Answering your commonly asked questions.

We understand that brokers are often the first call clients make when they have questions about their health and health coverage. As the situation evolves, we want to make sure you stay informed about Oscar’s policies, resources, and tools.
    • During this difficult and uncertain time, Oscar is fulfilling our promise to use technology and a member-first approach to ensure your clients have the care and support they need. What we are doing for Oscar members in response to COVID-19:
      • Waiving cost-sharing for all COVID-19 treatment for Individual and Small Group members through July 31, 2020. The cost share for COVID-19 care will be waived when delivered by in-network providers and the member has a confirmed COVID-19 diagnosis. At out-of-network facilities, the cost share will be waived if the member has obtained prior authorization. Some exceptions apply—see full details in the next question.
        • If any of your Oscar clients have already paid for COVID-19 care with normal cost-sharing, they may be eligible for a claim adjustment. Your clients can submit a claim adjustment request by messaging their Concierge team through their online account or in the Oscar app, or by calling their Concierge team at 1-855-672-2755.
      • Waiving cost-sharing for all COVID-19 testing for all members at both in-network and out-of-network facilities. This includes the cost of the visit associated with testing and the test itself.
      • Waiving early refill limits on most prescription drugs at all in-network pharmacies. Plus, we offer free home delivery through CVS nationwide and free same-day delivery through Capsule in New York City and Houston for most drugs. Learn more with our COVID-19 prescription FAQ.
      • Expanded telemedicine coverage policies in the following states:
        • NY: Members will pay $0 for any medically-necessary telemedicine visit with any in-network provider through September 9th.
        • NJ: Members will pay $0 for any medically necessary telemedicine visits (COVID-19 related and non-COVID-19 related) with any in-network provider, through October 30th.
        • CO: Members will pay $0 for any medically necessary COVID-19 telemedicine visits with any in-network provider through August 5th.
        • AZ: Members will pay $0 for any medically necessary telemedicine visits (COVID-19 related and non-COVID-19 related) with any in-network provider through July 25th.
        • TX: Oscar will cover medically-necessary telemedicine care with in-network providers subject to cost-sharing as if done in-person until September 12th.
        • CA, GA, KS, MO, VA, & TN: Oscar will cover medically-necessary telemedicine care with in-network providers, subject to cost-sharing as if done in-person.
        • In NY, NJ, TX, CA, GA, KS, MO, VA and TN this policy includes visits with Mental or Behavioral health providers - these visits will be subject to Outpatient Mental Health visit cost sharing.
        • We will reassess policy dates as needed.
      • Extending prior authorizations for any new or previously approved (between 2/19/20 - 3/20/20) request for outpatient services to be valid for 180 days (from 90 days). For DME, the extension is to 90 days (from 30 days).
      • Launched an end-to-end member experience including an at-home risk assessment survey, integration with Virtual Urgent Care, and testing center locator (if testing is recommended).
      • Created a COVID-19 Resource Center at hioscar.com/covid19. We’re updating this daily with the latest updates, helpful FAQs, and resources.
      • Oscar members pay $0 for phone or secure message consultations with a PCP through Oscar’s Virtual Urgent Care.
    • Yes, in most cases. Oscar waived cost-sharing for the treatment of COVID-19 for its Individual and Small Group members through July 31,2020. The cost share for COVID-19 care will be waived when delivered by in-network providers. At out-of-network facilities, the cost share will be waived if the member has obtained prior authorization. There are exceptions for prior authorization in some states, based on local regulations:
      • Georgia: We are complying with all state-mandated requirements outlined in Directive 20-EX-7 issued by the Georgia Office of Insurance and Safety Fire Commissioner.
      • New York: We are complying with all state-mandated requirements outlined in Insurance Circular Letter No. 8 issued by the New York Department of Financial Services.
      • Ohio: We are complying with all state-mandated requirements outlined in Bulletin 2020-05 issued by the Ohio Department of Insurance.
    • If any of your clients have lost their job or had a decrease in wages because of COVID-19, we want to make sure that you know their options.
      • Report your Individual clients’ income changes to healthcare.gov (or state-based exchange) as soon as you can. Here’s some more information on how that works. Call hold times are very long on the exchange now, so we recommend updating your clients’ income online through exchange websites.
      • Many state and local governments are providing financial relief through extended paid sick leave, paid family leave, small business loans, and payroll support. If you or your clients have been affected, we strongly encourage you to check out your local or state government website for details.
    • COVID-19 has disrupted all of our lives in many different ways. Many mental health providers are now accepting patients virtually. We encourage our members to visit hioscar.com/member/benefits/mental-health to find a provider that is right for them. Here’s how we’re helping Oscar members cope with the stress and emotional impact of the pandemic:
      • Robust mental health network - We partner with Optum for mental and behavioral health benefits. Your Oscar clients can visit hioscar.com/member/benefits/mental-health to find an in-network mental health provider and more details on their mental health benefits. You can also search our mental health network on Optum’s website (www.liveandworkwell.com) using guest code “OHP”.
      • Emotional support helpline: 1-866-342-6892 - Optum offers a toll-free emotional support helpline that’s free of charge and open 24/7. It’s also available to anyone, so both you and your clients can use it and even share with family and friends.
      • Virtual mental health visits - We partner with Doctor on Demand to provide virtual therapy and online appointment scheduling. Your Oscar clients can sign up for an account here by using their Oscar ID number and selecting “Oscar” as the Health Plan option in the drop-down menu. Please note that Doctor on Demand is only for in-network Mental Health services, not Medical Services.
      • Sleep and stress reduction tools - We’ve teamed up with Calm to offer all Oscar members 40% off an annual subscription. Calm provides guided meditations and sleep stories to help manage anxiety, lower stress, and improve sleep. Your clients can claim this offer at hioscar.com/member/benefits/perks.
      We’ve also created a dedicated webpage at hioscar.com/covid19/mental-health-resources that contains full details about all the mental health resources Oscar members have access to. Feel free to share this URL with your clients
    • Oscars members still have great access to care while following state and local Stay at Home orders. To understand what is available to your clients while at home please reference our Stay at Home guide.

