Your frequently asked questions about COVID-19 (coronavirus)

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

COVID-19 FAQ

Will AmeriHealth New Jersey cover the cost of the COVID-19 vaccine?

The COVID 19 vaccine will be covered for members as a preventive service, similar to the flu vaccine. That means AmeriHealth New Jersey will cover and waive member cost-sharing (such as copays, deductibles, and coinsurance) for administration of the COVID-19 vaccine. If you get the vaccine from an in-network provider at an office visit, and the office visit is not considered preventive, then cost-sharing will still apply for the office visit (not the vaccination).

The vaccines are approved by the Food and Drug Administration (FDA) for Emergency Use Authorization (EUA). The federal government will initially supply the vaccine to health care providers at no cost and they will be distributed by state governments according to state vaccine distribution plans. As with any vaccine, AmeriHealth New Jersey does not control the availability or prioritization of distribution.

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 we would cover testing¹ at any site for active COVID-19 (RT-PCR) at no cost to our members. We are waiving cost sharing (deductible, co-pays and coinsurance) for both in- and out-of-network testing 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. Please note, antibody testing requires authorization by a licensed or qualified health care professional.

At-home test kits and at-home self-sample collection kits are also being covered by AmeriHealth New Jersey when they are medically appropriate, ordered by a health care professional, and under FDA Emergency Use Authorization (EUA) guidance (the self-collection materials, including kits, also need to have specific FDA EUA approval in order to be covered).

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.

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.

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 for commercial groups and individual members through March 31, 2021. This means members will pay no co-pay, co-insurance or deductible in this scenario.

AmeriHealth New Jersey is also waiving the need for providers to call AmeriHealth New Jersey prior to transferring members with any diagnosis from acute in-network inpatient facilities to in-network post-acute facilities (long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities) and other in-network inpatient facilities through February 28, 2021. This also applies to in-network ambulance transfers.

In addition, AmeriHealth New Jersey is waiving prior authorizations for acute inpatient admissions for a COVID-19 diagnosis from the emergency room for commercial and individual members through March 31, 2021. Facilities must notify UM departments within two business days from admission. This includes transfers from acute in-network, in-patient facilities to in-network long-term ambulatory care, rehabilitation, or skilled nursing facilities; transfers from acute in-network inpatient facilities to other in-network in-patient facilities, transportation between facilities.

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.

Are there options available for consumer members who may be affected financially by the COVID-19 situation?

If your taxable income is expected to go down in 2021, you may be eligible for increased tax credits (subsidy). Remember, your tax credits are based on your expected household income for the 2021 health plan year, not your 2020 income. If your taxable income is expected to go down in 2021, contact us at 1-888-879-5331 (TTY: 711) and we can help report an income change.

For 2021 New Jersey transitioned to a state-based exchange, Get Covered New Jersey. In New Jersey all residents are required to have health care coverage, and this year consumers who purchase or renew a health plan through Get Covered New Jersey may be eligible for a new state-based subsidy, in addition to the existing federal subsidy. Open enrollment runs through January 31, 2021.

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. We 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 waiver of cost sharing (deductible, co-pays and coinsurance) for both in- and out-of-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.

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.