Please check the PHP website for the most up to date plan information.
https://www.phpni.com/covid-19
Information specific to PHP clients and members:
What does PHP cover for COVID-19?
PHP is expanding our COVID-19 coverage effectively immediately. PHP will cover the COVID-19 test and the visit where the test takes place at 100% with no deductible, copay or co-insurance. If you are diagnosed with COVID-19, your PHP benefit plan coverage applies to treatment.
This applies to all plan types, including self-funded plans. Employers may not opt-out.
PHP’s telemedicine service, 24/7 Call-A-Doc, is now available with no cost-sharing, until further notice.
How is my employees’ PHP eligibility affected by COVID-19 and work restraints?
Important points to keep in mind relating to PHP coverage eligibility:
- According to PHP’s group contracts (for fully-insured and LEVEL-funded plans), the group is solely responsible for determining eligibility for enrollment, coverage classification changes, and termination of eligibility for coverage. PHP reserves the right, however, to audit, verify, and investigate eligibility. Ineligible individuals may be terminated retroactively. The COVID-19 situation does not change this.
- PHP’s group contracts (for fully-insured and LEVEL-funded plans), provide coverage to employees (and their enrolled dependents) during an absence due to Family and Medical Leave Act (if applicable) and during any leave of absence, including short-term or long-term disability, or a sabbatical that does not exceed the timeframe (typically 90 days) specified in each employer’s contract.
- The terms of the contract govern, regardless of an employer’s policies.
Does a temporary layoff or reduction in work hours related to COVID-19 impact my employees’ PHP eligibility?
- The Families First Coronavirus Response Act, passed in the U.S. House on Friday, March 13, 2020, now moves to the Senate, and, if passed, will become law if signed by President Trump. This act may expand the types of leave eligible for maintaining coverage per PHP’s group contract as discussed above, but we cannot give you definitive information until the bill becomes law and we have a chance to evaluate the final terms.
- If an employer continues to withhold the employee contribution related to the medical benefit from any pay provided during a temporary layoff/reduction in work hours directly related to COVID-19, not to exceed 90 days, and continues to remit the full premium, the employee (and their enrolled dependents) will continue to remain eligible under the eligibility terms of the contract for the period stated in the contract (assuming all other eligibility requirements are satisfied).
PHP ProClaim Self-Funded Employers
- Under self-funded, each employer controls the eligibility for their group. Employer’s eligibility guidelines are covered in their self-funded plan documents. Employers should review their plan documents for verification of eligibility. If the documents do not reflect the employer’s intent, an amendment can be made. The PHP-ProClaim re-insurer must also agree to this amendment.
- If an employee is considered “on leave,” employed with the intent to return to work, and a plan document indicates the employees are covered when they are on leave, the employee will continue to be covered (by the re-insurer) as long as premiums are paid.
- If an employee is “laid off,” they would be considered a COBRA qualifying event. The employee would then be eligible for coverage through COBRA, if elected.
- Employers are encouraged to confirm with their brokers and/or ProClaim how they will handle eligibility for their group.
What resources are available for PHP members?
In an effort to reduce resource constraints within the local health systems, we encourage PHP members to utilize our telemedicine resources, 24/7 CALL-A-DOC and MyNurse24/7, if they are experiencing mild symptoms.
Telemedicine Services
- 24/7 CALL-A-DOC – Now available with no cost-sharing, until further notice!
- Phone number: 1-844-DOC-24HR
- 247calladoc.com
- MyNurse 24/7
- Phone number: 1-800-931-4714
Mail Order Pharmacy Services
PHP members can avoid the pharmacy and have prescriptions delivered to their door. Here’s a step-by-step guide to moving prescriptions to mail order through the member account at phpni.com.
Who can I contact at PHP for additional questions?
PHP Members – Contact PHP Customer Service at:
- 800-982-6257, ext. 11
- custsvc@phpni.com
- Online chat through your member account at phpni.com
PHP Employer Groups – Contact your PHP Account Manager.
Frequently asked questions about COVID-19
What is COVID-19?
A novel (new) coronavirus is a new coronavirus that has not been previously identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold. (CDC)
What are the symptoms of COVID-19?
The following symptoms may appear 2-14 days after exposure:
- Fever
- Cough
- Shortness of breath
How can I protect myself and my family from COVID-19?
There is currently no vaccine to prevent COVID-19. The best way to prevent this illness is avoiding exposure. Below are some preventative measures you can implement at home or at work.
- Clean your hands often
- Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public setting, after blowing your nose, coughing and sneezing.
- If soap is not available, use hand sanitizer that contains at least 60% alcohol.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with individuals who are sick
- Stay home if you’re sick
- Cover coughs and sneezes
- Clean and disinfect frequently touched surfaces daily.
- This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
What should I do if I think I have COVID-19?
We encourage you to contact your primary care provider if you believe you have been exposed to the COVID-19 virus. If a medical professional assesses you and determines that you may have been exposed to COVID-19, they will direct you to appropriate testing location.
If you need help finding a provider in your network, we encourage you to utilize our Find A Doctor tool on our website.
What can employers do to protect their workplace and employees?
The Allen County Department of Health has developed guidance to help prevent workplace exposures to illnesses such as COVID-19. It also provides planning considerations for employers in the event of an outbreak. Read more here.
Who is most at risk?
Older adults and those who have underlying medical conditions such as heart disease, diabetes, and cancer are at a higher risk for developing more serious complications from COVID-19. Please consult your healthcare provider about any additional steps you can take to protect yourself. (CDC)
How can I stay up-to-date on the latest information surrounding COVID-19?
Information is evolving on a daily basis. Please refer to the following websites for up-to-date information.
