Coronavirus Updates COVID-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: Per the President's Executive Order, At-Home Rapid COVID-19 tests will be covered 100% effective January 15, 2022. The State Health Plan (Plan) will offer this coverage to Plan members enrolled in the 80/20 and 70/30 PPO Plans as well as the High Deductible Health Plan (HDHP) via the pharmacy benefit. 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 January 15, 2022. 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 PLEASE NOTE: At this time many pharmacies are experiencing high volume at the pharmacy counter and have restricted OTC product processing to only those with a prescription. Most are requiring Plan members to pay. The State Health Plan can not require pharmacies to comply. Many are making this decision based on staffing. 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.) The COVID-19 vaccine is available to everyone 5 and older. Please visit the North Carolina Department of Health and Human Services to find a location. You have a spot. Take your shot! 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. 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. The COVID treatment cost share waiver expired June 30, 2021; therefore, treatment or services related to COVID-19 are subject to the applicable cost share amounts. 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 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, 2022. 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, 2022 (this does not include at-home COVID-19 tests). Through December 31, 2022, 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. 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 State Health Plan members are encouraged to utilize the free COVID-19 test kits available through federal and state programs: Residential households in the U.S. can order one set of 4 free at-home tests from USPS.com. There is a limit of one order per residential address. One order includes 4 individual rapid antigen COVID-19 tests. 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. 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. 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.