Coronavirus: Benefit and Coverage FAQs

Friday, April 3, 2020

A pair of reading glasses set on a desktop with a computer and mobile phone.

We understand that you may have questions relating to your benefits and coverage during these uncertain times. We’ve compiled this list of frequently asked questions to help provide information about what’s covered and what’s not in response to the COVID-19, or coronavirus, pandemic. If you have additional questions, please contact us through the Message Center.

Benefit Related Questions

Can I use a non-Teladoc telemedicine service if my physician offers one?
We will temporarily allow non-Teladoc telemedicine providers during this pandemic crisis. However, Teladoc will still be the only service we cover 100%.

Is COVID-19 testing covered?
TeamCare will cover medically necessary diagnostic tests that are consistent with CDC guidance related to the COVID-19 outbreak. In compliance with federal law, the COVID-19 testing will be covered at no cost to you. Testing for COVID-19 requires respiratory specimens (nasal swabs), which can only be conducted when medically necessary in an appropriate healthcare setting, such as hospitals and physician offices.

Is telemedicine (teledental) covered for a dental visit to be used to determine if it is indeed a dental emergency?
At this time, it would not be covered.

What should I do if I need new eyeglasses or lenses?
There are four scenarios to consider if you’re in need of a new complete pair of eyeglasses or replacement lenses. Please review the criteria below. If you have any questions, EyeMed’s Customer Care Center is available at 1-866-723-0514 to assist you. Please review the criteria below, and see “What are my options for contacting an eye doctor?” if you require care.

  1. If you have a valid prescription and have a state-mandated stay-at-home order, or you can’t leave due to illness/doctor’s recommendation.
    If you have a valid prescription, your prescription for eyeglasses should be valid unless there’s a documented expiration date. EyeMed recommends that you use online, in-network options, including Glasses.com, ContactsDirect, Ray-Ban.com, LensCrafters.com, and TargetOptical.com. If you’ve experienced any vision or medical changes, and you’re not certain if your prescription is still correct, contact your existing doctor.

  2. If you have current eyeglasses, your frame or lenses are broken, and you’d like replacement (duplicate) lenses.
    It is possible for an eye care professional to remake new lenses (or duplicate lenses) from your current lenses. In these cases, EyeMed recommends you contact your existing eye doctor first. However, another eye care professional may be able to duplicate lenses from your existing glasses as well.

  3. If you have no prescription and you’ve lost your eyewear, and you are able to leave your home.
    In many states where stay-at-home orders have been issued, optometry may still be considered an essential service. While routine care is discouraged given the circumstances, it may still qualify as an essential service as well. In certain states you may be able to visit an eye doctor to receive an eye exam and obtain new glasses.

  4. If you have no eyewear, you have no current prescription, and you can’t leave home due to illness/doctor’s recommendation.
    If you meet the criteria above, please contact EyeMed’s Customer Care Center at 1-866-723-0514. You may be eligible to receive an emergency pair of replacement Adlens Adjustable Glasses (subject to availability). These temporary, emergency glasses can be adjusted to switch focus for reading, computer, and distance.

What if I need new contact lenses?
Please be aware that federal law mandates the guidelines for issuing and distributing new contact lenses. As it stands today, these guidelines may temporarily limit your ability to obtain new contact lenses. Below are a few options:
  1. If you have a valid prescription and it’s less than 12 months since your exam. If you’ve received an eye exam within the last 12 months, EyeMed recommends that you use online, in-network options, including Glasses.com, ContactsDirect, Ray-Ban.com, LensCrafters.com, and TargetOptical.com. If you’ve experienced any vision or medical changes, and you’re not certain if your prescription is still correct, contact your existing eye doctor.

