Your frequently asked questions about COVID-19 (coronavirus)

Have a question about COVID-19? We’re here to help.

Will AmeriHealth New Jersey cover testing for COVID-19?

AmeriHealth New Jersey is committed to ensuring that our members have access to the care they need, at the right time, and in the right setting. As COVID-19 has escalated into a serious global health threat, we are working to make sure that our members can receive appropriate testing and treatment for this virus if needed.

In March, we quickly announced that we would cover testing¹ for active COVID-19 (RT-PCR) at no cost to our members. AmeriHealth New Jersey will cover and reimburse member cost-sharing (such as copays, deductibles, and coinsurance) for the COVID-19 test and the administration of the test when performed at an in-network physician’s office, urgent care center, or an emergency room. This is in effect for fully insured groups and individual members until 90 days after the end of both the state of emergency and the public health emergency related to COVID-19.

AmeriHealth New Jersey will cover COVID-19 antibody testing with no member cost-share in accordance with federal guidelines and company medical policy for the duration of the COVID-19 pandemic.

For services not related to COVID-19, we will continue to apply the appropriate member cost-sharing. This includes members enrolled in our commercial fully insured plans, employer-sponsored plans and the individual and family plans available through the Affordable Care Act.

Given that the test is new and specific billing codes for commercially available tests were only recently designated, members should report any concerns about claim payment to our customer service staff at the number on their member card. At this time, the Centers for Disease Control and Prevention (CDC) and state labs currently performing the testing are not billing for COVID-19 testing, so members should not incur costs when tested by these labs.

If members have any questions about whether they should be tested, they should contact a health care professional who will work with the state public health department in the member’s state and the CDC to determine if they need to be tested for COVID-19.

How can members find a testing location?

If you suspect that you may have COVID-19, your first step should be to contact your primary doctor. Your primary doctor will screen you for testing based on CDC guidelines. If you meet the testing criteria, your doctor will discuss your testing options with you. Members who don’t have a primary doctor can utilize MDLive services without cost-sharing for the duration of New Jersey’s public health emergency. An MDLive physician can perform the screening and determine your next steps. You can register for MDLive at amerihealthnj.com. For self-funded health plans, coverage of telemedicine services is provided for COVID-19 services related to testing without member cost-sharing consistent with the federal Families First law.

New Jersey residents can contact the NJ Department of Health for more information at 1-800-962-1253 or 1-800-222-1222.

Members can find testing locations in NJ on the AmeriHealth New Jersey COVID-19 website.

What about treatment?

AmeriHealth New Jersey is waiving member cost-sharing for in-network, inpatient, acute care treatment for COVID-19. This means members will pay no co-pay, co-insurance or deductible in this scenario.

AmeriHealth New Jersey will also waive cost-sharing for Emergency Department visits when members are admitted to the hospital under these same conditions. These changes are effective March 30, 2020 and will extend through December 31, 2020. The changes are for fully insured business; self-insured customers can opt-out of coverage.

AmeriHealth New Jersey also temporarily suspending prior authorizations for acute inpatient admissions from an Emergency Department at all in-network facilities for members with all diagnoses through December 31, 2020. In addition, prior authorization requirements are temporarily suspended for transfers from acute in-network inpatient facilities to post-acute in-network facilities (long-term acute care hospitals, rehabilitation or skilled nursing facilities) for any diagnoses. Temporary suspension of prior authorization includes waiving authorization of in-network transportation from facility to facility. Notification from facilities is still required.

This includes suspending prior authorization requirements for in-network transportation from an acute inpatient facility to a post-acute facility.

These steps are intended to facilitate and reduce administrative processes for the placement of COVID-19 patients to the most appropriate care settings.

If our members would like information about specific symptoms they are experiencing or have questions about their personal health, we recommend that they contact their doctor. For reliable information about the coronavirus disease (COVID-19), we suggest visiting the CDC website at cdc.gov/coronavirus.

Should members be using telemedicine?²

AmeriHealth New Jersey has expanded coverage of telemedicine services. The change is one of many efforts to encourage social distancing and increase access to care.

The expanded telemedicine coverage is in effect for fully insured groups and individual members until 90 days after the end of both the state of emergency and the public health emergency related to COVID-19. This includes:

  • Waiving cost-sharing on any in-network telemedicine services which may be appropriately delivered via video or telephone through telemedicine (including but not limited to primary care, specialty, ancillary services, behavioral health3)
  • Waiving prior authorizations on any telemedicine services while the COVID-19 emergency order is in place. Providers must notify AmeriHealth New Jersey that the member is receiving services.

The new expansion of telemedicine complies with recently enacted New Jersey legislation.

Members should ask their primary care doctor or specialist to see if they can conduct a visit by phone or video chat. Members can also access MDLive through our member website at amerihealthnj.com.

For self-funded health plans, coverage of telemedicine services is provided for COVID-19 services related to testing without member cost-sharing consistent with the federal Families First law.

Will AmeriHealth New Jersey waive prior authorization requirements for members who need treatment for COVID-19?

