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Medical Mutual’s top priority is the health and wellbeing of our members. We are closely monitoring the recent novel coronavirus disease 2019 (COVID-19) outbreak. It’s important to know the precautions and safety measures you can take to protect you and your family. If you have specific questions about coverage, please login to MyHealthPlan.


Health Plan Options for COVID-19 Business Disruption Frequently Asked Questions
 

Governor DeWine recently announced policies suspending or modifying business operations to help stem the spread of COVID-19. In light of this announcement, we know your groups will have questions regarding continuing health insurance coverage for their employees. To assist you, Medical Mutual has prepared the following FAQ.

Medical Mutual Special Broker Updates:

December 1, 2020

Reminder: COVID-19 Inpatient Treatment Covered with No Member Cost Sharing though December 31, 2020

Applies to: Individual, Small Group, 51-99, 100+, MEWA, All Medicare Business

As a reminder, Medical Mutual continues to waive member cost sharing for inpatient treatment related to COVID-19 through 11:59 p.m. on Dec. 31, 2020. Treatment includes hospitalizations and ground ambulance transfers for individuals with a positive COVID-19 diagnosis. This applies to services provided by both in-network and out-of-network providers.

Beginning on Jan. 1, 2021, member cost sharing will apply for these services at the in-network benefit level, consistent with regulatory requirements.

This decision applies to groups enrolled in the COSE MEWA.

If you have questions about Medical Mutual's response to COVID-19, please contact your broker or Medical Mutual representative.

 

July 27, 2020

Extension of Timeframes for Covering COVID-19 Testing and Treatment with No Member Cost Sharing

Applies to: Individual, Small Group, 51-99, 100+, MEWA, All Medicare Business

The U.S. Department of Health and Human Services has extended the COVID-19 national public health emergency to now go through Oct. 22, 2020. That means Medical Mutual will continue to pay for COVID-19 testing with no member cost sharing through 11:59 p.m. on Oct. 22, 2020. Testing includes the cost of the test, as well as the cost of the provider visit, which could include an office visit or a telehealth (telemedicine), urgent care, or emergency room visit, to determine whether COVID-19 testing is required, and the visit to administer the test.

 

Medical Mutual has also extended the period during which cost sharing for treatment related to COVID-19 will be waived to now go through Dec. 31, 2020. This decision applies to our fully insured groups and groups enrolled in the COSE MEWA. Treatment includes hospitalizations and ground ambulance transfers for individuals with a positive COVID-19 diagnosis. This applies to services provided by both in-network and out-of-network providers.

 

Medical Mutual is reaching out via phone and/or email to self-funded groups to confirm if the groups wish to extend coverage for COVID-19 treatment with no member cost sharing through Dec. 31, 2020. These groups have until Aug. 10, 2020 to respond.

 

Groups that do not contract with Medical Mutual for stop loss must contact their stop loss carriers to ensure coverage before making any benefit changes.

 

All decisions related to coverage of telehealth (telemedicine) services, as described on Medical Mutual's COVID-19 member webpage also continue to remain in effect at this time.

 

If you have questions about Medical Mutual's response to COVID-19, please contact your Medical Mutual representative.


April 3, 2020

COVID-19 Treatment Covered with No Member Cost Sharing

Applies to: COSE MEWA

As we continue to fight the spread of the coronavirus disease known as COVID-19, in partnership with Medical Mutual, the COSE Health and Wellness Trust (COSE MEWA) has decided to cover COVID-19 treatment with no cost sharing through May 31, 2020. Treatment includes hospitalizations and ground ambulance transfers for individuals with a positive COVID-19 diagnosis. This applies to services provided by both in-network and out-of-network providers. In addition, Medical Mutual will permanently cover FDA-approved medications and vaccines when they become available. This is effective retroactively to the beginning of the COVID-19 national public health emergency declared by the US Department of Health and Human Services effective January 27,2020.

In addition, an Ohio Department of Insurance (ODI) Bulletin 2020-05 mandates that Medical Mutual must cover all treatment related to COVID-19 diagnoses as emergency services effective March 20, 2020. This means services must be covered at the in-network benefit level regardless of whether the healthcare professional or facility is in our network. This bulletin applies to all fully insured groups, MEWAs and self-funded public entities.