  2. If you have a prescription but it is greater than 12 months since your last exam.
    Your current eye doctor may be able to extend a prior prescription. We first encourage you to reach out to your eye doctor to consider your current vision and medical needs and potentially obtain an extended prescription. If you are unable to reach your current eye doctor for an extended prescription, consider using an online, in-network provider, including Glasses.com, ContactsDirect, Ray-Ban.com, LensCrafters.com, and TargetOptical.com. You will be asked to complete information online, including submitting your last prescription. Once they receive your information, federal guidelines require them to contact your eye doctor to deny or approve your order.

    If neither of the options above enable you to receive new contact lenses, federal guidelines are likely to prevent you from purchasing new contact lenses at this time. In this situation, you may wish to consider temporarily switching to glasses. Eyewear can often be produced from a valid prescription older than 12 months so long as it does not include an expiration date, or in the event that it does, it has not expired. If you’re interested in new glasses, EyeMed recommends using any of the online, in-network options highlighted above.

  3. If you have no prescription and you can leave your home.
    In many states where stay-at-home orders have been issued, optometry may still be considered an essential service. While routine care is discouraged given the circumstances, it may still qualify as an essential service. In certain states you may be able to visit an eye doctor to receive an eye exam and obtain your new prescription.

  4. If you wear contacts, have no current prescription, do not have glasses, and you can’t leave home due to illness/doctor’s recommendation.
    Unfortunately, you will likely not be able to replace your contact lenses at this time since federal law requires a valid prescription less than 12 months old. Please contact EyeMed’s Customer Care Center at 1-866-723-0514. If you meet the criteria above, you may be eligible to receive an emergency pair of replacement Adlens Adjustable Glasses (subject to availability). These temporary, emergency glasses can be adjusted to switch focus for reading, computer, and distance.

     

Can I order eyewear/contacts online using my benefits?
Yes. You have multiple options to order prescription eyewear and contact lenses online using your EyeMed benefits. If you meet the qualifications in the above scenarios, you have multiple online, in-network options including Glasses.comContactsDirectRay-Ban.com, LensCrafters.com, and TargetOptical.com. It’s easy to order, your benefits are applied automatically, and your glasses or contacts will be delivered right to your home. Understanding the circumstances, many of these online providers are offering free expedited shipping and no-cost returns for extra convenience. Check with your online provider to verify available offers.

What are my options for contacting an eye doctor?
Whether you need to contact your existing eye doctor or find a new one, you should expect that numerous provider offices will be impacted due to federal, state, and local restrictions, staffing, safety, and other conditions. EyeMed recommends that members call their providers directly to verify modified location hours or closing. You have 24-hour access to provider contact information via EyeMed’s provider locator on EyeMed.com or on their app. You may also call EyeMed’s Customer Care Center at 1-866-723-0514.

Coverage Related Questions

Would TeamCare offer an extension of coverage for a dependent who turned 26 during the pandemic, lost their job, and does not have health insurance coverage?
An extension of coverage would not be provided. The dependent’s only option would be to apply for COBRA.

If I am off of work due to COVID-19, will my employer continue to make health contributions to provide coverage during this period? Some employers are implementing a policy directly related to COVID-19 that requires health contributions for a defined period. In addition, most national collective bargaining agreements (UPS, ABF NMFA, YRCW, NMATA), have an employer-pay obligation that requires an employer to make health contributions for four weeks while an employee is off work due to an illness or non-work-related injury. Further, an employer may be required to pay contributions under the Family Medical Leave Act under certain circumstances. We recommend that you check this information with your employer/human resources department.

Since emergency rooms are not allowing any visitors, if I’m brought to the ER and am unable to speak for myself, how can I guarantee that my doctor is in-network? Will there be an exception made for this?
There will not be an exception made for this. The member should try to confirm if they are able to, but if not, our plan rules will still be followed. If an out-of-network provider is used the claim would be processed as out-of-network, with no penalty if it is an emergency.

Will there be an exception made for late COBRA payments if I am not working and do not have an income? Will my coverage be extended if they cannot make their payment?
There will not be any exceptions made at this time. Our standard COBRA rules still apply.