Aetna: COVID-19 FAQs and resources
Effective March 6, 2020, a number of COVID-19 resources are available to Aetna members, including waived co-pays for all diagnostic testing related to COVID-19 for Commercial, Medicare and Medicaid members.
The CDC encourages people to stay at home as much as possible. CVS Health provides convenient options to avoid visiting the pharmacy for refills or new prescriptions.
Aetna offers 90-day maintenance medication prescriptions for insured and Medicare members.
Aetna Resources For Living® (RFL) is offering support and resources to individuals and organizations who have been impacted by COVID-19. Through this liberalization, those in need of support can access RFL services whether or not it is part of their benefits.
Individuals and organizations who don’t have RFL can contact RFL at 1-833-327-AETNA (1-833-327-2386)
Members and Plan Sponsors who do have RFL should call their designated RFL number available in program materials
Support to individuals and organizations that don’t have RFL includes:
In-the-moment phone support to help callers cope with the emotional impact of the event
Informational brochures about dealing with a crisis
Community resource referrals including local support services in the local area
Management consultation to help organizations respond to the needs of their employees, even if they’re not RFL customers
Employers may contact our specialized support line at 1-800-243-5240
Onsite services are available on a fee-for-service basis for companies to help their employees recover from the impact of these events on the workplace
Telemedicine cost-sharing and co-pay waiver announcement (March 6)
What are the start and end dates for the telemedicine cost share waiver?
For Commercial plans, the cost share waiver for any in-network covered telemedicine visit — regardless of diagnosis — began on the day of the CVS Health press release, March 6, 2020, and ended on June 4, 2020.
Cost share waivers for any in-network covered medical or behavioral health services telemedicine visit for Aetna Student Health plans are extended until December 31, 2020.
For Medicare Advantage plans, Aetna is waiving cost shares for any in-network primary care and specialist telehealth visits, including outpatient behavioral and mental health counseling services, through December 31, 2020.
What happens to the telemedicine cost-share waiver after the effective period? Can my self-insured plan sponsor extend it?
CVS Health and Aetna will continue to monitor the situation with COVID-19 as it unfolds. Any updates or changes to the policies and procedures will be communicated through the appropriate channels. Plan sponsors cannot make independent extensions at this time.
Do the cost share waivers for telemedicine apply to all providers or just Teladoc®? What about MD Live? What about third-party custom telemedicine arrangements?
Yes, this benefit for telemedicine cost share waiver is at the CPT code level and any in-network provider can bill for telemedicine using the appropriate telemedicine codes. One caveat to note is that MD Live is not able to apply the waiver at the point of care. However, the claim will adjudicate without a cost share and members will receive a refund.
Does the zero copay apply to the plan sponsors who have opted-in to the caregiver services through Teladoc®?
No, as this is not a benefit for the member.
Will a customer who is currently opted out of Teladoc® get access to all channels of telemedicine at $0 cost share to the member, if they opt into the recent 90-day initiative to support COVID-19 services?
No. Plan sponsors who opted out of Teladoc® would not have Teladoc® during the 90-day initiative but would have the $0 cost share for telemedicine through in-network providers.
If plan sponsors remain opted-in to ALL channels of telemedicine – Teladoc® and providers doing virtual care – would all have a $0 cost share? It’s all or nothing, right?
Yes. If plan sponsors remain opted in for the $0 telemedicine co-pay offering, it will apply to all visit types.
Can plan sponsors opt-out of the telemedicine cost share waivers for just behavioral health?
No. The only cost-share wavier opt-out options are provided on the form. Examples of designs that cannot be administered include:
Applying cost share for behavioral health, dermatology, care giver, etc. only. $0 cost share must apply to all types of telemedicine visits or to federally mandated COVID-19 diagnosis.
Applying different cost share levels for types of telemedicine visits (i.e., behavioral health, dermatology, care giver, etc.).
Steering members to designated telemedicine vendors by using different levels of cost sharing.
Any option not listed as Acceptable.
What is the cost for a Teladoc® or telemedicine visit that would now need to be covered by the self-insured plan sponsor if they chose to opt-in to waived cost-share?
The retail cost of a Teladoc® visit that would need to be covered by the self-insured plan sponsor is $40 or $45, depending on the health plan’s Teladoc configuration.
