In our continuing effort to expand COVID-19 coverage, PacificSource is now eliminating member cost shares for testing and treatment of COVID-19.
Expanded coverage now includes COVID-19 treatment
PacificSource is waiving member costs for COVID-19 testing, diagnosis, and treatment regardless of place of care for all fully-insured members from January 31 through June 30 (or through the end of the crisis). This cost waiver applies to:
- Individual members
- Fully-insured employer group members
- Medicare members
- Medicaid members: For members enrolled in a PacificSource coordinated care organization in Oregon (managed Medicaid), there is no cost sharing for COVID-19 treatment. For all other members enrolled in Medicaid not delivered through PacificSource, please contact the plan administrator or state Medicaid agency to learn more about cost sharing and any applicable cost waivers.
PacificSource will pay all providers at in-network rates and benefits
PacificSource will pay all providers who are treating for COVID-19-related care at the in-network co-insurance rate. This allows us to waive member out-of-pocket costs up to the in-network allowable rate for non-network providers.
Provisions for self-funded plans
PacificSource is working with self-funded sponsors to eliminate similar cost-sharing measures as directed. Members on self-funded plans should verify any COVID-19-related benefit changes with their employer.
Summary of other COVID-19-related updates:
- To support staying-at-home measures that help limit COVID-19 exposure, PacificSource is encouraging members to use telehealth phone or video services as their first option for care. This includes routine visits for primary care or specialty care as well as behavioral health. PacificSource is waiving all cost shares for telehealth visits if the visit is with Teladoc®. (Teladoc is available to members of fully-insured commercial plans. Members of self-funded plans will need to verify if they have access to Teladoc.)
- Only telehealth visits related to COVID-19 testing and treatment are fully covered. Using telehealth for other services is subject to the member's cost share.
- Prior authorizations and referrals for care have been eliminated for all providers in Idaho, Oregon, Montana, and Washington. Out-of-network providers outside of the four-state service area will need to obtain a prior authorization for services.
The safety and well-being of members and the greater community is our top priority. Thank you for helping us make healthcare more accessible for members. For questions, please contact email@example.com or call (800) 624-6052 (ext. 5489).