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 testing 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.

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.

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 June 30, 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 June 30, 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.

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.

Should members be using telemedicine?

AmeriHealth New Jersey has expanded coverage of telemedicine services for the duration of New Jersey’s public health emergency. The change is one of many efforts to encourage social distancing and increase access to care.

The expanded telemedicine coverage for fully insured plans includes:

  • Providing coverage for any service which may be appropriately delivered via video or telephone through telemedicine (including but not limited to primary care, specialty, ancillary services, behavioral health)
  • Waiving cost-sharing on any telemedicine services, including non-COVID-19 related services for the duration of New Jersey’s public health emergency.
  • 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?

In March AmeriHealth New Jersey announced that we were lifting prescription refill restrictions, such as the “refill too soon” limit, for members with AmeriHealth New Jersey pharmacy benefits. At that time, we also began encouraging members to talk with their doctor regarding using their 90-day mail order benefit to see if that option made sense for them. The measures we took in March are important and help members access the prescription drugs they need to manage chronic conditions and maintain good health.

You may have seen stories regarding medication shortages in parts of the country in the news. Out of an abundance of caution and to help prevent drug shortages, we are modifying the prescription refill restrictions that were previously lifted. Now, members must have used at least two-thirds of their current medication supply before a refill would be possible.

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 members who may be affected financially by the COVID-19 situation?

AmeriHealth New Jersey has been closely monitoring the situation with COVID-19 and we understand the financial impact our members may be experiencing.

In response to the COVID-19 pandemic, we are offering payment flexibility to members who may need it. You may defer payment of your April or May invoice (one month’s premium) with no interest and no penalty. The deferred premium must be paid by December 1, 2020. You can make incremental payments each month through December 1 or can satisfy the deferred premium any month prior to December. You must be up to date on payments in order to be eligible for payment deferral.

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.

To provide more flexibility, AmeriHealth New Jersey is accepting premium payments made with credit cards until July 31, 2020. Credit cards may be used to satisfy past due premiums as well as current amounts that are due. You may use an Amex, Discover, MasterCard, or Visa credit card. To pay with a credit card, you can:

If you are concerned about your ability to make a payment due to the COVID-19 pandemic, call us at 1-888-879-5331 (TTY: 711) for help evaluating your health plan options. If you purchased your plan through an independent broker, you can contact your broker for assistance or call us is you prefer.

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.

We have also been communicating the latest news and information about COVID-19 to providers through our existing communication channels.

We encourage our provider partners to visit the Provider News Center at amerihealthnj.com to get the latest changes in policy and coverage related to the COVID-19 pandemic.

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: