Priority Health COVID-19 Coverage Information
Since winter of 2020, Priority Health has continued to publish updates when needed regarding its handling of the COVID-19 pandemic and the benefits it's providing to help its members weather this storm.
Answers to Frequently Asked Questions for Employers
We know that 2020 has been one of the most difficult years for businesses in decades, in part because rules, regulations, and exceptions to rules surrounding COVID are constantly changing. Priority Health is here for employers. They can answer questions about:
- Your workforce returning to work after working mostly remotely
- COVID-19 testing and treatment
- IRS and DOL notices
This webpage can serve as your resource throughout the pandemic.
*Please note: Information provided by Priority Health is for educational purposes only and is not intended as legal advice. The information provided is based on regulations and legislation, which are updated frequently. Please consult your benefits attorney with any legal questions.
Resources for Employees
This link offers tools to help answer your employees' questions about:
- Finding coverage if they lose it
- Virtual care
- Using their Priority Health prescription coverage
- Staying mentally strong during COVID
- Financial relief
Here's a link to a general Member FAQs if none of their questions concern the above.
--Update from Priority Health on 5/20/2020--
As we continue to look at the effects of COVID-19, including the economic impact, Priority Health is announcing additional support we’re providing to members and employers.
- Medicare Advantage members: waiving cost sharing for in-person and telehealth primary care services May 1, 2020 through December 31, 2020
- MyPriority Individual plan members: A 15% premium credit will be applied to May and June invoices for June and July premiums for those who pay monthly. Other payment schedules (quarterly, semi-annual and annual) will receive a two-month premium credit, or a credit paid by check.
- Small group employers (2-50 employees): A 15% premium credit will be issued in June and July 2020 invoices against premiums billed for April and May
- Large, fully funded employers will receive consideration for premium credits upon renewal, beginning with 4th quarter 2020 renewals. We’ll share more information on this as it becomes available.
This announcement follows other relief Priority Health has committed to throughout this pandemic:
- Fully covering the cost of physician-ordered COVID-19 testing for all members
- Waiving all copays, deductibles and coinsurance for the treatment of COVID-19 through June 30
- Expanding $0 virtual care to most members for routine care through June 30
- Expanding free home medication delivery for all members
- Providing free access for all members to myStrength, an online mental wellness tool
- Accelerating value-based payments and quality bonuses to offer physician and provider partners financial stability
- Offered flexibility to employer groups on premium payments and eligibility criteria
Thank you for your continued support of employer groups and members during this time. Our account managers and sales executives are available to discuss any needs of the Group or Individual you’re working with. We’re all in this together.
--Update from Priority Health on 3/23/2020--
The State of Michigan is always encouraging groups to not terminate but temporary lay off workers. When a group does this and wants to continue health benefits please advise them not to change the employee status through their enrollment files:
Priority Health is allowing some flexibility due to the emergency situation to still consider these staff members 'active' for a temporary period (Effective 3/12/2020 through 4/30/2020). However, it is solely an employer decision to continue to offer benefit.
Please note that you have to offer the same option to all SIMILARLY situated employees. Premium payment is solely an employer obligation. The employer can continue payment of the premium for their members maintaining active health coverage. We strongly advise that the employer provide clear and up front communication about how the employee contribution will be handled.
Due to the state of emergency we are not requiring any changes to your plan document at this time related to eligibility. We will continue to evaluate this after 4/1 as the situation continues to evolve. We will continue to monitor the situation over the upcoming weeks.
There are several options that they can consider when setting premium contributions during this period:
1. Employer can pay for the employee contribution amount (contribution forgiveness)
2. Prepayment - If they understand that they were going to be closed for 30 days. Calculate the amount of contribution and have the employee pay it up front out of their next paycheck
3. Pay the employer directly like COBRA. Members would not get the benefit for the pre-tax like payroll contribution
4. Pay back once back to work - either lump sum or over a period of time. We strongly encourage the employer to be up front with their employees as failure to pay your contribution for health care is not a COBRA-triggering event for members.
What if an employer can't pay their premium?
Priority Health is currently maintaining our 45 day grace period of premium payment before termination is initiated, however as the situation continues to progress we will continue to assess options for employers, including repayment.
Please look for our updated bulletins coming up on your employer portal.
--Update from Priority Health on 3/09/2020--
With so much news around the COVID-19 Coronavirus, we are actively working with Governor Whitmer’s office, physician and legislative partners across the state, and especially the CDC to monitor the impact of the virus in order to continue to ensure our partners, customers, and members have access to the coverage and care they need when they need it.
Last Friday, Governor Whitmer’s office announced that many Michigan insurance companies, including Priority Health, will fully cover the cost of medically-necessary COVID-19 coronavirus test for members, including our out-of-state members, waiving copays and deductibles. If an employer group is self-funded and does not wish to cover the cost, we’ll work with them to opt-out of this coverage. Your Priority Health account manager can help work though considerations for self-funded groups.
We’ll be posting current information regarding COVID-19 Coronavirus coverage and access to care for members on priorityhealth.com. As always, and especially with contagious viruses, we encourage members to use virtual care for access to convenient care. The Priority Health member portal provides access to virtual care options that members can choose from.
We will continue to provide coverage information as we understand more about the impact of the virus. For the latest updates, we encourage you to visit the Center for Disease Control (CDC) website.
(c) 2020 Priority Health
1231 E. Beltline Ave. NE
Grand Rapids, MI 49525-7024
Click this link https://www.priorityhealth.com/landing/about-covid-19 to be taken directly to Priority Health's COVID response page, where you can view FAQs and the latest updates.