What is COVID-19?

It's a new coronavirus strain that causes respiratory illness. Originating in Wuhan City, China, the virus has infected thousands of people worldwide and caused deaths. Cases have now been reported around the world. The World Health Organization named the disease caused by the new coronavirus on Feb. 11, 2020. The new name is COVID-19, short for "coronavirus disease 2019."

What are the symptoms of COVID-19?

Common signs of infection include:

• Respiratory symptoms
• Fever
• Cough
• Shortness of breath
• Breathing difficulties

In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and death.

People with heart and lung disease or weakened immune systems, as well as infants and older adults, are at higher risk for lower respiratory tract illness.

How is COVID-19 spread?

Human coronaviruses are usually spread from an infected person to others through the air by coughing and sneezing and through close personal contact, such as touching or shaking hands.

Find out more:

• Centers for Disease Control and Prevention
• Wisconsin Department of Health Services
• World Health Organization Coronavirus disease outbreak

• CMS Prepares Nation's Healthcare Facilities for Coronavirus Threat
• Gartner: Lead Your Organization Through the Disruption of Coronavirus
• Associated Press Virus Outbreak page
• Associated Press Understanding the Outbreak page

New benefits added to your health plan

Your health coverage has been boosted with new benefits! Check out the list below and feel free to call Customer Service using the phone number on your customer ID card if you have any questions.

Note: Self-funded group health plans have the option to select these benefits. If you are enrolled under a self-funded employer plan, check with your group leader to see if these benefits are covered. If you are a group leader, you can contact your WPS Health Plan account manager with questions.

• Telehealth related to COVID-19 testing: Services have 0% cost sharing through March 13, 2021.
• COVID-19 antibody testing: Physician-ordered in vitro antibody testing for COVID-19 is now covered at $0 cost sharing through March 13, 2021.
• Coverage for furloughed employees The work exception for group health plans is extended through the remainder of 2020.
• Prior authorization: Requirements are waived for COVID-19 laboratory tests and treatment through Dec. 31, 2020.

Is the COVID-19 test covered under my health plan?

Arise will waive any cost-sharing for federally approved in vitro diagnostic tests which are used for the detection or diagnosis of the virus that causes COVID-19, including antibody testing. For some employers, Arise is only the claims administrator for their self-funded health plan, not the insurer. In these situations, it is the decision of the employer to determine how this will be covered. Self-funded clients will be able to opt in to coverage changes and will be contacted by the Arise Account Management team. This benefit enhancement ends the later of the end of the federal public health emergency or March 13, 2021.

The IRS has indicated that a health plan that otherwise satisfies the requirements to be an HSA qualified High-Deductible Health Plan (HDHP) may provide health benefits associated with the testing of COVID-19 without a deductible, or with a deductible below the minimum deductible (self-only or family) for an HDHP. An individual covered by the HDHP will not be disqualified from being an eligible individual because they received COVID-19 testing. This will apply to in-vitro diagnostic testing and related services on or after Jan. 1, 2020, with respect to plan years beginning on or before Dec. 31, 2021.

If I need to see a doctor for COVID-19, is that covered?

Arise will waive prior authorization requirements, and cover with no out-of-pocket costs to the customer, COVID-19 diagnostic laboratory testing and health care costs associated with provider visits for testing (e.g., office visits, urgent care visits, hospital visits, emergency room visits, etc.) for all fully insured policyholders and for self-funded plan policyholders where the group has instructed us to provide this coverage. This coverage applies for both in-network and out-of-network providers. This enhanced benefit will apply through the end of the federal public health emergency.

Can telehealth services be used to get care for COVID-19?

In most cases, telehealth services are available to Arise customers and their dependents to answer questions about the virus, evaluate their risk, and provide support by phone or video call if they develop symptoms. While self-funded groups with our Freedom Essentials plan will be able to opt out of this coverage, all other self-funded group health plans must opt in to this coverage change. Self-funded groups should get in touch with us right away to ensure they have the telehealth benefit they want for their employees.

This benefit enhancement will go through the federal public health emergency or Dec. 31, 2020, whichever is later.

