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Cost Sharing Grid
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Updated Information in Red! Last updated 03/04/2021
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PayerPlanCost Sharing PolicyTechnology Policy Link for Cost Sharing Policy
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HMSACommerical/Quest/Medicare AdvantageCost share waiver for all telehealth & COVID-related visits ended 12/31/2020 for Commercial plans only* Audio only telehealth or phone visits are temporarily longer covered (until 4/1/2021) For MA patients, telehealth visits are continued to be waived** (for covid-related treatment regular plan benefits apply as of of 4/1/2021); Fed 87 members: telehealth visits and treatment related to COVID are waived (no end date posted) **End date mirrors the end date of the public health emergency declaration, which is set to expire 4/1/21Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://hmsa.com/help-center/covid-19-coverage-changes/ For most recent notices, please check HHIN, or the second tab of this spreadsheet: https://hhin.hmsa.com/HHIN/Login/Login.aspx
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HMSAMedicaid/QuestTelehealth and COVID-related visits are waived*, for in-office, copays still apply.
End date mirrors the end date of the public health emergency declaration, which is set to expire 4/1/21
Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://hmsa.com/help-center/covid-19-coverage-changes/
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United Health CareCommerical For COVID-19 testing-related telehealth visits, in network and out-of-network, UnitedHealthcare is waiving cost-sharing through the end of the PHE.

For in-network and out-of-network COVID-19 telehealth treatment visits, UnitedHealthcare cost-share waiver ended 1/31/2021.

Benefit plans to resume regular coverage as of 2021.
Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-telehealth.html
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United Health CareMedicare AdvantageFor COVID-19 testing-related telehealth visits, in network and out-of-network, UnitedHealthcare is waiving cost-sharing through the end of the PHE.
For in-network and out-of-network COVID-19 telehealth treatment visits, UnitedHealthcare cost-share waiver ended 1/31/2021.

For primary care telehealth services, both in-network and out-of-network, UnitedHealthcare cost share is determined based on the member's benefit plan. Most MA plans have $0 copay for outpatient appts.
Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-telehealth.html
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CMSMedicareProviders are able to waive or reduce cost share for patients under the 1135 waiver until the state of healthcare emergency is declared over, as of now it is scheduled to end 04/30/2021https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf
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UHAAllParticipating Providers: Coinsurance requirements are waived for telehealth visits for the duration of the PHE, regardless of reason for visit. (as of now PHE ending 4/30/2021) Non-Participating Providers: Coinsurance is waived for COVID-related telehealth visits only.
Coinsurance requirements are also waived for COVID-related inpatient services and office visits. (must include a COVID-related diagnosis code on the claim)
Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://uhahealth.com/uploads/forms/form_mis_Telehealth-Telemedicine.pdf https://uhahealth.com/page/coronavirus-covid-19-information-for-providers
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HMAAllNo copays have been waived during this time; same as face to face visit coverageN/A
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HMAAAllCost share is waived for telemedicine visits provided through HiDoc Patient PortalPhysicians encouraged to use HMAA online portal HiDochttps://myemail.constantcontact.com/HiDoc-Online-Upgrade-on-April-9--2020.html?soid=1104692932210&aid=J-rfwg22x-4%22
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HumanaAllFor Medcare Advanatge: Visits related to positive-COVID diagnosis are covered at 100%, with no copay. Effective 1/1/21 standard benefits and costsharing apply for employer group members and commerical plans. Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://www.humana.com/coronavirus/telemedicine
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TricareAllTricare is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayment or cost-share. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees. Video-chat applications (for example, Skype and Facetime) may not meet such requirements and should not be used unless appropriate measures are taken to ensure the application meets these requirements and that appropriate business associates agreements (if necessary) are in place to utilize such applications for telemedicine.
https://www.tricare-west.com/content/hnfs/home/tw/prov/benefits/costs/ov_costs.html
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AlohaCareAllCost share is waived related to laboratory testing only. All other cost share policies apply for telemedicine visits or face to face visits. Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://www.alohacare.org/userfiles/file/PDF/QUEST/Provider/Plan%20Publications/Provider%20Advisories/COVID-19%20Provider%20Advisory%20FINAL%20%203-20-20.pdf
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PSWAAllPatient pays 10% of eligible chargeN/A
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AARPMedicareFollows United HealthCare MA guidelines
Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies.
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OhanaAllAny claim with a date of service beginning 3/17/2020 and billed with a place of service of 02 will have $0 member liability. This applies to both PAR and non-PAR. This is in effect until the PHE is declared over.

No cost to eligible members when using MDLIVE.
Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies.

Members are encouraged to access telehealth services though MDLIVE.
https://www.wellcare.com/Hawaii/Members/Medicaid-Plans/QUEST-Integration/Benefits/Co-Pay-Information

https://www.wellcare.com/en/Hawaii/Providers/Medicaid/MDLIVE-Telehealth
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CignaAllCost share is waived for diagnostic testing and office visits related to COVID ended 01/21/2021. COVID-related treatment cost share waiver ended 2/15/2021Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html
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CignaMedicare AdvantageCost share is waived for diagnostic testing and office visits related to COVID ended 01/21/2021. COVID-related treatment cost share waiver ended 02/15/2021.Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html
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AetnaCommercial Cost share waiver for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services ended 01/31/2021.Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://www.aetna.com/health-care-professionals/covid-faq/telemedicine.html
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AetnaMedicare AdvantageCost share is waived for all in-network primary care and specialist telehealth visits ended 01/31/2021.Following CMS standards for technology; waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies. https://www.aetna.com/health-care-professionals/covid-faq/telemedicine.html
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Pacific AdministratorsHawaii Laborers UnionCost share is waived for telehealth visits only ended 1/31/2021. All other cost share policies apply to face to face visitsN/A - contact by phone at 808-441-8600 x-700
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Veterans Administration
VA Pacific Islands Health Care SystemCost share is waived for most routine telehealth services to patient home. Physicians to use VA Video Connect for telehealth visitsN/A - contact by phone: Shelly Briereyoneda 808-436-8979
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Public Health Emergency (PHE) currently extended through 4/30/2021
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