Regulatory Updates

A Message From Kathy Major, our Executive Director, and Dr. James McGinnis, our Medical Director:

UCHealth Plan Administrators understands and appreciates the need to share up-to-the-minute information regarding COVID-19.  As you know, information is constantly changing and we want to point you to the most credible resources for timely information to educate and inform on the clinical features and the epidemiological risk of the virus.  Our business operation continues to operate without interruption.  We have a disaster recovery plan ensuring service continuity should circumstances change, and will notify our employers, brokers, providers and members should the need arise.

We encourage you to review credible sources such as the Colorado Department of Public Health and Environment, Center for Disease Control, and to take responsible and necessary precautions. If you believe that you have been exposed or are showing symptoms of the Coronavirus, COVID-19, contact your health care provider prior to visiting their office. While no prior authorization is required, you will need a doctor’s note for COVID-19 testing performed at drive-up testing sites.  UCHealth is also providing updates on COVID-19, please visit the featured stories section on

Should you have questions regarding your coverage, please contact our customer service representatives at 1-800-207-1018.

Thank you, and stay healthy.

Effective January 15, 2022, at-home over-the-counter COVID-19 diagnostic testing is eligible for plan reimbursement up to $12 per test. Tests must be FDA approved and used for personal use only. Tests are limited to 8 per member, per month. For more testing criteria and reimbursement information, please visit your UCHealth Plan Administrators portal or call 1-800-207-1018 to speak with a customer service representative. 

As a result of the COVID-19 Relief Bill signed on December 27, 2020, the Mental Health Parity and Addiction Equity Act (MHPAEA) was amended to impose certain compliance requirements with respect to non-quantitative treatment limitations (NQTL), meaning scope, duration, and availability of benefits for mental health and substance abuse disorders. Effective February 10, 2021, the amendment allows the Department of Health and Human Services (HHS) to request an audit of health benefit plans which include mental health and substance use disorders as a covered benefit.

 In terms of the audit objectives, the following items would be reviewed:

  • The specific plan or coverage terms regarding the NQTLs and the medical/surgical (“med/surg”) and mental health/substance use disorder (“MH/SUD”) benefits to which the terms and NQTLs apply;      
  • The factors used to determine that the NQTLs apply to med/surg or MH/SUD benefits;
  • The evidentiary standards used to evaluate the factors and any other source or evidence relied upon to design and apply the NQTLs to med/surg or MH/SUD benefits;
  • The comparative analysis demonstrating that the processes, strategies, evidentiary standards, and other factors used to apply the NQTL to MH/SUD benefits are comparable to and no more stringent than those used to apply it to med/surg benefits; and
  • The specific findings and conclusions by the plan/issuer about whether it is or is not in compliance.

As your healthcare partner, UCHealth Plan Administrators is ready to support our employer groups with reporting requirements as requested by HHS. 

Contact your Account Manager for more information.

As a result of the announcement made by Governor Polis earlier today, January 29th, UCHealth will begin the vaccination process of school districts and educators on February 8th, based upon vaccine supply. This is a significant effort and we continue to appreciate the patience of all employers during the process.   UCHealth Plan Administrator employers will be contacted in the coming weeks in terms of additional information regarding the UCHealth vaccination distribution process as it becomes available.  

On Friday, December 18, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for a COVID-19 vaccine made by Moderna. This is good news as it means there are now two FDA-authorized vaccines being shipped to hospitals and providers across the nation. UCHealth is now vaccinating health care workers who have the most frequent and direct contact with patients who have COVID-19. All COVID-19 vaccinations must follow the distribution guidelines from the State of Colorado. UCHealth locations received our first shipments of the Moderna COVID-19 vaccine on Dec. 22. These allocations will allow us to offer a COVID-19 vaccine to all of the staff and providers in phase 1 of our vaccine distribution. According to the state of Colorado’s distribution plan and current estimates of COVID-19 vaccine availability, higher-risk individuals may be able to be vaccinated this spring. The vaccine may be available to the general population in summer or fall of 2021. The U.S. Food and Drug Administration (FDA) has rigorous scientific and regulatory processes in place to help develop and to ensure the safety, effectiveness and quality of COVID-19 vaccines.

Q: What is COVID-19, formerly called the 2019 novel coronavirus (Wuhan)?

A: The COVID-19 is a new strain of a cold virus that was first detected in China. Doctors believe that this new strain of the coronavirus transmitted in ways similar to the flu – through the air by coughing and sneezing, close personal contact like shaking hands, or by touching an object that has the virus on it, then touching your mouth, nose or eyes before washing your hands.

Q: What are symptoms of the virus?

A: Symptoms of COVID-19 are similar to a respiratory illness and include fever, cough, headache, runny nose, sore throat or difficulty breathing. A health care provider may order lab tests to diagnose the virus if a patient has symptoms and has recently traveled to China, Italy, Japan, South Korea or Iran or has been exposed to someone who is sick with COVID-19.

Q: What do I do if I think I might have COVID-19?

A: If you have cold/flu symptoms and you recently returned from travel in China, Italy, Japan, South Korea or Iran or you have been exposed to someone with a diagnosis of COVID-19, please call your provider and ask them to schedule you for an evaluation. Seek immediate medical attention if you are having difficulty breathing.

Q: What can I do to protect myself?

A: While there is currently no vaccine, there are several things you can do to reduce your risk of infection from this and other diseases: wash your hands with soap and water or use alcohol based sanitizers, avoid touching your eyes, mouth or nose with unwashed hands, and avoid close contact with people who are sick. If you’re sick, avoid public areas and limit your exposure to others.

Q: How does this compare to the Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) outbreak? 

A: COVID-19 is in the same family as SARS and MERS. The CDC is studying the virus to learn more.

Q: Does the COVID-19 test require a Prior Authorization?

A:  This is dependent upon your Plan. Most self-funded employers are not requiring a prior authorization to obtain the COVID-19 test; however, there are certain medical criteria that must be met along with a doctor’s written order.

Q: What is needed to obtain the COVID-19 test?

A:  Currently, in order to obtain the COVID-19 test, certain criteria must be met along with a doctor’s written order.

Q:  Where can I get the COVID-19 test conducted?

A:  Please consult with your physician for their lab work affiliations and check to see if those labs are participating with your network.

Healthcare Bluebook Comply Solution – Effective July 2022

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