Telemedicine visits may be billed by any network provider. Cost share waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for Commercial plans will continue until December 31, 2020. Self-insured plans may offer this waiver at their own discretion. In most cases, Aetna will reimburse network providers for telemedicine services at the same rate as in-person visits. Provider contracts vary and exceptions may apply for some providers.
Who will pay the member cost share for telemedicine visits?
Self-funded plan sponsors will be responsible for covering their employees’ member cost share for all covered in-network general medical, mental health and dermatology visits while the Aetna cost share waivers are in effect, unless they have opted out. Aetna will cover member cost shares for covered in-network fully insured telemedicine visits.
What kind of Teladoc® visits are covered by the COVID-19 cost share waiver?
Member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for Commercial plans has been extended through December 31, 2020.
Member cost shares will be waived for in-network covered Teladoc® general medical visits through December 31, 2020 for Medicare Advantage members.
Some employers (plan sponsors) do not have Teladoc® and are confused. How does the telemedicine cost share waiver work?
In order to help members avoid unnecessary exposure to COVID-19, Aetna is encouraging the use of telemedicine for appropriate symptoms or conditions to limit potential exposure in physician offices.
Teladoc®, MD Live, and other third-party telemedicine vendors, are one way for members to receive a telemedicine visit. Member cost sharing will be waived on any of these visits, subject to claim processing rules and any other requirements in their benefit plan, including whether the vendor’s providers are in-network.
Telemedicine CPT codes can be found in the internal provider FAQs. Keep in mind, some self-insured plan sponsors may not offer the telemedicine cost share waiver, which would apply to any telemedicine visits (Teladoc® or otherwise), except those mandated by the Families First Coronavirus Response Act (resulting in COVID-19 testing).
Do the cost sharing waivers for telemedicine and diagnostic testing apply to Aetna Funding Advantage products?
How is Aetna’s 90-day waiver for member out-of-pocket fees for all telemedicine services compliant with a High Deductible Health Plan?
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law on March 27, 2020, indicates that a plan shall not fail to be treated as a high deductible health plan for failing to have a deductible for telehealth and other remote care services.
Cost-sharing and co-pay waivers announcement (March 25)
Will Aetna cover the cost of COVID-19 testing for members?
Aetna will waive member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured Commercial and Medicare Advantage plans and is effective immediately for any such admission through December 31, 2020. Self-insured plan sponsors offer this waiver at their discretion.
Will Aetna cover the cost of COVID-19 treatment for its Medicare members?
Yes, Aetna will cover the cost for treatment of COVID-19 for our Medicare Advantage members in full in the provider office. We will also cover the cost of the hospital stay for all of our Medicare Advantage members admitted March 25, 2020, through December 31, 2020.
Will Aetna cover the cost of COVID-19 treatment for its Medicaid members?
Regulations regarding cost-sharing for Medicaid beneficiaries vary by state and continue to evolve in light of the current situation. We have suspended cost-sharing requirements, including premiums and copays, for adults and children covered by Medicaid and CHIP, in those states where permitted to do so by the appropriate regulators.
For COVID-19 treatment required prior to March 25, 2020, will cost sharing be waived for Aetna members?
All claims received for Aetna-insured members going forward will be processed based on this new policy. If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service so the claim can be reprocessed accordingly.
For COVID-19 treatment required prior to March 25, 2020, will cost sharing be waived for Aetna members?
All claims received for Aetna-insured members going forward will be processed based on this new policy. If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service to so the claim can be reprocessed accordingly.
How does this change impact the business going forward? Are premium spikes expected?
Similar to other COVID-19 waivers previously announced, Aetna-insured plan sponsors can expect the following:
Current premiums will not change as a result of COVID-19 or the changes we’ve made to cost sharing policies.
We can identify and isolate the direct costs associated with COVID-19, as well as any cost sharing waiver policies that we implement. These costs can be considered separately from “normal” plan costs.
We will use sound actuarial principles to set future rates. This may include making adjustments to experience from the COVID-19 outbreak and/or utilizing actuarial and economic models to anticipate future utilization in the wake of the outbreak.
Treatment Prior Authorization
Why is Aetna liberalizing prior authorizations now?
