English version
-------------------- Medical Care ---------------------
1. Will DIANins plans cover COVID-19 screening and testing?
Yes. In these extraordinary times, WellAway Limited will continue to cover COVID-19 testing provided by in-network providers consistent with CDC and WHO guidelines (determined to be medically appropriate by an individual’s healthcare provider in accordance with current accepted standards of medical practice) and diagnostic testing (approved by the applicable local laws where the insured person resides). WellAway Limited will waive cost share amounts such as co-payments, coinsurance, and deductible (with in-network providers in the USA), whether at an approved testing facility, provider’s office, urgent care center or via telemedicine until April 15, 2022. Testing will be covered at 100% of Usual, Reasonable and Customary Charges, with a maximum benefit of $100 per test. Only a health care provider can administer the test and send the sample to an approved lab for results. Diagnostic testing may include testing of symptomatic patients, as well as testing of asymptomatic patients when determined to be medically necessary based on an individualized assessment of the patient, such as for an upcoming procedure or recent known or suspected exposure to an infected individual. This is applicable to all WellAway products. Locate a Covid Testing Center Near You | UnitedHealthcare® (uhc.com)
2. Are all types of COVID-19 tests covered by DIANins plans?
No. Not all diagnostic tests are covered - only the COVID-19 tests that have received an emergency use authorization under the Federal Food, Drug, and Cosmetic Act enacted in the United States will be covered. A complete list of the approved tests can be found here: FDA website. There is also a list of clinical laboratories and commercial manufacturers that have notified the FDA that they are offering the test in accordance with FDA guidance. These tests may also be covered; however, WellAway may request that a laboratory or commercial manufacturer provide documentation demonstrating the request for emergency use authorization.
3. Does DIANins plans cover COVID-19 at-home testing?
If your policy covers outpatient medication through our Pharmacy Benefit Manager, EHIM, we will cover a maximum of 8 over-the-counter at-home COVID-19 tests per insured person per month for the cost of $12 per test during the public health emergency period. You will need to obtain the at-home tests at one of EHIM’s participating pharmacies and present your prescription ID card at time of purchase. If you prefer to purchase an over-the-counter at-home COVID-19 test(s) on your own, you can submit the expense as a paper claim to EHIM for reimbursement. Note: whether you purchase an over-the-counter at-home COVID-19 test(s) or obtain the at-home test(s) at one of EHIM’s participating pharmacies, the maximum coverage is 8 tests per insured person per month (at the cost of $12 per test). Learn more about how to get an over-the-counter at-home COVID-19 test, coverage information and reimbursement details.
Free over-the-counter at-home COVID-19 test are also available through the Federal government. Each household can order a one-time shipment of 4 free over-the-counter at-home COVID-19 tests which are shipped directly from covidtests.gov.
4. Will DIANins plans limit the number of tests that are covered?
Most Wellaway plans do not limit the number of tests covered which are provided by in-network providers as long as the test is: (i) consistent with the CDC guidelines; (ii) diagnostic; and (iii) determined to be medically appropriate by an individual’s healthcare provider in accordance with current accepted standards of medical practice. Testing will be covered at 100% of Usual, Reasonable and Customary Charges, with a maximum benefit of $100 per test.
5. Are COVID-19 treatments covered?
Yes. For in-network providers, WellAway will cover treatments for COVID-19, subject to any cost-share and maximum benefit amounts in accordance with your policy terms and conditions, including any co-payments, coinsurance, deductible or out-of-network costs. The treatments that WellAway will cover for COVID-19 from doctors, hospitals, and other health care professionals are those covered under Medicare or other applicable state regulations in the United States. The company will reimburse health care providers at WellAway’s in-network rates. Providers must use proper diagnosis and procedure codes related to COVID-19. Certain student and short-term plans in any geographic region will only cover screening services and diagnostic testing. Coverage for expatriates will be determined in accordance with the member’s policy terms and conditions (as any other illness) when medically necessary. Treatment must be delivered by the proper healthcare professional or facility.
6. Will DIANins plans Limited cover the cost of treatment for COVID-19 Out of Network?
If the member visits an out-of-network provider, COVID-19 treatment will be covered in the case of a medical emergency and paid as out of network benefits. Members should seek care from in-network providers whenever possible to minimize costs and to avoid higher cost share amounts. Out-of-network providers may charge more than the covered benefit amount; in this case, the member may be responsible for paying the difference and cost share amounts.
7. Is prior authorization required for COVID-19 screening and testing?
No. Prior authorization is not required for the COVID-19 test. However, please refer to your policy for pre-authorization requirements pertaining to certain medical services.
