Coronavirus (COVID-19) Broker Frequently Asked Questions - Testing and Vaccine

Vaccine

During the COVID-19 outbreak, you and your clients will have many questions. We understand that as the situation continues to evolve, staying on top of the latest information is a priority for you. Find answers to questions about our business and member policies here.

The FDA has approved two vaccines for COVID-19, and more may be approved in the coming months. State governments are creating distribution plans based on CDC advice and vaccines are being distributed based on state eligibility rules. To see if you are in a category of people eligible for a vaccine, visit your city or state COVID-19 vaccine sites for information: New York City, New York State, New Jersey, Connecticut, Pennsylvania

To see if you are in a category of people eligible for a vaccine, visit your city or state COVID-19 vaccine sites for information: New York City, New York State, New Jersey, Connecticut, Pennsylvania

We will continue to inform and guide our members when it comes to COVID-19 prevention and care, including when appointments can be made at vaccination sites and at AdvantageCare Physicians (ACPNY).* 

Please take a moment to check your contact information using your myEmblemHealth account. Be sure to update your email address, cell phone number, and preferred language. You can also call us at the number on your member ID card. A Customer Service representative will be happy to help update your records. 

If your doctor has a patient portal, you’ll want to be sure you are registered, and your contact information is correct. 

*ACPNY is part of the EmblemHealth family of companies.

The FDA has approved two vaccines for COVID-19, and more may be approved in the coming months. FDA-approved COVID-19 vaccines will be covered under member plans. In some situations, the government may cover the vaccine cost. Members will pay $0 out-of-pocket for both doses of the vaccine they receive. This applies whether they visit health care providers in or out of our network.

No. Members will pay $0 out-of-pocket for both doses of the vaccine. This applies for vaccination visits to health care providers in or out of our network.

The two current FDA-approved vaccines are similar in effectiveness. Both vaccines will be covered by EmblemHealth plans. Members can find trusted information on the COVID-19 vaccine, including safety, doses, and more, on the CDC’s website. They can also stay up to date by visiting the NYC Department of Health website, the NYS Department of Health website, or their home state or city’s website. 

Both current FDA-approved vaccines require two doses. It’s important for members to get both doses of the vaccine at the right time based on CDC guidance

No. Members will pay $0 out-of-pocket for both doses of the vaccine. This applies whether they visit health care providers in or out of our network.

Testing

Members should speak to their doctor before being tested for COVID-19. Only diagnostic testing, if a doctor, pharmacist, or other licensed clinical health care professional orders the test after a clinical review, is covered. There are no limits on the number of diagnostic, medically necessary tests a member can receive. 

Diagnostic testing is covered for all members, with no cost-sharing (no copay, deductible, or coinsurance). More information on testing can be found here: COVID FAQs

Members can visit their doctor, a designated lab, or AdvantageCare Physicians (ACPNY) for testing. In some states, members may also be able to be tested at a local pharmacy. Diagnostic testing is covered for all members, with no cost-sharing. 

Members can find more information about the different kinds of tests on the FDA’s website

Rapid and PCR COVID-19 tests with an order from a doctor, pharmacist, or other licensed health care professional after a clinical review, also known as diagnostic testing, are covered with no cost-sharing. Testing for return to work or school is not covered. 

Antibody tests should be requested in consultation with a health care professional. 

According to the CDC, antibody test results should not be used to diagnose someone with an active COVID-19 infection. If a member’s doctor or licensed health care professional orders a COVID-19 antibody test because it is clinically indicated, the visit and FDA-authorized test will be covered. There will be no cost-sharing, including copays, coinsurance, or deductibles. 

 We encourage members to use Quest Diagnostics for their testing. Quest is EmblemHealth’s in-network preferred lab and testing provider. 

Members can also reach out to AdvantageCare Physicians (ACPNY) at 866-749-2660. ACPNY is part of the EmblemHealth family of companies.

Members should speak to their doctor before being tested for COVID-19. Only diagnostic testing, if a doctor, pharmacist, or other licensed health care professional orders the test after a clinical review, is covered. Testing is only covered when medically necessary. 

FDA-approved COVID-19 home tests that are sold at a pharmacy or store without a prescription or order from a licensed health care professional are not covered. Most health insurance plans do not cover COVID-19 tests for reasons other than diagnosis or treatment by a health care professional. For example, tests conducted for return-to-work purposes or travel are generally not covered. 

There are no limits on the number of diagnostic, medically necessary tests a member can receive. 

Resources/links

Support link: https://www.emblemhealth.com/covid19/resources-and-support-during-covid19 

The EmblemHealth Nurse Hotline is staffed with experienced, licensed nurses who are continually briefed on the latest information and are available for confidential, one-on-one health counseling and to answer health questions 24 hours a day, 7 days a week. Members can reach the Nurse Hotline at 877-444-7988

Go to CDC.gov for information about the vaccine.