Removing the need for prior authorizations for those members requiring in-patient treatment for COVID-19 allows for delivery of timely and seamless access to care.
What segments does this liberalization apply?
All segments – Commercial, Medicare and Medicaid, where applicable by state regulation.
In what states do prior authorization liberalizations apply?
We are constantly evaluating the needs based on rising instances of COVID-19 to determine when and how we apply this policy. We’ve made this available in states with highest prevalence of confirmed cases as well as where it’s required by state mandate or gubernatorial suspensions of elective procedures.
Will Aetna cover COVID-19 diagnostic and antibody tests under any circumstance?
Aetna will cover, without cost share, diagnostic (molecular PCR or antigen) tests to determine the need for member treatment.
Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Aetna’s health plans do not cover serological (antibody) tests that are for purposes of: return to work or school or for general health surveillance or self-surveillance or self-diagnosis, except as required by applicable law.Refer to the CDC website for the most recent guidance on antibody testing.
This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.
Does Aetna’s no cost share coverage of COVID-19 testing apply to pre-admission testing?
Prior to COVID-19, testing for infectious diseases were included in the rate for surgical procedures and that policy will continue during the COVID-19 pandemic. Cost to the member will be determined by each individual health plan.
Does Aetna’s no-cost share coverage of COVID-19 testing apply to provider visits in and out of network?
Yes. If the plan provides in and out of network coverage, then the cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. The policy aligns with Families First legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share.
Is a physician’s order required for coverage of a COVID-19 test?
An order from an authorized health care professional is required for covered COVID-19 tests for Aetna Commercial and Medicare plans.
Will Aetna cover other virus testing if those services are for the purposes of COVID-19 testing?
Routine testing for influenza, strep, and other respiratory infections without a COVID-19 test will be covered subject to applicable cost sharing under the member’s plan.
We cover, without member cost sharing, a same day office, emergency room, or other provider visit at which a COVID-19 test is ordered or administered. If as part of that visit the provider administers or orders a test for influenza, strep, or other respiratory infection, that additional testing will also be covered without member cost sharing.
What’s Aetna’s position relative to reimbursement for home administered tests?
Current home-administered tests are sent to a lab for analysis and we strongly encourage the lab, rather than the individual, to submit a reimbursement claim for that test. If an individual chooses to submit the claim on behalf of the lab, the submission should include CPT-4 Code, Dates of Service, and receipt for the test.
As new FDA COVID-19 antigen tests, such as the polymerase chain reaction (PCR) antibody assay and the new rapid antigen testing, come to market, will Aetna cover them?
Yes, Aetna will cover both. Testing for COVID-19 is evolving rapidly, please refer to the FDA and CDC websites for the most up to date information.
Does Aetna require that the laboratory test have FDA authorization for payment?
For Medicare and Commercial plans, the lab tests must be FDA authorized.
Will Aetna health plans cover tests performed by or on behalf of an employer for employment related purposes?
Aetna’s health plans generally exclude any health examinations required to obtain or maintain employment. This includes testing for infectious diseases such as COVID-19. Unless required by law, neither antigen nor antibody COVID-19 testing will be covered if the test is performed at the direction of a member’s employer in order to obtain or maintain employment or to perform the member’s normal work functions. While there are currently no coding descriptions that differentiate between employer-required COVID-19 tests and those tests ordered for other reasons, we will work to implement the proper coding, as it becomes available. We continue to explore alternative reimbursement arrangements for those customers that require employment-related testing.
Does Aetna plans include COVID-19 testing frequency limits?
At this time, covered tests are not subject to frequency limitations. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria.
Does Aetna cover the FDA-authorized at-home antibody testing options available from Quest and LabCorp for COVID-19?
Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Aetna’s health plans do not cover serological (antibody) tests that are for purposes of: return to work or school or for general health surveillance or self-surveillance or self-diagnosis, except as required by applicable law. Refer to the CDC website for the most recent guidance on antibody testing.
The preferred option for Aetna members is to access this testing at one of the patient draw centers operated by Quest and LabCorp. This enables the best experience for members by directly accessing their health benefits, as the lab will submit a claim, and also minimizes the administrative burden for Aetna. When requesting a direct to consumer at-home test, individuals must submit payment when the test is ordered. In some cases, the labs will not submit claims to health plans or the government for reimbursement. Individuals may be able to submit the expenses associated with this testing to their health savings account, flexible spending account, health reimbursement account or to insurance for reimbursement.
