FAQs for COVID-19, Relief PPO Plan Benefit Coverage

Testing For COVID-19

Does LAFRA cover the test for COVID-19?

Yes. 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, through a telehealth visit or incurred In‐ or Out‐of‐Network.

Other costs, beyond the test and test‐related services, will be covered based on the terms of 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 for services unrelated to COVID‐19?

Yes. Members may contact a medical provider through LAFRA’S telehealth vendor – LiveHealth Online. Also, to increase flexibility when it is needed most, we are expanding our telehealth policies to all Network and Out‐of‐Network care to make it easier for Members to connect with a healthcare provider.

How much will a Telehealth visit cost?

The cost of your telehealth visit will vary depending on the type of services and providers utilized.

• Designated LiveHealth Online Telehealth: LAFRA will waive the upfront collection of cost‐share for any medical telehealth visits through LiveHealth Online (livehealthonline.com) until September 13, 2020. Cost share will apply after September 13, 2020. Utilizing LiveHealth Online allows you to 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 for Non-Covid-19 Related Care:  Effective March 1, 2020, Members may see 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 or December 31, 2020, whichever is earlier. If you are seeing a provider outside of LiveHealth Online, covered benefits that are not for the screening or testing of COVID‐19 will be processed according to the plan benefit, which can include copays, deductibles and coinsurance.

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 with 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 1, 2020 and are extending these for 90 days. Opioid medications are excluded from the automatic extension.

COBRA Coverage

If my coverage terminates, how long do I have to elect COBRA coverage?

The DOL and Internal Revenue Service (IRS) issued a Joint Final Rule extending certain time frames affecting a participant’s right to continuation of group health plan coverage under COBRA. A qualified beneficiary normally has 60 days from the date of receipt of the COBRA notice to elect COBRA. The Joint Final Rule extends this deadline by requiring plans to disregard the period from March 1, 2020, until 60 days after the announced end of the National Emergency, known as the “Outbreak Period”. For COBRA election purposes, this means if a qualifying beneficiary receives the election notice on or after March 1, 2020, the 60‐day initial COBRA election period does not begin until the end of the Outbreak Period. If the Cobra election is not postmarked within 60 days after the end of the Outbreak Period, you and your qualified dependents will lose the right to elect COBRA coverage.

When do I have to pay my COBRA premium?

COBRA guidance gives a qualified beneficiary 45 days after the date of the COBRA election to make their initial required COBRA premium payment. Subsequent payments are due at the beginning of the month and must be received within 30 days.

Under the Joint Final Rule, the time requirement of 45 days for the first monthly payment after the election of COBRA will not start until the day after the COBRA Election (if elected after the end of the Outbreak Period.) If the initial monthly payment is not postmarked within 45 days from the COBRA election after the end of the Outbreak Period, you and your qualified dependents will lose the right to elect COBRA coverage. This also means there are extensions for all subsequent monthly payments.

For more information on the extensions related to COBRA including any extensions that might apply for any right to elect COBRA or require a payment, please contact our COBRA Administrator at: 866‐995‐2372.

All of the information provided above is subject to change and advanced notice will be provided.

Relief PPO Medical Plan Amendment #1 

• Covid-19 Coverage