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Latest Updates

Expanded member benefits during the coronavirus outbreak

COVID-19 treatment is covered at 100% (Updated 02/04/2021)

TML Health will cover all in-network claims for COVID-19 treatment at 100%, for service dates until April 30, 2021.

You will not need to pay copays, deductibles, or coinsurance percentages for these claims. If you have already had claims processed for COVID-19 treatment, we will automatically review these claims and reprocess them for 100% payment. You do not need to file an appeal to receive these enhanced benefits.

Out-of-network claims for COVID-19 treatment will be paid at 100% of the reasonable and customary rate. We cannot guarantee you will owe no out-of-pocket cost for COVID-19 treatment at an out-of-network provider, but we will work with you to resolve these claims if you had no in-network options. If this has happened to you, please call Customer Care at (800) 282-5385 to request assistance. To find a provider who is in-network, login as a member, click Find a Provider or Facility, then click Search the Choice Plus Network.

First Responder Worker's Compensation (Updated 01/12/2021)

Members who are first responders and contract COVID-19 in the course of their work may be eligible for Workers’ Compensation benefits. Contact your employer to report the diagnosis and get the process started.

First responders, particularly Emergency Medical Services (EMS), should refer to the CDC Guidance for EMS for more information on personal and public safety concerning suspected cases of coronavirus.

The link to the CDC Guidance for EMS, states “ This interim guidance applies to all EMS personnel across multiple EMS models including, but not limited to, free standing, third-service, fire-based, hospital-based, and related EMS providers. Note that fire services are also included as they respond to emergency medical calls and may do so with or without an ambulance.”

Prior Authorization Penalties Waived for Coronavirus-Related Hospital Admissions (Updated 05/01/2020)

We are doing everything we can to help our members get the care they need so they can get better soon, and to ease the administrative burden on strained healthcare providers and support easy access to needed care. TML Health is waiving the usual penalties for late prior authorization or no prior authorizaton for inpatient admissions, in cases related to COVID-19.

Prescription Drug Benefit Prior Authorization Timeframes Returning to Normal (Updated 04/30/2020)

With the stay at home order lifted, and healthcare providers’ offices starting to reopen across the state, we are returning to our normal prior authorization procedures for prescription drugs.

Wellbeing Resources from Navigate - Free for 90 Days (Updated 4/16/2020)

Beginning this week, all members have free 90-day access to personal challenges, the new Snap Challenge tool, and additional wellbeing resources to help stay physically, emotionally, and financially healthy during this time.

  • Personal Challenges:Our regularly updated library of personal challenges meet participants wherever they are on their unique wellbeing journey with options addressing each of our Power of 8 categories: Purpose, Physical, Mindfulness, Nutrition, Social, Balance, Financial and Community.
  • The Snap Challenge Tool:This easy-to-use tool allows participants to create their own friendly steps, activity or weight challenges and invite others to join – a fun, healthy way to keep in touch with teammates while working from home.
  • Financial Wellbeing Resources:Timely video learning resources to help ease financial worry.

Waiving member costs for COVID-19 testing (Updated 04/01/2020)

To help ensure our members get the testing and treatment they may need for the COVID-19 coronavirus, and to help prevent community transmission by increasing access to testing, we are waiving all out-of-pocket expenses for COVID-19 diagnostic testing at approved facilities for members of TML Health.

Emotional support (Updated 03/31/2020)

Through our relationship with Optum, we are offering our members access to a free 24/7 emotional support line at 866-342-6892. This Help Line is staffed by professionally trained mental health experts.

Members can also get emotional support by downloading the Sanvello app. Sanvello is available 24 hours a day, 7 days a week, and is free. Specially trained mental health specialists can help deal with stress and anxiety, as well as provide referrals to community resources for specific concerns.

Texas Health and Human services has also launched a 24/7 statewide mental health support line to help Texans experiencing anxiety, stress, or emotional challenges due to COVID-19 pandemic. People can call the statewide COVID-19 mental health support line 24 hours a day, 7 days a week toll-free at: 833-986-1919.

ID Card and Debit Card Mail Distribution (Updated 03/26/2020)

In response to many “Shelter in Place” orders now being issued throughout Texas, TML Health will temporarily mail identification and debit cards directly to employees’ homes rather than to the employers for distribution. As a reminder, employees may also access an electronic copy of their Identification card online at www.tmlhealthbenefits.org.

Teladoc (Updated 03/20/2020)

All Teladoc patient consults are now be screened for COVID‐19 symptoms and risk factors. Teladoc Health care providers are evaluating symptoms (e.g. fever, cough, shortness of breath) and contact history (e.g. known exposure to a person diagnosed with COVID‐19, recent travel or living in an area with an active outbreak, healthcare worker who may have increased risk of exposure) to assess COVID‐19 risk. Although your copay (if any) will be collected by Teladoc at the time you request an appointment, if the provider makes a COVID-19 diagnosis, TML Health will reimburse you for your copay.

If the doctor gathers information that supports testing for COVID‐19 in accordance with Texas guidelines, Teladoc will contact the appropriate public health department in accordance with local reporting requirements. Each public health department defines its own parameters regarding how they will contact patients to initiate diagnostic testing, conduct contact tracing, and/or implement at‐home self‐monitoring, at‐home supervised isolation, or quarantine requirements.

