Cranbury, NJ, December 29, 2020 — AmeriHealth New Jersey is extending many of its waivers for COVID-19-related care. In addition to those extensions, AmeriHealth New Jersey is waiving all cost-sharing (such as copays, deductibles, and coinsurance) for the administration of the COVID-19 vaccine to commercial group and individual members.
To date, the U.S. Food and Drug Administration (FDA) has authorized the emergency use of vaccines developed by Pfizer, Inc. and Moderna, Inc. The federal government is initially supplying the vaccines to health care providers to administer to their staffs who are on the front lines of treating people who are sick with COVID-19. The Centers for Disease Control and Prevention also recommends that the vaccine be given first to residents of long-term care facilities, who are at especially high risk of dying from the disease.
As with all vaccines, AmeriHealth New Jersey has no control over the availability and prioritization of distributing the vaccine. Distribution of the COVID-19 vaccine will be controlled by the federal government, in collaboration with state and local governments.
AmeriHealth New Jersey has also extended several other waivers related to COVID-19 care, including:
- Waiving member cost-sharing for diagnostic and antibody testing related to COVID-19 at any site for commercial group and individual members until 90 days after the end of both the state of emergency and the public health emergency related to COVID-19. 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).
- Continuing to waive member cost-sharing for all telemedicine1,2, services for commercial group 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 visits with in-network primary care doctors and specialists (urgent care, behavioral health specialists3, nutritionists, video-only visits for physical and occupational therapy; and audio or video for speech therapy.)
- Waiving member cost-sharing for in-network, acute in-patient treatment of COVID-19 through March 31, 2021.
- Waiving the need for providers to call AmeriHealth New Jersey prior to transferring members without a COVID-19 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 January 31, 2021. This also applies to in-network ambulance transfers.
- Waiving prior authorizations for acute inpatient admissions for any COVID-19 diagnosis from the emergency room for commercial group and individual members through March 31, 2021. 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.
For more information, visit amerihealthnj.com/covid19.
¹References to telemedicine include telehealth.
²Out-of-network testing and diagnosis of COVID-19 is covered without cost sharing (deductible, co-pays and coinsurance) when performed during in-person or telemedicine visits, or at any site, 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.
3Out-of-network services are not covered unless included in the applicable benefit design or permitted by AmeriHealth New Jersey due to network adequacy or access limitations.
About AmeriHealth New Jersey
For more than 25 years AmeriHealth New Jersey* has been dedicated to enhancing the health and well-being of the people and communities we serve. Our members are at the center of everything we do. Since the onset of the Affordable Care Act, we have been committed to offering health plans on the Individual Marketplace, which has expanded access to coverage for New Jersey residents. The company also participates in New Jersey’s state-based exchange that was established in 2020. We are exclusively focused on New Jersey with plans designed to meet the unique needs of individuals, small- and mid-sized businesses, municipalities and boards of education across the state. We also provide access to administrative services for self-funded groups. Named one of the Best Places to Work for the past nine years, AmeriHealth New Jersey is located in Cranbury, NJ. For more information visit amerihealthnj.com.
Manager, Public Relations
AmeriHealth New Jersey