8. Is DIANins plans covering COVID-19 serology (antibody) testing?
Yes, but only when it is medically necessary to determine a treatment plan, and the antibody test is provided in line with CDC recommendations. According to guidance from the FDA, CDC and WHO, antibody tests should not be used as the basis for diagnosis, and there are only very limited benefits and medically necessary applications for the use of antibody tests in the treatment of COVID-19. If antibody testing is approved, it will be covered at 100% of Usual, Reasonable and Customary Charges, with a maximum benefit of $42 per test or based on the rates established by the Centers for Medicare and Medicaid Services.
9. Will DIANins plans cover costs for COVID-19 testing so members can return to work or for travel?
No. COVID-19 testing performed for non-diagnostic purposes, such as for public health surveillance or social purposes will not be covered (such as employment (return to workplace), education, travel, or entertainment). Specifically, return to work testing is not done to improve the health outcome of the employee being tested; and, therefore, would not be covered as a benefit under a WellAway Limited plan. This is consistent with coverage for other types of testing that might be administered for the benefit of an employer, such as employer-required drug or alcohol testing (which is not covered as a health plan benefit).
10. Is an approved vaccine covered?
Yes. Approved vaccines that are currently available for the treatment or prevention of coronavirus are covered.
----------------------- Pharmacy Benefits -------------------------
1. Are members allowed to fill their prescriptions earlier or have larger fill or refill amounts to offset difficulties with getting medications?
Yes. For the duration of the public health emergency, WellAway Limited will waive early refill limits on prescription medications. These refills cannot exceed guidelines for drug administration and no more than a 90-day supply. Please note that WellAway Limited does not recommend stockpiling medications. However, early refill limits have been adjusted so that members can refill an extended supply of their medication according to their benefit. For any questions regarding early refills, members may call the ConciergeCare number on the back of their WellAway ID card or by calling WellAway Limited for further information.
2. What happens if there are shortages of medications due to this pandemic?
In the event of a prescription drug shortage, WellAway Limited has a standard process in place to take immediate steps so that members have access to alternative medications to treat their condition. WellAway Limited’s process includes monitoring drug shortage notifications from the FDA, CDC and WHO evaluating and changing formulary coverage, and if necessary, identification of alternative medications to treat the same condition. Affected members and their prescribers will be notified of the shortage and applicable treatment alternatives in the event of a shortage.
3. Can members receive home health infusion by a nurse in their home instead of going to a hospital in order to avoid exposure to COVID-19, and help reduce traffic at the hospital?
Yes. If members normally receive drug infusion services in a facility, they should talk with their doctor about whether their drug infusion services should be continued and if they can be administered at home instead. If the member's physician or authorized prescriber determines he/she can safely receive drug infusions at home, WellAway Limited and members are eligible for physician-ordered and plan authorized home infusion services.
4. How can members practice social distancing and conveniently access their prescription medications?
Members can practice social distancing by:
• Contacting their local retail pharmacy about delivery services.
• Filling extended day supply of maintenance medications.
• Access 90-day supplies of maintenance medications used to treat chronic conditions.
• Contact their physician to switch to a 90-day prescription refill.
------------------------ Virtual Care ------------------------
1. Does your plan cover telemedicine?
Yes. Telemedicine and international telemedicine services are covered under WellAway Limited’s standard plan designs. In the United States, telemedicine services are available through Teladoc as a covered benefit through those network providers that offer such services.
In addition, WellAway Limited is expanding access to telemedicine services in response to COVID-19 by allowing providers to offer COVID-19 screening services using an expanded range of telehealth platforms when the practitioner is seeing patients via Zoom portal, Microsoft teams or other types of virtual services adopted by the accredited medical practitioner (when performed appropriately during the COVID-19 public health emergency). Visits should be billed by the provider using the normal billing process for an office visit. In the United States, this is covered for all in-network providers. If the member uses an out-of-network provider, the service will be paid as out-of-network benefits. Members should seek care from in-network providers whenever possible to minimize costs and to avoid higher cost share amounts. Out-of-network providers may charge more than the covered benefit amount; in this case, the member may be responsible for paying the difference.
2. Will WellAway Limited cover Teladoc COVID-19 visits?
Yes. Copays for any Teladoc visits will be waived for members enrolled in all WellAway Limited plans whether or not related to COVID-19.
3. If a member pays for the co-payment, either through an office visit or Teladoc or International Telehealth, because the provider requested payment at time of service, will they be reimbursed?
Yes. If a member is improperly charged for a co-payment, the member should call the number on the back of his/her ID card and ConciergeCare will contact the provider obtain a reimbursement for the member.