Many health departments and health systems are prioritizing testing for patients with the greatest risk of COVID‐19 complications or greatest risk of spreading to others. Teladoc advises individuals suspected to have been infected with COVID‐ 19 to call their local doctor or their state’s public health hotline to verify test availability and to notify the in‐person care facility in advance of their arrival, so that healthcare personnel on-site can direct them appropriately and minimize potential exposure for others.

Service to Member Groups

Upcoming Changes to COVID-19 Coverage (Updated 05/13/2021)

With vaccines against COVID-19 now readily available, we highly recommend encouraging your teams to get vaccinated. As COVID-19 becomes a largely preventable disease, TML Health will no longer provide 100% coverage of COVID-19 treatment, but will cover these expenses as normal medical claims.

COVID-19 testing and vaccinations are still covered 100% in-network. If your employees are struggling to find available vaccination shots, we recommend going to Texas' official vaccine page to find the latest information on the different vaccines available and where they can be found locally.

If we all work together, we can reduce the spread of COVID-19 and bring back the Texas we know and love!

Antibody Testing (Updated 06/01/2020)

The CDC has issued new guidance for COVID-19 antibody testing on its website. Recommendations on the use of serologic tests to determine protective immunity and infectiousness among persons recently infected with SAR-CoV-2 will be updated here.

We have become aware of several local providers who are reaching out to cities and offering to perform a COVID-19 antibody test for all of their employees. We would like to issue a word of caution to fund contacts and members about this.

The FDA website explains more about the concerns regarding the accuracy of these tests, and also whether the presence of antibodies provides any actual immunity to the virus. This is still not known.

There are only 2 tests approved by the FDA so far. The others available on the market are operating under Emergency Use Authorization and may not be as reliable. Our carrier, UnitedHealthcare is advising providers to use only FDA-approved tests, and in order for the pool to cover antibody testing, the test must be ordered by a physician or appropriately licensed healthcare professional. TML Health Benefits Pool covers testing and treatment for employees who are ill. The group health plan does not cover any pre-employment or return-to-work testing that an employer requires for all employees or for an entire class of employees to return to work.

Waiver of Actively-at-Work Eligibility Requirements (Updated 05/11/2020)

TML Health will extend the temporary waiver of actively-at-work eligibility requirements until September 30, 2020 for employees who are furloughed or have temporarily reduced hours due to the Coronavirus, provided that:

  • The employer’s contribution is paid for all eligible employees each month, including those with modified eligibility or actively-at-work provisions;
  • Employers must notify the Pool of any employee for whom modified eligibility or actively-at-work provisions have been applied; and
  • The employer continues to pay at least 50% of the employee’s health insurance contributions.
Therefore, for those employees whose hours have been temporarily reduced through September 30, 2020 due to the Coronavirus, employers are not required to terminate the affected employees from the benefit plan(s) just because of the reduction in hours. You can read more details on the available options here.

Employee Assistance Program (Updated 03/31/2020)

For our Member Groups with Deer Oaks Employee Assistance Program, additional information can be found at www.deeroakseap.com or by calling 1-866-327-2400.

ID Card and Debit Card Mail Distribution (Updated 03/26/2020)

In response to many “Shelter in Place” orders now being issued throughout Texas, TML Health will temporarily mail identification and debit cards directly to employees’ homes rather than to the employers for distribution. As a reminder, employees may also access an electronic copy of their Identification card online at www.tmlhealthbenefits.org.

Renewal Extensions (Updated 03/25/2020)

We know renewal paperwork is the last thing on your mind right now, and you still need health coverage. To take at least one concern off your plate, we will automatically renew coverage for any Member Group that does not change their plan sponsor.

For our groups that scheduled open enrollment in March or April and would like to postpone, we are extending the renewal date to October 1 so that you can hold open enrollment later this year. Groups requesting this extension will have the same benefit plan and rates as they have today extended until October 1. This is how we live our core value of Public Service. Please contact your Account Executive to request an extension.

TML Intergovernmental Risk Pool Resource Page (Updated 03/23/2020)
Texas Municipal League (TML) COVID-19 Resource Page (Updated 03/23/2020)
CDC recommendations for businesses and employers (Updated 03/08/2020)

General Coronavirus Information

New CDC Guidance on Self-Isolation(Updated 07/28/2020)

The CDC has issued new guidelines for when patients with COVID-19 being treated at home may end self-isolation. When:

  1. at least 10 days have passed since you started having symptoms
  2. and you've had no fever for at least 24 hours without using medication for fever
  3. and your other symptoms have improved
you may stop self-isolating under CDC guidelines. A second test is usually not necessary to confirm it is safe to end self-isolation.

Some patients who have severe cases of COVID-19 may be contagious even after 10 days and need to continue self-isolating. For more information, including how to self-isolate if you have no symptoms but have tested positive for COVID-19, see the CDC's website.

What if I May Have Been Exposed? (Updated 03/19/2020)

If you have been in a situation that may have exposed you to the COVID-19 coronavirus, for example as a first responder, an attendee at an event attended by an individual who tested positive, or sharing a household with or caring for someone with the virus, the CDC recommends the following:

  • Self-isolate for 14 days after your potential exposure.
  • Monitor your symptoms.
  • If you develop fever, cough, or shortness of breath, call (not visit) your doctor. They can evaluate and refer you for testing. Currently, you cannot be tested without a referral.

You can find more information at: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

COVID-19 información en español (Updated 03/24/2020)
CDC coronavirus situation summary (Updated 03/21/2020)
CDC Guidance for EMS (Updated 03/08/2020)

Resources for Returning Back to Work

Resources for Returning Back to Work (Updated 06/17/2020)