Can you provide information on the diagnosis/CPT codes for serological (antibody) testing?
What are the testing priorities when evaluating and testing people for COVID-19?
CDC’s guidance is to prioritize those with symptoms and anyone prioritized by health departments or clinicians, for any reason, such as for public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals according to state and local plans. Refer to the CDC website for the most recent guidance.
Is testing done at independent pharmacies covered?
Yes. COVID-19 testing done at independent pharmacies is covered, with no member cost-share.
I asked for a COVID-19 test, but my doctor said I don’t need one. What are my options?
Your doctor is in the best position to advise if testing is needed based on your symptoms. With tests in limited supply, providers are using a strict set of guidelines to determine when testing is appropriate.
If your symptoms change, contact your doctor again.
What is considered a dental emergency?
Aetna will allow your dentist to determine what constitutes an emergency and Aetna will cover emergency care for both PPO and DMO members with no referral required.
Where can I go for emergency and urgent dental services?
You should call your dentist’s office to find out how they are handling emergencies and follow their instructions. If you are having trouble reaching your dentist directly, you can contact Aetna member services and our team will assist you with finding a dental provider.
What if a member’s only option for emergency care is an out-of-network dentist?
Aetna will pay all out-of-network emergency claims as in-network during this time for both DMO and PPO members.
What options are there for members who are losing coverage soon and cannot schedule a cleaning before that termination date?
Aetna will grant an extension once dental offices reopen. More details will be communicated in the coming weeks.
What is Aetna’s policy on telehealth (tele-dentistry) services for dental members?
During this time many dentists are offering tele-dentistry services to facilitate emergency oral evaluations of their patients using telephone and video-conferencing capabilities. We encourage members to contact their current dentist to see if such services are offered.
If they are being offered, Aetna’s policy has always been that any oral evaluation covered under our dental plans will be reimbursed no matter whether it is performed via tele-dentistry or in a traditional practice setting. Aetna will cover all emergency exams at 100% during the COVID-19 pandemic crisis.
Does Aetna provide tele-dentistry services for members if my provider doesn’t offer it?
Yes. Aetna has launched a new tele-dentistry program to provide dental members with a simple, convenient solution to access care from the convenience of their homes.
How it works:
If a member has a dental emergency and their existing provider is not available, they can contact customer service who will assist them in finding a tele-dentistry provider. Members will not be charged for emergency exams provided via tele-dentistry during the COVID pandemic. Aetna will continue to reassess this policy based on need as circumstances warrant.
Once the COVID-19 pandemic is over, members will still have access to this tele-dentistry program. Costs for these services will be based on the member’s current benefit plan.
During this unprecedented time, please know that Aetna is continuing to administer your vision benefits with the same dedicated level of customer service you’ve come to expect. The health and well-being of our members is our top priority, and Aetna is following all COVID-19 guidance and protocols provided by the Centers for Disease Control and Prevention (CDC), as well as state and local public health departments. We recommend that you follow CDC guidelines regarding routine eye exams, including postponing routine visits.
Many of our clients and members have asked questions about vision benefits and eye safety during the COVID-19 crisis. Below is helpful information regarding vision benefits. We will continue to provide updates as more questions come in.
Can I still use my vision benefits during this time?
Yes. We recommend you follow CDC guidelines regarding routine eye exams, including postponing routine visits.
However, should you need care, lose or break your glasses or require replacement contacts, we recommend calling your provider directly to verify amended store hours or closing. You have 24-hour access to provider contact information via our Provider Locator. You may also call our Customer Care Center directly at 877-973-3238.
You also have the option of utilizing online in-network options through glasses.com, contactsdirect.com, ray-ban.com, lenscrafters.com, and targetoptical.com. Your Aetna benefits will automatically be applied during checkout, and your glasses or contacts will be mailed directly to your home. Many of these online providers are offering free, expedited shipping and no-cost returns for extra convenience. Check with online providers to verify available offers.
What if I don’t have a current prescription and cannot leave my home?
