Coronavirus Updates

coronavirusCOVID-19 Coverage Information

For Members on the 80/20 Plan, 70/30 Plan and High Deductible Health Plan:

The State Health Plan is providing the following COVID-19 benefits:

  • At-Home Rapid COVID-19 tests continue to be covered 100%. There is a limit of 8 At-Home Rapid tests per 30 days (based in the number of tests not kits).

Plan members will have two options for coverage of At-Home Rapid COVID-19 tests:

  • Purchase your At-Home Rapid COVID-19 test at a local pharmacy using your State Health Plan ID card. When purchased at the pharmacy with your ID card, there should be no cost to the member, or

  • Purchase an At-Home Rapid COVID-19 test online or in a store and submit a receipt and claims form for reimbursement.

  • State Health Plan members are encouraged to utilize the free COVID-19 test kits available through federal and state programs such as:

    • NC DHHS and Labcorp are teaming up to make at-home kits for COVID-19 testing available to North Carolina residents. For more information and to place an order visit the NCDHHS website.

  • Several retail pharmacy chains are now offering more convenient ways to order COVID-19 tests, including the ability to order them online. Check with your pharmacy for more information.

Members electing to purchase the test and submit a claim should use the Over-the-counter, at-home COVID-19 Test Reimbursement Claim Form located on the Plan’s website. Members should submit a receipt, that clearly indicates the test purchased, along with the claims form. Expect the claims reimbursement process to take between 30 and 90 days.

  • The Plan is waiving the cost associated with the testing of COVID-19 regardless of site of service (where you receive the test). This waiver as directed by the CARES Act is currently in place until the end of the CARES Act. The waiver includes associated deductibles, copayments and coinsurance. (Testing and treatment at an out-of-network provider may incur non-reimbursable charges.)

    • Please be aware the most pharmacies require you to meet certain criteria to have the test done at no cost.  If you do not meet the criteria, you have to pay out of pocket and seek reimbursement. Criteria such as, pregnancy, exposure to someone who is known to have tested positive, elderly, or symptomatic.

  • The COVID-19 vaccine continues to be covered at 100% by the Plan. While there is no member cost, the State Health Plan is paying for the administration of the vaccine, so it is important that employees present their ID card. The vaccine is currently being paid for by the federal government. Please visit the North Carolina Department of Health and Human Services to find a location. You have a spot. Take your shot!

  • 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 December 31, 2022. 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:

  • Per the President's Executive Order, At-Home Rapid COVID-19 tests will be covered 100% effective April 4, 2022, for Medicare Part B members. This includes members enrolled in a Medicare Advantage plan, like the State Health Plan’s Humana Medicare Advantage Base and Enhanced Plans. There is a limit of 8 At-Home Rapid tests per 30 days (based in the number of tests not kits). This does not apply to tests purchased prior to April 4, 2022. These tests will be covered by CMS, and not Humana, so members will need to show their red, white, and blue Medicare card. For more information regarding this order and participating providers click here: Medicare & Coronavirus.
  • The COVID-19 vaccine is covered 100%. 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. This includes coverage for the booster vaccines. You will want to show your Medicare ID card when you get the vaccine since this will be covered by Original Medicare.  
  • There will be no cost to members for the testing and treatment of COVID-19 through December 31, 2022. 
  • Beginning January 1, 2023, coverage for the testing and treatment of COVID-19 will be the same as any illness, subject to the applicable cost share based on the service received and the place of treatment. This includes coverage for FDA-approved medication based on the tier it falls on the Humana drug list.

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 and asks for personal information, like your Medicare number, hang up and report it to 1-800-MEDICARE.