As a reminder, Medical Mutual the COSE Health and Wellness Trust was already covering testing for COVID-19 with no member cost sharing, per the Families First Coronavirus Response Act signed into law by President Trump on March 18, 2020. Testing covers the cost of the test, as well as the cost of the provider visit, which could include a telehealth (telemedicine), urgent care or emergency room visit, to determine whether the COVID-19 testing is required, and the visit to administer the test. This is a federal mandate, so groups are not able to opt out of this coverage.

A sample of the letter that is posted on COSEMEWA.com can be found here.

Important information for Medical Mutual members about COVID-19 and our response is available at MedMutual.com/Coronavirus.

If you have questions about Medical Mutual's response to COVID-19, please contact your Medical Mutual account representative. 



March 25, 2020

All Medical Mutual Plans to Cover COVID-19 Testing with No Cost Sharing per Families First Coronavirus Response Act

Applies to: All Market Segments

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March 27, 2020

State of Ohio Issues New Limitations on Certain Drugs Due to COVID-19

Applies to: Individual; Small Group (1-50); 51-99; 100+; MEWA; All Medicare Business

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March 17, 2020

Medical Mutual Offers Options for Members Seeking Early Refills of Prescriptions due to COVID-19 Concerns

Group: Pharmacy
Applies to: Individual; Small Group (1-50); 51-99; 100+; MEWA; All Medicare Business

As our members prepare for the COVID-19 (Coronavirus) pandemic, including the possibility of quarantines, some people may ask for early refills of current prescriptions. The CDC recommends having a two-week supply of both prescription and over the counter medications, along with food and other essentials.

Members can get their prescriptions filled as they normally would. Medical Mutual will allow early refills, should a member want to receive their medication early. Pharmacies have been given the ability to use their judgement to allow an exception for early refills.

Members can receive the plan allowance for days supply at retail pharmacies and through mail order. Most plans allow a 30-day supply at retail and a 90-day supply through mail order; however, members should check their specific plan limitations. If a member experiences any issues trying to refill their medication and is unable to get it, they should call the Rx Information number listed on their ID card.

This only applies to customers who have Express Scripts as their pharmacy benefit manager through an arrangement with Medical Mutual.

 

March 12, 2020

COVID-19 Coronavirus Testing Covered with No Member Cost Sharing

Applies to: All Lines of Business

To help combat the spread of COVID-19, Medical Mutual is covering all diagnostic testing for the virus, as long as it is ordered by a medical provider. We are also waiving all member cost sharing, including copays, coinsurances and deductibles for these tests.

If any self-funded group questions or concerns with this approach or want to opt-out, they should contact their Medical Mutual representative. Labor groups are required to opt-in for covering COVID-19 testing with no member cost sharing.

IRS Guidance on HSAs and COVID-19 Testing and Treatment
The IRSissued guidance on March 11, 2020, allowing pre-deductible coverage of testing for and treatment of COVID-19, as determined by the health plan. This applies to high-deductible health plans (HDHP) with health savings accounts (HSA). This means that Medical Mutual's HDHPs with HSAs can cover COVID-19 testing and treatment without member cost sharing.

Business Continuity Assurance
Medical Mutual has a business continuity plan in place that covers a variety of incident, including illness outbreak. Should the situation with COVID-19 warrant, we are prepared to initiate that plan for all our offices. We are confident Medical Mutual can continue to serve our members regardless of where our people are physically located. 

 

 

Credible COVID-19 Resources
We are working with and will follow all guidelines issues by the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services, the US Food and Drug Administration, the Ohio Department of Health (ODH) and other state and local public health departments in supporting our members' needs. We encourage our customers to seek information from the following sources: 

 

CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html

 

ODH: https://coronavirus.ohio.gov/wps/portal/gov/covid-19/

 

Important information for Medical Mutual members about COVID-19 and our response is available at https://www.medmutual.com/coronavirus.

 

If you have questions about Medical Mutuals response to COVID-19, please contact your Medical Mutual account representative.