID-19. For additional questions about your coverage, please call the number on the back of your ID card.

Is antibody testing for COVID-19 a covered benefit?
Yes. SummaCare covers provider-ordered antibody blood testing that determine whether you have been infected with COVID-19 with no co-pays or deductibles for all members (i.e. Medicare Advantage, Individual and Commercial and Self-Funded) whether in or out-of-network.  This coverage applies for the duration of the public health emergency.

How can I be tested for COVID-19 antibodies?
A COVID-19 antibody blood test should only be ordered by a trusted medical provider.  Check with your doctor to determine if they offer antibody tests.

What if I have more questions about COVID-19?
For the latest information about the virus, please visit the following websites dedicated to this issue:

• summahealth.org/coronavirus
• Public Health Emergency
• Ohio Department of Health
• Centers for Disease Control and Prevention
• World Health Organization

Summa Health also established a Coronavirus hotline available 24/7 at 234-867-6314.

Access to Care

Are telehealth services through my doctor a covered benefit?
Yes. In compliance with the most up-to-date CMS requirements, we are now covering the cost of telehealth services for a wide array of health care needs. Telehealth services are a great option to still get the care you need, while staying safe in the comfort of your own home and avoiding exposure and potential spread of the virus.  

• Telehealth services will be covered regardless of your location.
• Telehealth services coverage will expand to include audio telephone only.
• Telehealth services coverage includes physical therapy, occupational therapy and behavioral health. 

This coverage is effective through the duration of the public health emergency. Talk to your provider about your telehealth options.

What if I have a previously scheduled appointment or procedure coming up?
Contact your doctor’s office and they will give you instructions.

Where is it safe to continue dialysis treatment during the COVID-19 outbreak?
Dialysis patients, although at higher risk of complications from the Coronavirus, should NOT stop treatment during this time. The CDC has provided dialysis centers with permission to implement measures to stem the spread of the virus by separating diagnosed or symptomatic COVID-19 patients from those who do not show signs of having contracted the virus. If you think you have been exposed to COVID-19 or are experiencing symptoms such as fever, cough and difficulty breathing, contact your health care provider. You may be instructed to obtain your dialysis treatment at a different location from your usual facility. All participating centers – Davita, Fresenius (also known as BMA), and US Renal Care – are in-network for our self-funded groups.

Access to Prescription Medications

Can I receive an additional supply of my prescriptions?
To ensure you have access to your needed medications during this time, we have implemented our Emergency Preparedness process for all self-funded members through their Pharmacy Benefits Manager. Effective 03/17/2020 and retro back to 03/12/2020 any “refill too soon” reject will be overridden at the pharmacy and you will be able to fill up to a 90-day supply of your medication. You will still be responsible for any applicable copays. There may be some benefit exclusions that still apply to your day supply.

If you are out of refills, meaning no valid refills are left on your prescription, the Ohio State Board of Pharmacy has granted an Extension of Emergency Refills to pharmacists in Ohio. Effective through the duration of the public health emergency, dispensing pharmacists may authorize emergency refills per the following:

• Extend the emergency refill of schedule III-V controlled substances to not exceed a thirty-day supply or the days’ supply as indicated in the pharmacy’s records, whichever is less (as opposed to a 72-hour supply limitation).
• Permits a pharmacist to authorize emergency refills for a particular drug up-to three times in any twelve-month period (as opposed to once in any twelve-month period). This applies to both schedule III-V controlled substances and non-controlled substances.
• In lieu of three 30-day emergency refills, a pharmacist may dispense a one-time emergency refill of a 90-day supply for a particular non-controlled substance medication.

We will continue to monitor COVID-19 and related guidance and will work with your Pharmacy Benefits Manager to make adjustments as needed.

Last Updated: July 24, 2020