FAQs for COVID-19, Relief PPO Plan Benefit Coverage

May 20, 2020

Testing For COVID-19

Does LAFRA cover the test for COVID-19?

LAFRA will waive cost sharing (copayment, coinsurance, and deductible) for COVID-19 testing, including approved antibody tests, during this national emergency. We are also waiving cost sharing for COVID-19 testing and screening related visits during this same time, whether the related visit is received in a health care provider’s office, an urgent care center, an emergency department or through a telehealth visit.

Other costs, beyond the test and test-related services, will be covered based on terms in the medical plan and applicable state and federal mandates. Therefore, deductibles, copayments and coinsurance would apply to care, and certain services or supplies beyond the test itself and test-related provider visit.

Telehealth Services

Is there a Telehealth option for members?

Yes. Members may contact a medical provider through LAFRA’S Telehealth vendor – LiveHealth Online.

Will LAFRA waive cost share for Telehealth visits?

To increase flexibility when it is needed most, we are expanding our telehealth policies to make it easier for Members to connect with a healthcare provider.

Designated LiveHealth Online Telehealth

LAFRA will waive the upfront collection of cost-share for any medical telehealth visits through LiveHealth Online, until June 14th*. You can visit with a board-certified doctor from the comfort of home, minimizing the risk of exposure to yourself and others. Doctors are available 24/7.

Telehealth Visits to In-Networks Providers

Members may see in-network providers who have the ability to connect with their patients through live video conferencing or audio, until the State of California Emergency declaration has been lifted. If you are seeing a provider outside of LiveHealth Online, the benefits, that are not for the screening of COVID-19, will be processed according to the PPO Plan benefit, which can include copays, deductibles and coinsurance. Non-PPO (out-of-network) telehealth visits will not be covered.

COVID-19 Screening

LAFRA is waiving cost-sharing for in-network and out-of-network telehealth screening-related visits for COVID-19.

Can telehealth providers evaluate symptoms and send the individual for a COVID-19 test?

A telehealth provider may determine whether the individual should be sent to a CDC approved location for a COVID-19 test. The COVID-19 test and test-related telehealth visit is paid at no cost share.

Prescription Benefits

Have any changes been made to the prior authorization program for medications covered through the pharmacy benefit? Are you extending authorizations?

Yes, we have identified prior authorizations expiring for select medications between March 1 and July 1st and are extending these for 90 days. Opioid medications are excluded from the automatic extension.

*Date may be extended.

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