Everything you need to know about SEP.

We know that having health coverage is more important now than ever. Learn below about enrollment and eligibility changes we’ve made in response to COVID-19 and how to enroll clients.
    • Currently California, New York, and Ohio have added or adjusted QLEs for Individual & Family plans in response to COVID-19. Learn more by clicking into each state below.

      Colorado's COVID QLE expired on 4/30/2020.

    • If an employer offers COBRA or State Continuation Coverage and if one person remains actively employed, employees may elect to continue coverage under COBRA/State Continuation Coverage by following the normal notice and election procedures.If there are no active employees, then the plan is terminated and COBRA/State Continuation Coverage will not be an option. In either case, employees will have the option to enroll in Individual coverage through Special Enrollment Period (loss of employer coverage).If workers are only temporarily laid off: Starting on April 11th, 2020, employees rehired (specifically designated as a Rehire who was previously covered by Oscar) by May 31, 2020 will not be subject to the employer's waiting period, if the employer chooses.
      • For New Jersey: Any employees laid off after March 1, 2020 and later re-hired will not be subject to the employer’s waiting period.
      We’ve also published articles to help guide small business owners navigate the coronavirus and understand their options. Feel free to share these resources with your Small Group clients.
    • In California, CCSB has extended the new enrollment submission deadline through June due to COVID-19. Qualified employees and enrollment in CCSB employer plans that are permitted during a COVID-19 Special Enrollment Period through the end of June are as follows:
      • A qualified employee and/or dependents (i.e., spouse, child(ren)) declined coverage during renewal or original enrollment, but now wants to sign up for CCSB plans offered by the employer.
      • A qualified employee signed up for one of the plans offered during renewal or open enrollment but wants to change to the other plan that was offered.
      • All received enrollments will be effective first of the following month from receipt of the completed application
      For other states, only employees currently enrolled on the group plan remain eligible for coverage until a group’s renewal period.
    • Yes. CMS has opened a Special Election Period (SEP) In response to the current public health emergency, As a result, Oscar Medicare Advantage is granting an SEP for qualifying individuals. At this time, the SEP is valid until 7/13, though we will let you know if the SEP is extended.

