• Printer Friendly Version
  • Decrease Text Size Increase Text Size
  • Download as PDF

COVID-19 Information for Aspirus Arise Members

Is the COVID-19 test covered under my health plan?

Aspirus Arise will waive any cost-sharing for laboratory tests related to COVID-19. For some employers, Aspirus Arise is only the administrator, not the insurer. In these situations, it is the decision of the employer to determine how this will be covered.

The IRS has indicatedthat a health plan that otherwise satisfies the requirements to be an HSA qualified High-Deductible Health Plan (HDHP) may provide health benefits associated with the testing of COVID-19 without a deductible, or with a deductible below the minimum deductible (self-only or family) for an HDHP. An individual covered by the HDHP will not be disqualified from being an eligible individual because they received COVID-19 testing.

  • Aspirus – Testing covered at 100%. Early prescription refills available.
  • City of Antigo – Testing covered at 100%. Early prescription refills available. Teladoc services will continue at 10% coinsurance.
  • Lincoln County – Testing covered at 100%. Early prescription refills available. $0 co-pay on Teladoc.
  • Mid-Wisconsin Beverage – Testing covered at 100%. Early prescription refills available and ability to fill in a 90-day supply.
  • North Central Health Care – Testing and treatment covered at 100%. Early prescription refills available.
  • Wausau Coated – Testing covered at 100%, Teladoc services covered at 100%. Early prescription refills available.
  • Wausau School District – Testing covered at 100%. Early prescription refills available. Teladoc will be available for a $10 copay starting May 1, 2020.

If I need to see a doctor for COVID-19, is that covered?

Aspirus Arise will waive prior authorization requirements, and cover with no out-of-pocket costs to the customer, COVID-19 diagnostic laboratory testing and health care costs associated with provider visits for testing (e.g., office visits, urgent care visits, hospital visits, emergency room visits, etc.) for all fully insured policyholders and for self-funded plan policyholders where the group has instructed us to provide this coverage. This coverage applies for both in-network and out-of-network providers.

Can I use telehealth services from Teladoc® to get care for COVID-19?

In most cases, telehealth services are available to Aspirus Arise customers and their dependents to answer questions about the virus, evaluate their risk, and provide support by phone or video call if they develop symptoms. Cost-sharing for office visits to determine if COVID-19 testing is needed and the testing itself are waived, which means customers pay no copays, deductibles, or coinsurance. For services not related to COVID-19 testing, Teladoc® is our preferred provider and other telehealth services (such as those offered by provider groups) will be covered based on the terms of the customer's health plan

Members are encouraged to call the number on their Aspirus Arise ID card to review coverages in more detail.

  • Telehealth services under an HSA-qualified HDHP will be subject to applicable deductible and coinsurance amounts as stated in your health plan.
  • Other, non-Teladoc, telehealth services (such as services offered by provider groups) will be covered based on the terms of the customer’s insurance plan.

What if I need to be hospitalized for COVID-19?

Hospitalizations are covered under the terms of your health plan.

If I may be quarantined, can I get a larger supply of my prescription medications?

Early refills are available as appropriate, and you may also use a 90-day supply via home delivery. We encourage the use of home delivery for medications when available to help maintain social distancing.

What if I am laid off or have my work hours reduced?

During a temporary layoff or a temporary reduction in hours, Aspirus Arise will allow employers to retain employees and their dependents on their group plans as follows:

  • Fully insured:Aspirus Arise will waive its requirement for employees to be actively working in order to be eligible for coverage through May 31, 2020, as long as the monthly premium payment is received and at least one employee of the group remains actively at work. Coverage must be offered on a uniform, nondiscriminatory basis to all employees.
  • Self-funded group health plans will be able to opt in to the following change: Aspirus Arise will waive its requirement for employees to be actively working in order to be eligible for coverage through May 31, 2020, as long as the payment of administrative fees, claims cost, and WPS stop-loss premium are received and at least one employee of the group remains actively at work. Coverage must be offered on a uniform, nondiscriminatory basis to all employees. If WPS is not the client’s stop-loss carrier, we recommend that the client verify coverage for this situation with their stop-loss carrier.

Who at Aspirus Arise can I call with questions about COVID-19 and my Aspirus Arise insurance plan?

You can call our Customer Support team using the number on your customer ID card.

Will there be coverage for a COVID-19 immunization when one becomes available?

Immunizations are an essential and highly effective way to prevent infectious disease in large populations. Unfortunately, an immunization for COVID-19 is not yet available. If and when an immunization is developed, it will be covered similar to other immunizations.

Are medical supplies such as masks, gloves, and disinfectants covered?

Most of these supplies are not currently covered by insurance plans in general.