We will keep you updated of any further COVID-19 developments. We are always available to answer any questions: ConciergeCare U.S. +1-855-773-7810 | ConciergeCare International: +1-786-453-4008 (collect) | Email: conciergecare@wellaway.com
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中文
WellAway Limited 遵循以下指南：美国疾病控制中心 (CDC)、美国食品和药物管理局 (FDA)、世界卫生组织 (WHO)、欧洲药品管理局 (EMA) 和世界贸易组织 (WTO)。在美国，我们通过了家庭优先冠状病毒救济法案 (FFCRA) 和 CARES 法案，以及医疗保险和医疗补助中心 (CMS) 的指导。在世界其他地区，遵循并采用适用监管机构、国家或地区的指导。根据上述指南，我们为在其许可范围内行事的医疗保健提供者订购或管理的患者提供医疗必要的诊断测试（PCR 或抗原），而无需分摊费用。 COVID-19 诊断治疗是否属于医疗必须的情况应由医疗保健提供者根据 COVID-19 的体征和症状进行评估来确定。
-------------------- 医疗保健 ---------------------
是的。在这些非常时期，WellAway Limited 将继续涵盖由网络内提供者提供的 COVID-19 检测，这些检测符合 CDC 和 WHO 指南（由个人的医疗保健提供者根据当前公认的医疗实践标准确定在医学上是适当的）和诊断测试（经被保险人居住地适用的当地法律批准）。 WellAway Limited 将在 2022 年 4 月 15 日之前免除共同支付、共同保险和免赔额等分摊费用（适用于美国的网络内合作机构）。无论是在经批准的测试设施、医生办公室、紧急护理中心（urgent care）还是通过远程医疗，测试将按通常、合理和惯常收费（URC）的 100% 支付，每次测试的最高限额为 100 美元。只有医疗保健提供者可以管理测试并将样本发送到批准的实验室以获得结果。诊断测试可能包括对有症状患者的测试，以及在基于对患者的评估由医生认为医学必要性时对无症状患者进行测试，例如针对即将进行手术或最近已知或疑似接触感染者。这适用于所有 WellAway 产品。
不是。并非所有诊断测试都包括在内 - 只有根据美国颁布的《联邦食品、药品和化妆品法案》获得紧急使用授权的COVID-19测试才会被覆盖。批准测试的完整列表可以在这里找到：FDA网站。 还有一份临床实验室和商业制造商的名单，他们正在根据FDA的指导方针提供测试。这些测试也可能包括在内;但是，WellAway可能会要求实验室或商业制造商提供证明紧急使用授权请求的文件。
如果您的保单通过我们的药房福利经理EHIM承保门诊处方药，我们将在公共卫生紧急期间，每位被保险人每月最多承保8次非处方家庭COVID-19测试，每次测试费用为12美元。您需要在EHIM的一家参与药店进行at-home测试，并在购买时出示您的保险ID卡。如果您希望自己购买非处方自测盒，您可以将费用以书面形式提交给EHIM进行报销。注意：无论您是购买非处方家用自测盒，还是在EHIM合作药房的其中一家购买家庭测试盒 ，最大承保范围为每个人每月8次（每次测试的费用最高为12美元）。点击了解如何获得非处方家用自测盒，以及覆盖信息和报销详情。
联邦政府也可获得免费的非处方家用自测盒。 每个家庭可以一次性订购4盒免费的非处方自测盒，这些自测盒直接从covidtests.gov发货。
大多数Wellaway计划不限制网络内提供商提供的测试数量，只要测试是：（i）符合 CDC指南;（二） 诊断;（iii）根据当前公认的医疗实践标准，由个人的医疗保健提供者确定为医学上适当的。测试将覆盖100%的常规，合理和习惯性收费，每次测试的最大收益为100美元。
是的。WellAway 会承保 COVID-19 的治疗，但须根据您的保单条款和条件承担任何分摊费用和最高福利金额，包括任何共付额、共同保险、免赔额或网络外费用。WellAway 会承保从医生、医院和其他医疗保健专业人员获得的COVID-19治疗，其治疗需是联邦医疗保险或美国其他适用州法规所承保的治疗。该公司将以 WellAway 的网络内费率向医疗保健提供者报销。医疗提供者必须使用与 COVID-19 相关的正确诊断和程序代码。任何地理区域的学生和短期计划将仅涵盖筛查服务和诊断测试。外籍人士的承保范围将在医疗必要时根据会员的保单条款和条件（与任何其他疾病一样）确定。请参阅您的福利摘要以了解最高福利金额（如果有）。治疗必须由适当的医疗保健专业人员或机构提供。
如果会员是在网络外医疗提供者那就诊，COVID-19 治疗会承保在医疗紧急情况下，并作为网络外 福利支付。会员应尽可能向网络内提供者寻求护理，以尽量减少成本并避免更高的成本分摊金额。网络外医疗提供者收取的费用可能超过承保的福利金额；在这种情况下，会员可能负责支付差额和费用分摊金额。