      Who is eligible? Individuals who are enrolled in an MA plan and were unable to exercise their OEP election. Note: If they made a plan switch during OEP, they are not eligible for this SEP. Individuals who moved, aged-in or had another life event that opened an SEP but who did not use that SEP.

      How do brokers enroll clients using this SEP? If you choose to use the Oscar Medicare Advantage enrollment application, please be sure to include a completed “Attestation of Eligibility for an Enrollment Period” and mark the item related to FEMA-declared disasters.

      What documentation is required? Oscar will not be collecting documentation to verify this SEP.

      What are the dates associated with this SEP? Effective date options are 6/1, 7/1 and 8/1. At this time, the SEP is valid until 7/13.

    • Who is eligible for this QLE? The COVID-19 QLE may be used for your California clients who are not currently enrolled in an ACA-compliant health benefit plan and are not eligible for coverage under any government program (e.g. Medicaid). Your California clients can use this QLE to change their plans.How can I enroll clients in this QLE? You may enroll clients on-exchange via Covered California or off-exchange through your Oscar Broker account (business.hioscar.com). If you choose to use your Oscar Broker account to enroll off-exchange, you should select the QLE option "COVID-19: I am currently uninsured and not eligible for other government coverage (Medicaid, Medicare, Essential Health Plans)”. What documentation is required to verify this QLE? No documentation is required. This QLE is satisfied with a simple self-attestation.What are the dates associated with this QLE? The QLE is valid from 3/20/2020 until 7/31/2020, and the effective date is the first of the month following enrollment (e.g. enrollments in April will have a 5/1 effective date).
    • Who is eligible for this QLE? The COVID-19 QLE may be used by prospective NY members who are not currently insured and are not eligible for coverage under any government program (e.g. Medicaid). How can I enroll clients in this QLE? Brokers may enroll clients on-exchange via the NYSoH, or off-exchange through your Oscar Broker account (business.hioscar.com). If you choose to use your Oscar Broker account to enroll off-exchange, you should select the QLE option "COVID-19: I am currently uninsured and not eligible for other government coverage (Medicaid, Medicare, Essential Health Plans)."What documentation is required for this QLE? Oscar will not be collecting documentation to verify this QLE.What are the dates associated with this QLE? Effective date options are 4/1 (only for enrollments submitted before 4/15), 5/1, 6/1, and 7/1. The QLE is valid from 3/16/20 until 7/15/2020.
    • Which QLE is being changed? The only QLE which is being impacted is the Loss of Job QLE - "My health insurance coverage ended because I, or a family member, left a job that was providing health insurance." No other QLEs are being changed at this time.

      Is this change for both on and off-exchange? No. This change only applies to off-exchange enrollments. It allows employees who have recently lost their job to obtain coverage the day after they lost their existing coverage via off-exchange enrollment. On-exchange enrollments follow the standard effective date options.

      What documentation is required for this QLE? Oscar requires the standard QLE documentation as proof.

      What are the dates associated with this QLE? In addition to the standard QLE start dates, OH enrollments with the Loss of Job QLE may now select to have their new coverage begin as of the date they lost their existing coverage (i.e., a prospect who loses their coverage 4/2 could enroll with a 4/3 effective date). This change is effective 3/20/20 and will remain in effect until Ohio determines otherwise.

Footnotes
Last updated July 14, 2020.
This content on this entire page does not constitute medical advice and is not meant to be a substitute for professional medical advice, including diagnosis or treatment. Contact your physician with any questions you may have regarding COVID-19 or your personal health. If you are experiencing a medical emergency, dial 9-1-1 for immediate assistance.