Facebook Linkedin Instagram

COVID-19 Information

Important COVID-19 Information

Sonder Health Plans is committed to protecting the health of our Members and providing timely services. As such, we follow all CMS guidelines for providing benefits during a disaster or public health emergency declaration.

Official Georgia Vaccination Plan

Vaccination Sites In Your Area

We’ve compiled a list of Georgia approved vaccination sites within Cobb, Gwinnett, Dekalb and Fulton counties. You can download this list below.

Vaccination Site List

Part C Requirements

  • Out of Network Services

    Cover Medicare Parts A and B services and supplemental Part C plan benefits furnished at non-contracted facilities subject to § 422.204(b)(3), which requires that facilities that furnish covered A/B benefits have participation agreements with Medicare.

  • Primary Care Provider Approval

    Waive, in full, requirements for gatekeeper referrals where applicable.

  • Cost Sharing Change

    Provide the same cost-sharing for the enrollee as if the service or benefit had been furnished at a plan-contracted facility.

  • Benefit Change

    Make changes that benefit the enrollee effective immediately without the 30-day notification requirement at § 422.111(d)(3). (Such changes could include reductions in cost-sharing and waiving prior authorizations as described below.)

These special requirements are in effect until the end date identified in the Public Health State of Emergency, State Declaration, or other applicable regulatory requirement or order; if no end date is identified by State or Federal orders, Sonder Health Plans will apply a 30 days end date.

If you have any questions regarding COVID-19, or require assistance, please contact our Member Services team at 1-888-428-4440

Part D Requirements

01 Refill-Too-Soon:

Relax the “refill-too-soon” edits if circumstances are reasonably expected to result in a disruption in access to drugs at the point-of-sale. Health Plans may also allow an affected enrollee to obtain the maximum extended day supply available under their plan, if requested and available.

02 Out of Network:

Consistent with §423.124(a) of the Part D regulations, Health Plans are required to ensure enrollees have adequate access to covered Part D drugs dispensed at out-of-network pharmacies when those enrollees cannot reasonably obtain covered Part D drugs at a network pharmacy. Enrollees remain responsible for any cost sharing under their plan and additional charges (i.e., the out-of-network pharmacy’s usual and customary charge), if any, that exceed the plan allowance.

03 Mail or Home Delivery:

In situations when a disaster or emergency makes it difficult for enrollees to get to a retail pharmacy, or enrollees are actually prohibited from going to a retail pharmacy (e.g., in a quarantine situation), Health Plans will relax any plan-imposed policies that may discourage certain methods of delivery, such as mail or home delivery, for retail pharmacies that choose to offer these delivery services in these instances.  Prior Authorization for Part D Drugs: Health Plans may choose to waive prior authorization requirements at any time that they otherwise would apply to Part D drugs used to treat or prevent COVID-19, if or when such drugs are identified. Any such waiver must be uniformly provided to similarly situated enrollees who are affected by the disaster or emergency.

04 Prior Authorization for Part D Drugs:

Health Plans may choose to waive prior authorization requirements at any time that they otherwise would apply to Part D drugs used to treat or prevent COVID-19, if or when such drugs are identified. Any such waiver must be uniformly provided to similarly situated enrollees who are affected by the disaster or emergency.

05 Drug Shortage:

Health Plans will follow the existing drug shortage guidance in Section 50.13 of Chapter 5 of the Part D manual in response to any shortages that result from this emergency.

06 Coverage of Vaccine:

Under current law, if a vaccine becomes available for COVID-19, Medicare will cover the vaccine. Health Plans will be required to cover the vaccine if it is a Part D drug.

Additionally, Sonder Health Plans

  • Waives enrollee cost-sharing for COVID-19 laboratory tests, telehealth benefits or other healthcare services to address the outbreak.
  • Provide enrollees access to Medicare Part B services via telehealth in any geographic area and from a variety of places, including Members’ homes.
  • Waive Plan’s prior authorization requirements that otherwise would apply to tests or services related to COVID-19 at any time.

These special requirements are in effect until the end date identified in the Public Health State of Emergency, State Declaration, or other applicable regulatory requirement or order; if no end date is identified by State or Federal orders, Sonder Health Plans will apply a 30 days end date.

For questions regarding services already rendered, claims, contracts, etc., please contact your Provider Relations Representative or send an email to: [email protected].

If you require immediate assistance, contact Provider Services team at 1-888-216-5210.

To view CMS updates related to COVID-19 waivers, please visit the information available on CMS.gov in the link below:

Coronavirus Waivers & Flexibilities

Other useful COVID-19 related information from CMS is available on the links below:

© Copyright 2024 – Sonder Health Plans, Inc.