• For WPS Medicare supplement insurance customers: Due to recent guidance from the Centers for Medicare & Medicaid Services, Medicare and our Medicare supplement insurance plans will cover telehealth benefits through a medical provider (not Teladoc at this time) for as long as it is covered by Medicare.

Will cost-sharing apply to telehealth visits for services not related to COVID-19?

For telehealth services not related to COVID-19 testing, Teladoc is our preferred provider. For customers with health plans that are not HSA-qualified High Deductible Health Plans (HDHP), Arise will waive copays for telehealth services for any condition provided by Teladoc providers and other participating providers. If a customer has an HSA-qualified HDHP, deductibles and coinsurance will still apply. While self-funded groups with our Freedom Essentials plan will be able to opt out of this coverage, all other self-funded group health plans must opt into this coverage change. Self-funded groups should get in touch with us right away to ensure they have the telehealth benefit they want for their employees. This benefit enhancement will go through Dec. 31, 2020.

If I may be quarantined, can I get a larger supply of my prescription medications?

There is no change in the way prescription drug coverage is administered. However, we encourage the use of home delivery for medications when available to help maintain social distancing. Early refills are also available. Arise will allow early refills for both 30-day supplies and 90-day supplies of retail and home delivery prescriptions for both fully insured and self-funded groups. Note that not all medications are approved for extended supplies and the amount of the refill will vary depending on the number of refills remaining on the prescription.

What is covered if I'm quarantined?

Your Arise insurance plan covers all medically necessary services based on the terms of your policy. There is no coverage for housing, food, and other items.

What if I need to be hospitalized for COVID-19?

Hospitalizations are covered under the terms of your health plan.

How is WPS Health Plan handling temporary layoffs, furloughs, shutdowns, or reductions in hours for group health plan customers?

During temporary conditions such as these, Arise will allow employers to retain employees and their dependents on their group health plans as follows:

• Fully insured: Arise will waive its requirement for employees to be actively working in order to be eligible for coverage through Dec. 31, 2020, as long as the monthly premium payment is received and at least one employee of the group remains an eligible employee as defined in the group health plan. Coverage must be offered on a uniform, nondiscriminatory basis to all employees.
• Self-funded employer groups: Groups may opt into this benefit. Arise will waive its requirement for employees to be actively working in order to be eligible for coverage through Dec. 31, 2020, as long as the payment of administrative fees, claims cost, and Arise stop-loss premium is received and at least one employee of the group remains an eligible employee as defined in the self-funded group health plan. Coverage must be offered on a uniform, nondiscriminatory basis to all employees. If Arise is not the client’s stop-loss carrier, we recommend that the client verify coverage for this situation with their stop-loss carrier.

Who at Arise can I call with questions about COVID-19 and my Arise insurance plan?

You can call our Customer Support team using the number on your customer ID card.

Will there be coverage for a COVID-19 immunization when one becomes available?

Immunizations are an essential and highly effective way to prevent infectious disease in large populations. Unfortunately, an immunization for COVID-19 is not yet available. If and when an immunization is developed, it will be covered similar to other immunizations.

Are medical supplies such as masks, gloves, and disinfectants covered?

Most of these supplies are not currently covered by insurance plans in general.

• Wash your hands often with soap and water for at least 20 seconds, especially before eating and after going to the bathroom, blowing your nose, coughing, or sneezing.
• If you do not have soap and water, use an alcohol-based hand sanitizer with at least 60% alcohol.
Always wash hands with soap and water if hands are visibly dirty.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

New benefits added to WPS health plans

WPS coverage has been boosted with new benefits! Check out the list below and refer your patients to our Customer Service if they have questions. They can call the phone number on their WPS ID card.

Note: Self-funded group health plans have the option to select these benefits. Group members should check with their group leader to see if these benefits are covered. Group leaders who have questions can contact their WPS Health Insurance account manager.

• Telehealth related to COVID-19 testing: Services have 0% cost sharing through March 13, 2021.
• COVID-19 antibody testing: Physician-ordered in vitro antibody testing for COVID-19 is now covered at $0 cost sharing through March 13, 2021.
• Coverage for furloughed employees: The work exception for group health plans is extended through the remainder of 2020.
• Prior authorization: Requirements are waived for COVID-19 laboratory tests and treatment through Dec. 31, 2020.