不需要。 COVID-19 测试不需要事先授权。但是，有关某些医疗服务的预授权要求，请参阅您的政策。
可以，但只有在医疗必须情况下，且抗体检测符合CDC的建议时才可以。根据美国FDA、CDC和WHO的指导意见，抗体检测不应作为诊断依据，使用抗体检测治疗COVID-19的益处和医学上的必要应用非常有限。如果抗体检测被批准，它将以100%的正常、合理的按照保险福利覆盖，每次检测的最高报销额度是42美元，或基于医疗保险和医疗补助服务中心建立的费率。
不会。出于非诊断目的（例如公共卫生监测或社交目的）（例如就业、重返工作场所、教育、旅行或娱乐）而进行的 COVID-19 检测不在承保范围内。具体而言，复工检测并不是为了改善被检测员工的健康状况；因此，不会作为 WellAway Limited 计划的福利承保。这与可能为雇主利益而进行的其他类型检测的承保范围一致，例如雇主要求的药物或酒精检测（不作为健康计划福利承保范围内）。
是的。 目前可用于治疗或预防冠状病毒的批准疫苗包括在内。
----------------------- 药房福利 -------------------------
1. 是否允许会员提前配药或有更大的配药或补充药量来抵消获得药物的困难？
是的。在公共卫生紧急情况期间，WellAway Limited 将免除处方药的提前补充限制。这些补充装不能超过药物管理指南，也不能超过 90 天的供应量。请注意，WellAway Limited 不建议储存药物。但是，提前补充限制已经过调整，以便会员可以根据他们的利益补充延长的药物供应。如果您对提前续费有任何疑问，会员可以拨打 WellAway ID 卡背面的 ConciergeCare 号码或致电 WellAway Limited 了解更多信息。
2. 如果因为这次大流行病导致药物短缺怎么办？
遇到处方药短缺的情况下，WellAway Limited 有一个标准流程可以立即采取措施，以便会员能够获得替代药物来治疗他们的病情。 WellAway Limited 的流程包括监控来自 FDA、CDC 和 WHO 的药物短缺通知，评估和更改处方覆盖范围，并在必要时确定治疗相同病症的替代药物。受影响的成员及其开药者将收到短缺情况以及出现短缺时适用的治疗替代方案。
3. 会员是否可以在家中接受护士到家的输液，而不是去医院，以避免接触 COVID-19，并帮助减少医院的人流量？
是的。如果成员通常在机构接受药物输注服务，他们应该与他们的医生讨论是否应该继续他们的药物输注服务，以及是否可以在家中进行。如果会员的医生或授权开药者确定他/她可以在家中安全地接受药物输液，WellAway Limited 和会员有资格获得医生订购和计划授权的家庭输液服务。
4. 会员如何保持社交距离并方便地获取他们的处方药？
会员可以通过以下方式进行社交距离：
• 联系当地零售药房了解送货服务。
• 补充长期供应的维持药物。
• 获得用于治疗慢性病的 90 天维持药物供应。
• 联系他们的医生以改用 90 天的处方补充剂。
------------------------ 虚拟护理 ------------------------
1. 您的计划是否涵盖远程医疗？
是的。 WellAway Limited 的标准计划设计涵盖了远程医疗和国际远程医疗服务。在美国，远程医疗服务可通过 Teladoc 获得，作为提供此类服务的网络提供商的承保福利。
此外，WellAway Limited 正在扩大远程医疗服务的使用范围，以应对 COVID-19经认可的医生采用的虚拟服务（在 COVID-19 公共卫生紧急情况期间适当执行时）。医疗提供者应使用办公室访问的正常计费流程对访问进行计费。在美国，这适用于所有网络内提供者。如果会员使用网络外提供商，则该服务将作为网络外福利支付。会员应尽可能向网络内医疗提供者寻求护理，以最大限度地降低成本并避免更高的成本分摊金额。网络外医疗提供者收取的费用可能超过承保的福利金额；在这种情况下，会员可能负责支付差价。
2. WellAway Limited 会承保 Teladoc COVID-19 就诊吗？
是的。对于参加所有 WellAway Limited 计划的会员，无论是否与 COVID-19 相关，都将免除任何 Teladoc 访问的Copay（挂号费）。
3. 如果会员通过医生办公室访问或 Teladoc 或国际远程医疗被要求支付Copay（挂号费），因为提供者在服务时要求会员付款，那他们会得到这个费用的报销吗？
是的。如果会员因Copay（挂号费）被不当收取费用，会员应拨打其身份证背面的电话号码，ConciergeCare 将联系提供商为会员获得补偿。
我们将随时向您通报 COVID-19 的任何进一步发展。我们随时可以回答任何问题：ConciergeCare U.S. +1-855-773-7810 | ConciergeCare International：+1-786-453-4008（收集）|电子邮件：conciergecare@wellaway.com
ConciergeCare U.S +1-855-773-7810 | ConciergeCare International: +1-786-453-4008
Email: conciergecare@wellaway.com