Coverage updates
We at Quartz are doing everything we can to keep you informed during this pandemic. We have several updates on extended terms for fully insured business members.
Extended deadlines for no-out-of-pocket coverage
COVID-19 viral tests:
- For commercial affiliates From Quartz, there will be no copayment, coinsurance, or deductible for medically necessary COVID-19 tests * ordered by a provider in our network until the end of the federal public health emergency.
- For Quartz Medicare Advantage members, there will be no copayment, coinsurance, or deductible for medically necessary * COVID-19 tests ordered by a provider in our network until the end of the federal public health emergency.
COVID-19 Antibody Test:
- Medically necessary * tests ordered by a network provider will continue to be covered until the end of the federal public health emergency.
* Medically necessary testing includes testing for members with known or suspected symptoms, known or suspected exposure, and those entering health facilities for service.
Third-party screenings for employment, school admission, or travel are not covered.
As you can see, we cover provider-ordered tests to meet the medical needs of members. We do not cover screening tests requested by third parties, such as those given for employment, admission to school, or travel.
- Tests requested for reinstatement to work, school, or participation in a sports team are usually paid for by the requesting organization or by the person receiving the non-covered service.
- Tests performed in public health facilities and home tests, whether performed at home or sent to outside laboratories for analysis, are not covered by Quartz.
COVID-19 vaccines are covered 100% with a cost share of $ 0.
Vaccines and COVID-19 administration costs are covered at a $ 0 cost sharing for all Quartz members. The cost of the COVID-19 vaccine will be initially paid for by the federal government and should not be presented to Quartz for reimbursement.
See below for guidance on billing the administration of COVID-19 vaccines.
- Medicare Advantage: Providers must follow CMS guidelines and submit claims for COVID-19 vaccine administration to the CMS Medicare Administrative Contractor (MAC) for payment.
- Employer Business Groups and Individual Plans: Quartz will cover the administration of COVID-19 vaccines with a $ 0 cost share. Please bill using the recently published vaccine specific CPT administration codes.
- Medicaid: Providers must follow state-issued guidance when submitting bills for administering the COVID-19 vaccine.
COVID-19 monoclonal antibody infusion
Quartz will not pay vendors for monoclonal antibody products that they receive free of charge.
- Medicare Advantage: Suppliers must follow CMS guidelines and submit claims for COVID-19 monoclonal antibody infusion to the CMS Medicare Administrative Contractor (MAC) for payment.
- Groupscommercial from employers and individual plans: Quartz will provide reimbursement at contracted rates for the cost of the monoclonal antibody infusion for the treatment of COVID-19. Members’ normal share of expenses will apply. Please bill using the antibody specific CPT infusion codes.
- Medicaid: Providers must follow state guidelines when submitting claims for monoclonal antibody infusion to treat COVID-19.
Telehealth visits and virtual visits have returned to their usual cost.
To help through tough times, Quartz waived member cost sharing for telehealth visits and virtual visits until December 31, 2020. This benefit enhancement ended for most members * with the start of the new Year. Members now pay their out-of-pocket expenses.
* Members of an Illinois licensed policy have a $ 0 cost share until the end of the Illinois Disaster Proclamation.
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