​​​​​​​​​COVID-19 (Coronavirus): Telemedicine services for Independence members

May 19, 2021

This article was revised on May 19, 2021, to update the Medicare Advantage News Article link.

For more information about telemedicine services, please refer to Medical Policy #00.10.41h: T​elemedicine Services (Independence). It was posted as a Notification on December 31, 2020, and will go into effect July 1, 2021.

Expansion of telemedicine coverage

To encourage social distancing and increase access to care, Independence continues to expand its telemedicine services for our members. This chart provides details of the expanded coverage.

Commercial * Keystone HMO CHIP Medicare Advantage

Coverage timeline

Effective March 6, 2020, through June 30, 2021.

Effective March 6, 2020, through the end of the PA public health emergency, which is currently                 May 28, 2021, for all telemedicine services provided by in- and out-of-network providers.

  • Effective March 6, 2020, through the end of the PA public health emergency, for telemedicine services provided by in- and out-of-network providers.

  • MDLive® coverage is effective January 1, 2021 through                 December 31, 2021.

 

Primary care provider (PCP) visits

 

  • As of January 1, 2021, member cost-sharing     (i.e., copayment, deductible, and coinsurance) will be waived for COVID-19 related telemedicine PCP visits only.

  • For high-deductible health plan (HDHP) members, cost-sharing will be waived for COVID-19 testing and PCP COVID-19 related telemedicine visits, which will be covered even if deductible has not been met.

$0 copayment for COVID-19 related telemedicine primary care.

$5 copayment for in- and           out-of-network providers, which is waived if there is a COVID-19 diagnosis.

Specialists visits

  • ​Cost-sharing will be waived for telehealth visits related to COVID-19 for specialists visits; nutrition counseling; urgent care; video-only visits for physical and occupational therapy; and audio or video for speech therapy.

  • Telehealth visits with specialists that are not related to COVID-19 are subject to the appropriate member cost-sharing.

$0 copayment for COVID-19 related specialist visits.

Regular cost-sharing applies for specialist telemedicine visits.

Copayment depends on the member's benefit plan. The copayment is waived if there is a COVID-19 diagnosis.

Behavioral health visits

  • Based on the member’s benefit plan, cost-sharing will be waived for all       in-network and            out-of-area telemedicine visits related to COVID-19 with behavioral health specialists.

  • Behavioral health telehealth visits that are not related to COVID-19 are subject to the appropriate member   cost-sharing.

$0 copayment for behavioral health telemedicine visits.

As of January 1, 2021, behavioral health copayment applies. The amount depends on the member's benefit plan (in accordance with CMS filed benefits for 2021). The copayment is waived if there is a COVID-19 diagnosis through the end of the public health emergency.

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.

Keystone CHIP members do not have MDLive coverage.

 

  • As of January 1, 2021, members will have a $5 cost-share for MDLive behavioral health visits and $0 copayment for MDLive PCP visits.

  • As of January 1, 2021, MDLive telemedicine visits for non-urgent medical conditions will continue to have $0 copayment in accordance with our filed benefits.

*Self-funded groups

Primary care

  • Cost-sharing will be waived for all telemedicine visits for all PCP and behavioral health visits related to COVID-19 beginning January 1, 2021.
  • Cost-sharing will be reinstated for all non-COVID related telemedicine visits with a network PCP beginning January 1, 2021, unless the group chooses to waive it.

Specialists

  • Cost-sharing will be waived for telehealth visits related to COVID-19 for specialists; nutrition counseling; urgent care; video-only visits for physical and occupational therapy; and audio or video for speech therapy.
  • Telehealth visits with specialists that are not related to COVID-19 are subject to the appropriate member cost-sharing.

Behavioral health

  • Based on benefit design, cost-sharing will be waived for all in-network and out-of-area telemedicine visits related to COVID-19 with behavioral health specialists.
  • Behavioral health telehealth visits that are not related to COVID-19 are subject to the appropriate member cost-sharing

MDLive visits

  • Cost-sharing is waived for all MDLive telemedicine visits related to COVID-19 through June 30, 2021. Customers that have opted to waive cost-sharing on MDLive visits for any diagnosis may choose to continue this waiver through June 30, 2021, or until their 2021 renewal, whichever is first, at which time cost-sharing will be reinstated. ​

Medicare Supplement

Telemedicine services are payable as a Medicare covered service for all Medicare-eligible providers as long as the Centers for Medicare & Medicaid Services (CMS) dictates.

Independence is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all Independence members and providers to visit our dedicated COVID-19 webpage regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Learn more

Read more about coverage requirements, billing, reimbursement, and proper coding in the News Articles posted on our Medical and Claim Payment Policy Portal:

​​​