Arise Health Plan is actively monitoring the current international and domestic environment for COVID-19 as well as the related risks so we can prepare accordingly. On this page, you’ll find links to information about COVID-19, related news, and information on what Arise is doing to help our customers.
Note: The content below is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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."
Common signs of infection include:
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.
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.
Arise will waive any cost-sharing for diagnostic laboratory tests related to COVID-19. For some employers, Arise is only the administrator, 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.
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.
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.
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. Cost-sharing for office visits to determine if COVID-19 testing is needed and the testing itself are waived, which means customers pay no copays, deductibles, or coinsurance. For services not related to COVID-19 testing, Teladoc® is our preferred provider and other telehealth services (such as those offered by provider groups) will be covered based on the terms of the customer's health plan. 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.
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.
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.
Hospitalizations are covered under the terms of your health plan.
During temporary conditions such as these, Arise will allow employers to retain employees and their dependents on their group health plans as follows:
You can call our Customer Support team using the number on your customer ID card.
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.
Most of these supplies are not currently covered by insurance plans in general.
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, Arise Health Plan will waive the enforcement of certain Provider Obligations:
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.
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:
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.
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.
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.
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.
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.
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.
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.
Given the rapidly evolving nature of this disease, the above guidance is subject to change.