Update as of March 23, 2021:
The COVID-19 vaccine is currently being administered to certain populations. Please visit the North Carolina Department of Health and Human Services to learn more about the vaccination rollout to determine if you are eligible. Once eligible, members are albe to contact their local health department for assistance. To find your local health department, visit North Carolina Department of Health and Human Services.
When you are eligible to receive the vaccine there will be no cost for members, it will be covered 100% by the State Health Plan. While there is no member cost, the State Health Plan is paying for the administration of the vaccine, which is why it’s important to present your ID card. The vaccine is currently being paid for by the federal government.
COVID-19 Coverage Information
For Members on the 80/20 Plan, 70/30 Plan and High Deductible Health Plan:
The State Health Plan will be extending the following COVID-19 benefits:
- The Plan is waiving the cost of treatment (medical treatment only) for members diagnosed with COVID-19, including associated deductibles, copayments and coinsurance. Any medications prescribed to treat COVID-19 will be subject to the copay/coinsurance. This waiver is in effect until March 31, 2021.
- The Plan is waiving the cost associated with the testing of COVID-19 regardless of site of service (where you receive the test) to ensure there are no cost barriers to testing. This waiver is in effect until the federal CARES Act requirement expires. The waiver includes associated deductibles, copayments and coinsurance.
- Testing and treatment at an out-of-network provider may incur non-reimbursable charges.
- CVS Pharmacy offers drive-through, self-swab COVID-19 testing at select North Carolina CVS Pharmacy locations. Members must register in advance to schedule an appointment and follow instructions provided during registration process.
- The Plan is waiving the copay for in-person and virtual Primary Care Provider (PCP) visits to screen for COVID-19. Screening visits will not be subject to your deductible or coinsurance, even if your deductible has not been met. This waiver is in effect until the federal CARES Act requirement expires.
As a reminder, many providers offer tele-health or virtual visits. These types of visits are covered under your Plan benefits and this will remain in effect until June 30, 2021. The applicable copay for a PCP office visit will apply. If you are outside of North Carolina, please confirm with your provider as each state may have different rules regarding tele-health services.
For Humana Medicare Advantage Plan Members:
- The COVID-19 vaccine will be covered 100%, regardless of copays and deductibles. Coverage applies no matter where the member gets the vaccine -- including at both in-network and out-of-network providers. It also covers instances in which two vaccine doses are required.
- There will be no cost to members for the treatment of COVID-19 through December 31, 2021.
- There will be no cost to you for the COVID-19 test (includes antibody test). If you think you have been exposed to the virus, contact your Primary Care Provider. Copays and coinsurance are also waived for visits associated with the COVID-19 testing, regardless if care is furnished in physician office, urgent care or ER.
- Virtual visits related to COVID-19 testing are covered at 100% through December 31, 2021.
- Through December 31, 2021, there will be $0 copayment for in-network and out-of-network non-COVID-19 primary care physician, specialist, behavioral and substance abuse, and urgent care virtual visits for members. In-network and out-of-network providers must have the ability and be qualified to offer virtual medical visits. To locate an in-network provider, visit https://our.humana.com/ncshp/tools-resources and use the Find a Doctor tool to easily lookup providers in the Humana Medicare PPO network. If you have questions about virtual visits, please call the dedicated North Carolina State Health Plan Humana Group Medicare Customer Care team at 1-888-700-2263 (TTY: 711), Monday – Friday, 8 a.m. – 9 p.m., Eastern time.
- Plan members are eligible for a Health Essentials Kit, limited to 1 kit per member per year, covered at $0 copayment. Kit includes over-the-counter items useful for the prevention of COVID-19 and other viruses. To request a Health Essentials Kit, please call the dedicated North Carolina State Health Plan Humana Group Medicare Customer Care team at 1-888-700-2263 (TTY: 711), Monday – Friday, 8 a.m. – 9 p.m., Eastern time.
- For those Plan members with a COVID-19 diagnosis, you may be eligible for 14 days of meals (28 meals), available at no cost. Please call the North Carolina State Health Plan Humana Group Medicare Customer Care team at 1-888-700-2263 (TTY: 711), Monday – Friday, 8 a.m. – 9 p.m., Eastern time to check eligibility.
- If you need an early prescription refill, you may request one through your pharmacy. Look at your current supply of medications, as well as what you might need in the near future, to decide if you should refill early. Check to see if home delivery is an option with local pharmacy or use Humana Pharmacy through Humana.
- For the most up-to-date information from Humana, please visit Coronavirus Updates and Resources - Humana or visit the CDC website.
For more information, call Humana Customer Service at 888-700-2263. Click here for more North Carolina COVID-19 Vaccine information from Humana.
All Members
Plan members are advised to follow the same precautions as the Centers for Disease Control and Prevention recommends:
- Avoid close contact with people who are sick.
- Avoid touching your eyes, nose, and mouth.
- Stay home when you are sick.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
- Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
- Wash your hands often with soap and water for at least 20 seconds.
The Plan continues to monitor the ongoing developments around this virus. If other precautions or actions are warranted, additional information will be communicated to Plan members via email and posted on the Plan’s website. You can view a recording of our member webinar, "Update on Your State Health Plan Benefits and COVID-19", by clicking here.
You may be asked to monitor your health and watch for symptoms of COVID-19. Notify your doctor if you develop symptoms, and seek medical care if your symptoms worsen or become severe.
Additional COVID Resources
- For more details and updates, visit the Centers for Disease Control and Prevention (CDC) website.
- For the most current information on testing and testing resources, visit NC DHHS.
- For the most current recommendations regarding infection prevention, therapeutic options and other topics, visit the CDC website.
- You can find more information about Contact Tracing here from the Centers for Disease Control and Prevention.
- Be aware of scammers pretending to be COVID-19 contact tracers. Legitimate contact tracers will never ask for you Medicare number or financial information. If someone calls adn asks for personal information, like your Medicare number, hang up and report it to 1-800-MEDICARE.
Previous updates:
Press Release, July 21, 2020: State Health Plan Extends COVID-19 Cost Waivers
Member Alert, June 1, 2020: COVID-19 Update - CVS Pharmacy Provides Drive-Through COVID-19 Testing
Member Alert, May 26, 2020: Update on Your State Health Plan Benefits and COVID-19
Member Alert, April 2, 2020: State Health Plan to Waive Costs Associated with COVID-19
Member Alert, April 2, 2020: COVID-19 Update for UnitedHealthcare Members
Member Alert, March 25, 2020: Update on Your State Health Plan Benefits and COVID-19