At this time, treatment of COVID-19 is primarily supportive care, and any medical management would be similarly aligned and in accordance with the terms of an individual’s insurance plan. We are carefully monitoring COVID-19 developments and will make any necessary modifications accordingly.

Prior authorization is not required for members seeking care in an urgent care setting or emergency room. In addition, AmeriHealth New Jersey will temporarily suspend prior authorization for acute inpatient admissions from the Emergency Department for all diagnoses, including COVID-19. Temporary suspension of prior authorization includes waiving authorization of in-network transportation from facility to facility.

Will AmeriHealth New Jersey waive prescription drug refill limits?

We are carefully monitoring COVID-19 developments and will make adjustments to policies as appropriate. We recommend that members call the Pharmacy Services number on their ID cards as needed if they require additional medication refills due to a potential quarantine situation.

How is AmeriHealth New Jersey helping consumer members who may be affected financially by the COVID-19 situation?

AmeriHealth New Jersey encourages all members who are able to pay their health plan bill on time to continue to do so, but we understand the toll this crisis is taking on many families and individuals.

To provide more flexibility, members can pay their premium via credit card payments until December 31, 2020. Credit card payments may be used to satisfy past due premiums as well as any current amounts that are due. AmeriHealth New Jersey will accept American Express, Discover, Visa, and MasterCard. To further help consumer members, AmeriHealth New Jersey will waive the fees associated with credit card payments. Members can make credit card payments by:

If your taxable income is expected to go down in 2020, you may be eligible for increased tax credits (subsidy). Remember, your tax credits are based on your expected household income for the 2020 health plan year, not your 2019 income. If your taxable income is expected to go down in 2020, contact us at 1-888-879-5331 (TTY: 711) and we can help report an income change.

If members have questions or need additional help related to premium payments, they can call AmeriHealth New Jersey at 1-888-879-5331 (TTY: 711).

How is AmeriHealth New Jersey communicating with its employees about COVID-19? How is AmeriHealth New Jersey working to keep its workforce safe?

AmeriHealth New Jersey remains steadfast in the aim to reduce the impact of COVID-19 on our workforce, our members, our customers, and our business. We communicate regularly with our associates and have taken several steps to safeguard their health.

On Tuesday, March 17, AmeriHealth New Jersey announced that that the company will close its office, effective March 18, until further notice. All employees are working remotely to reduce the risk of illness through person-to-person contact. Company leadership is developing a reentry strategy based on guiding principles that focus on the health and safety of our associates. We remain committed to maintaining high-performing operations to ensure the stability of our business and service to our members and customers.

How is AmeriHealth New Jersey working with, and communicating with, providers related to COVID-19?

AmeriHealth New Jersey is fortunate to have strong relationships with the providers, hospitals and health systems that provide care for our members. Our executives are staying in close contact with leaders within the provider community to monitor this rapidly changing situation and make the most appropriate decisions to help maintain the health and wellness of people in the communities we serve.

AmeriHealth New Jersey launched a COVID-19 Provider Hub website to inform doctors, hospitals, health systems, and other health care professionals on everything AmeriHealth New Jersey is doing to support front line workers during the pandemic. We have also been communicating the latest news and information about COVID-19 to providers through our existing communication channels.

How is AmeriHealth New Jersey working with elected officials related to COVID-19 planning and prevention?

AmeriHealth New Jersey is actively monitoring developments as identified by public health organizations and elected officials at the regional, state and federal levels. Our executives are readily available to leaders at all levels as they monitor this rapidly changing situation and are making the most appropriate decisions to help maintain the health and wellness of people in the communities we serve.

If members or employers want more information about COVID-19, where should they go?

If our members or employers would like information about specific symptoms they are experiencing or have questions about their personal health, we recommend that they contact their doctor.

For reliable information about the coronavirus disease (COVID-19), we suggest visiting the Centers for Disease Control and Prevention (CDC) website at cdc.gov/coronavirus. The State of New Jersey has also established a website with information about COVID-19.

AmeriHealth New Jersey launched a comprehensive website dedicated to COVID-19 information and resources at amerihealthnj.com/covid-19. As well, we will continue to update our newsroom and our social media channels with the latest information about COVID-19, and we will continue to proactively communicate with our key stakeholders through our existing channels, as needed.

Additional resources include:

¹The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that member cost sharing (deductible, co-pays and coinsurance) is waived both in and out-of-network for the testing and diagnosis of COVID-19 through the public health emergency. When the public health emergency referenced by the FFCRA and CARES Act ends, the waiver of cost sharing for out-of-network COVID-19 testing and diagnosis will end. The waiver of cost sharing for in network testing and diagnosis of COVID-19 will continue until 90 days after the end of both the state of emergency and public health emergency declared by the State of New Jersey in response to COVID-19. For High Deductible Health Plans, in-network cost sharing waivers for inpatient COVID-19 treatment detailed above will remain in effect through December 31, 2020 unless prohibited by law.

²References to telemedicine include telehealth.

3Unless the benefit design provides otherwise or out-of-network visits are permitted by AmeriHealth New Jersey due to network adequacy or access.