COVID-19 Legislation Update

As the landscape changes with the coronavirus pandemic, we want to keep you up to date on legislation and recommendations to keep you and your family safe.  Following are important notes on two topics:  (1) COVID-19 mandatory coverage; and (2) expanded coverage of telehealth visits. 

 

COVID-19 Legislation Update 

What you should know 

While early recommendations focused on the coverage for testing at $0 out of pocket to health plan members, the final legislation requires private health plans to provide coverage for COVID-19 diagnostic testing, including the cost of a provider, urgent care center, and emergency room visits in order to receive testing.  Coverage must be provided at no cost to the covered member.  Treatment for COVID-19 will continue to be covered as it otherwise would be under the terms of your plan for similar illnesses. 

 

What you should know

COVID-19 Vaccines: What to Know

With constantly developing information regarding the COVID-19 vaccine, it can be hard to keep track of it all. Because we care about your health, we are providing you with the latest COVID-19 information so you can keep yourself as well as your loved ones informed.

Now that there are authorized and recommended vaccines to prevent COVID-19 in the United States, below are some things to know regarding the available COVID-19 vaccines as updates are made.

  1. There Are Vaccines for Emergency Use Authorization.

The Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 Vaccine are being offered to help prevent COVID-19. Though not FDA approved, they are authorized for emergency use with the promise of altering the course of the pandemic. Vaccines are not interchangeable; you should complete the series with the same product. For those receiving the Pfizer vaccine, the second dose is administered 21 days after the first. Moderna's second dose is administered 28 days after the first dose. Please refer to the CDC COVID-19 Vaccines page for more information.

  • After you have received the first dose of the COVID-19 vaccine, you will receive a vaccination card with information on what COVID-19 vaccine you received, along with when and where it was administered.
  • Remember to ask your provider to give you a V-safe information sheet. V-safe is a tool that provides a personalized health check-in after you’ve received your first vaccine. You will need a smartphone to access V-safe.

  1. Certain Groups Are Excluded from Getting the Vaccine.

The FDA has authorized the emergency use of the Pfizer-BioNTech COVID-19 Vaccine in individuals 16 years of age and older and the Moderna COVID-19 Vaccine in individuals 18 years of age or older. People with a severe allergic reaction after a previous dose of this vaccine or to any ingredient of this vaccine should not receive it.

  1. There Is Priority for Who Gets the First Vaccines.

Due to initially limited supply, the CDC and Advisory Committee on Immunization Practices (ACIP) recommends that vaccines be allocated in a phased approach.

Phase

Groups recommended to receive COVID-19 vaccine

1a

Health care personnel

Long-term care facility residents

1b

Frontline essential workers

Persons aged ≥ 75 years

1c

Persons aged 65-74 years

Persons aged 16-64 years with high-risk medical conditions

Essential workers not recommended for vaccination in Phase 1b

2

All persons aged ≥ 16 years old not previously recommended for vaccination


For state-specific vaccine information, please follow the links by clicking on the state name:

 

  1. There Might Be Side Effects.

Side effects are possible, but serious reaction is rare. For more information on side effects, please visit the CDC or call your doctor. Side effects can include:

  • Pain
  • Swelling
  • Fever
  • Chills
  • Exhaustion
  • Headaches

 

  1. There Is No Cost for The Vaccine.
    Whether insured or uninsured, every American is entitled to vaccines to fight against COVID-19 at no cost. However, vaccination providers may be able to charge administration fees for giving the shot. Under the Affordable Care Act, providers are required to cover preventive care. Since the vaccine falls under preventive care, you have the right to file a claim.

 

As Always, Don’t Forget To:

  • Wash Your Hands
  • Stay at least 6 feet away from others
  • Use a face mask when around others
  • Cover coughs and sneezes

 

General Guidelines of the Centers of Medicare & Medicare Servces (CMS)

Healthcare Highways Health Plan follows the general guidelines of the Centers for Medicare & Medicaid Services (CMS). Recently, CMS broadened access to telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. So, what does this mean to you?  

  • You receive the same benefit coverage and pay the same amount for a physician visit delivered in office or via telehealth. 
  • Primary care providers and other practitioners, such as certified clinical psychologists, nutrition professionals, etc. can offer telehealth visits. Importantly, telehealth vendors like MDLive or HealthiestYou that may already be included in health plan benefits will continue to apply normal member benefits and cost sharing to their specific services, (i.e., telehealth vendor visit copays still apply).  
  • You pay your standard copays for a telehealth visit to a PCP, specialist, etc., or other providers if it’s not related to COVID-19.    
  • Telehealth visits to a PCP, specialist, etc., or other providers for COVID-19-related cases are covered at $0 out of pocket to members. 

 

What you should do 

Call your PCP for guidance. Your primary care physician is your best resource for getting answers to your questions or concerns about coronavirus.  They can determine if you are a candidate for testing, and provide you with the right authorization and information to obtain the test.  Call first, as many are now providing telephonic office visits in lieu of or in place of physical office visits. 

To help the healthcare provider’s office take steps to keep other people from getting infected or exposed, you should wear a facemask in public and especially before you enter a healthcare provider’s office. 

If you need assistance finding a local provider, accessing your information, or have a question on COVID-19 or your coverage, our Customer Experience Team is here to provide extra support 844-869-5640, 8 AM to 5 PM, Monday through Friday.