We recommend first contacting your provider to discuss your options. While many states do regulate the expiration timeframe for prescriptions, most providers have the discretion to extend them as they deem necessary.
If you are unable to reach your provider and you need glasses or contacts in the event of an emergency, please contact our Customer Care Center at 877-973-3238. Members may be eligible to receive an emergency pair of replacement Adlens Adjustable Glasses (subject to availability). These temporary, emergency glasses can be adjusted to switch focus for reading, computer and distance.
We are continuing to work closely with the American Optometric Association (AOA) and state optometric departments with the goal of providing prescription relief, and we are actively monitoring Department of the Interior (DOI) orders as they relate to vision. Updates will be made available as we have them.
Note: Regulations have already been changed to allow Medicare members to use expired prescriptions during the outbreak. Medicare members will need to contact the provider they last visited for replacement materials.
Are telehealth services available for exams?
At this point in time routine exams still require an in-person office visit.
Who should I contact if I have an emergency?
We encourage you to contact your optometrist’s office directly to determine if your condition qualifies as an emergency. If so, they will provide instructions on what to do.
Where do I go if I have more questions?
Aetna is here to make things easier for you by providing you with different service options.
Our Customer Care Center is available during normal business hours at 877-973-3238 for information on nearby in-network providers and any changes to their hours of operation.
24/7 service is available via aetnavision.com through our mobile app (available on both iPhone and Android). Use these tools to access to provider contact information, your benefits, eligibility and more.
As vision offices start to re-open, how can Aetna vision members verify that a vision provider is following safety and cleanliness guidelines?
Finding the right eye doctor is more important than ever. As providers begin to re-open, members can expect to see a few changes when they head in for their next eye exam. Things like required social distancing, temperature taking or added time in between appointments to allow for deep cleaning may be the norm.
That’s why Aetna Vision Preferred is offering an easy way for members to locate providers who’ve let us know they follow stringent safety and cleanliness guidelines.
All they have to do is visit the Provider Locator and look for the Safety Ready badge. They can even filter their search results using the “Safety Ready” toggle on the provider locator page.
As always, members can also consider one of our many in-network online option options including:
Members can visit aetnavision.com to find a provider and schedule their eye exam today.
Specialty – Voluntary
Voluntary – Accident, Critical Illness, Hospital Indemnity Plans
Is COVID-19 testing covered under the Health Screening Benefit for Aetna’s Accident, Critical Illness and Hospital Indemnity Plans?
Yes. If your plan includes a health screening benefit and it hasn’t been used yet this year, you can use the benefit for COVID-19 testing if needed. The claim can be filed the same way as any other health screening benefit. Aetna will pay claims received after March 1, 2020 regardless of the date of service. COVID-19 will also remain on our list of covered health screening benefits.
Are there other benefits for COVID-19 available in Aetna’s Accident, Critical Illness and Hospital Indemnity Plans?
Please see below for each plan:
The Aetna Hospital Indemnity Plan includes benefits if you need to be hospitalized due to COVID-19, such as hospital admission and daily stay.
The Aetna Accident Plan covers accidents and therefore does not pay benefits for COVID-19 or any other illness, unless the plan includes the inpatient sickness rider.
The Aetna Critical Illness Plan does not include COVID-19 as a covered condition. However, if a covered condition occurs while being treated for COVID-19, these benefits will cover that condition.
I have an Aetna Accident plan. Can I use telemedicine services instead of going to the doctor’s office?
Yes. Aetna's Accident plans include coverage for Telemedicine visits either as a specific Telemedicine benefit (newer Accident plans) or as an Initial or Follow-up Office Visit benefit (older Accident plans).
If my surgery or other covered service(s) related to a covered accident under my Aetna Accident Plan was postponed due to COVID-19, will Aetna waive the time requirement?
Yes, Aetna will waive the timeframe for care a member receives related to an accident that’s postponed due to COVID-19. Member must be covered at the time of care and care must be received by December 31, 2020.
Voluntary – Fixed Indemnity Plan
Does the Fixed Indemnity plan cover COVID-19?
The Aetna Fixed Indemnity Plan includes benefits if you need care and treatment related to COVID-19, such as hospital admissions, daily stays, office visits, telemedicine visits, diagnostic testing, x-ray and laboratory services.