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Coverage for COVID-19

CDPHP Waiving Cost-Share for Behavioral Health Care Services for Essential Employees

The COVID-19 crisis has had an immeasurable impact on all New Yorkers, particularly those on the front lines, such as health care workers, first responders, and all employees deemed essential. As such, Governor Andrew M. Cuomo has issued an emergency regulation removing all cost-share for essential employees seeking outpatient behavioral health care services with an in-network provider. Effective May 2, 2020, this regulation has recently been extended through May 26, 2021.

If you are an essential worker, you will pay no out-of-pocket costs when receiving mental health care services. For a list of employees considered essential, visit the NYS DFS website.

The change affects all CDPHP commercial, Medicaid (although there is no cost-share for Medicaid), Child Health Plus, and Essential Plan members, as well as all self-funded ASO groups that have elected to waive cost-shares for essential employees. The change does not apply to CDPHP Medicare Advantage members or members of self-funded groups that did not choose to follow the mandate.

Please note, the regulation does not apply to members enrolled in federally qualified health savings accounts (HSAs). For federally qualified plans that do not have an HSA, you must meet the deductible before CDPHP will waive any applicable co-insurance or copays.

The emotional and psychological well-being of essential workers is critically important in the continuing fight against COVID-19. We thank you for your support.

Coverage for COVID-19 Testing/Treatment

The health and safety of our members and the community is a top priority at CDPHP. With this in mind, CDPHP is waiving cost-share* (copays, coinsurance, and deductibles) for coronavirus (COVID-19) related testing and treatment. This change is retroactive for all COVID-19 treatment, including hospitalizations, office visits, and testing.

CDPHP will pay for COVID-19 testing (including rapid testing)* that has been determined to be medically appropriate by an attending provider or pharmacist, and when testing is approved by the FDA or issued an Emergency Use Authorization (EUA). 

Testing ordered or requested by someone other than an attending provider or pharmacist, or performed without an order, including testing on asymptomatic individuals as required by employers, schools, camps, sports, and epidemiological research, or for the purpose of travelling to and from New York state, is not covered.

If you have COVID-19 symptoms, please contact your provider or schedule a telemedicine visit.

If you are asymptomatic, please visit The New York State Department of Health website to locate a free testing site. 

CDPHP will cover at-home test kits that are FDA-approved or issued an EUA by the FDA. At-home test kits must be ordered by an attending provider or pharmacist. Members will need to submit both the itemized receipt and a copy of the physician or pharmacist order for reimbursement. 

Coverage/ Billing/ Financial Hardship

  • As part of New York's ongoing response to the COVID-19 pandemic, the Open Enrollment Period for uninsured New Yorkers will be extended through December 31, 2021. New Yorkers can apply for coverage through NY State of Health, New York's Official Health Plan Marketplace, or directly through CDPHP

  • CDPHP will not terminate any subsidized member currently enrolled in the Essential Plan or Child Health Plus for non-payment throughout the duration of the crisis. Full-pay Child Health Plus members will be required to pay premium per state guidance. If you are having any difficulty in paying you premium, our enrollers would be happy to assist you in reviewing your application to see if additional subsidies are available. Please call 1-844-237-4773. 

  • If a subsidized individual is new to these products, they will still receive a premium invoice, but will not be terminated for non-payment.

  • Medicaid, Child Health Plus, and Essential Plan cases with a coverage end date through March 31, 2021, will be extended for an additional 12 month period.

  • This extension also applies to Medicaid enrollees whose coverage originated through a local Department of Social Services (LDSS). 

  • In addition, Medicaid enrollees with coverage terminations on or after March 18, 2020 will be reinstated. 

  • Enrollees who have already received a renewal notice do not need to act. Consumers will receive a new renewal notice from NY State of Health when the emergency has ended.

  • The new notice will inform the consumer of the new deadline to renew their coverage.

  • If you have had a change in income due to the pandemic and are currently a NY State of Health member, you may be eligible for additional subsidies or financial help. We are here to help you update your information and you can reach us at 1-844-237-4773.   


*Some employers who self-insure do not have this benefit. If you are unsure if your plan includes this benefit, please contact CDPHP member services.

During a Crisis, Knowing Your Health Benefits is More Important than Ever

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