How does COVID-19 impact the filing of a claim or appeal?

Each Provider Agreement contains provisions related to the timely filing of claims and appeals. In order to allow our Provider partners to focus their efforts on responding to the national health crisis and caring for their patients and our customers, WPS Health Plan will waive the enforcement of certain Provider Obligations:

• Timely filing limits will not be enforced for claims submitted between April 1, 2020, and Dec. 31, 2020. This applies to both new claims and claims that were resubmitted due to corrections.
• Timely filing limits for all provider appeals are waived for the remainder of 2020. Please note that Member Grievances are governed by the customer’s certificate of coverage and are not included in this extension.
• Providers who had already received Prior Authorization for procedures and services that have been canceled or postponed due to the COVID-19 crisis will be granted an additional 90 days to perform the procedure or service without needing to obtain another Prior Authorization.

Are there changes to how telehealth services work?

We have temporarily expanded our coverage of telehealth and telemedicine services to allow providers to render important healthcare services while protecting both patients and caregiving staff from avoidable exposure to COVID-19. Review our temporary telehealth policy.

Will customer cost sharing apply to COVID-19 testing?

Fully insured groups: No, effective March 18, 2020, our individual health plans and our group/employer health plans, including grandfathered and transitional health plans, must cover COVID-19 testing and the visit for testing from in-network and out-of-network providers, with no cost-sharing to our customers. This includes not requiring prior authorizations or other medical management requirements.

Specifically, we will not apply cost-sharing to:

• The tests and their administration
• Items and services provided during an office visit (including a telehealth visit), urgent care visit, or emergency room visits that result in an order for a test or its administration, to the extend they relate to the furnishing or administration of, or evaluation for, the test.

This change in coverage will not apply to services for the treatment of a positive COVID-19 test result.

Self-funded groups: For customers on a self-funded plan, the employer will need to make the determination on how COVID-19 testing claims should be adjudicated. The self-funded group (employer) will need to provide Arise with written direction on how to change their plan benefits. If a self-funded group health plan notifies us that they would like to change their benefit plan (e.g., waive the cost-sharing for testing), the group will see an increase in claims costs.

Will waiving the cost sharing for COVID-19 testing on an HSA-qualified High-Deductible Health Plan (HDHP) disqualify the individual from being able to make tax-favored contributions to an HSA account?

Fully insured groups: No. On March 11, 2020, the IRS released a notice that allows insurers to provide health benefits associated with the testing for COVID-19 (Coronavirus Disease 2019) without first applying the HDHP's applicable deductible. As stated in the notice, this is true until further guidance is issued.

Self-funded groups: Arise will make this change to self-funded groups upon receipt of written confirmation.

What if a practitioner needs to work at a different location?

Many providers have asked for flexibility in moving practitioners between service locations during the crisis. We have temporarily modified our process to allow practitioners to provide care at any location within the same entity (as defined by a single tax ID), even if that practitioner was not previously registered to that address. Please continue to provide roster updates as normal.

How does WPS Health Plan handle practitioners with licenses in other states?

We acknowledge the CMS 1135 waiver for state licensing, which temporarily allows out-of-state practitioners to provide services if they are licensed in another state. In the State of Wisconsin, organizations must follow the provisions outlined in the Wisconsin Department of Health Services Emergency Orders #16 and #20, found at evers.wi.gov/Documents/COVID19/EMO16-DSPSCredentialingHealthCareProviders.pdf and dsps.wi.gov/Documents/EmergencyOrder20.pdf.

Stimulus check scams

The Internal Revenue Service urges taxpayers to be on the lookout for a surge of scam phone calls and email phishing attempts about the coronavirus, or COVID-19. The schemes are related to the economic impact payments being issued by the U.S. government.

Read the news release

COVID-19 test kits

Beware of solicitors who try to sell you a coronavirus disease (COVID-19) test kit. Legitimate COVID-19 tests are ordered by your attending physician.

Do not give out personal information

If you are called by anyone other than your attending physician, please do not provide personal or health-related information. Never give your bank or credit card information to any solicitor over the phone.