What you need to know about your plan’s coverage for COVID-19 related testing and services with the end of the Public Health Emergency on May 11, 2023.
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Coronavirus (COVID-19)
Coverage and Benefits
In-Network testing
- COVID-19 PCR or rapid lab tests are covered by your plan when an in-network health care professional orders it for medically appropriate reasons. When you have COVID-19 symptoms, or have been exposed to it, a PCR or rapid test is medically appropriate. You will pay your copays, coinsurance and/or deductibles for the lab test and visit according to your plan’s benefits.
- COVID-19 PCR or rapid lab tests for screening purposes are not covered by your plan. You will pay the full cost of your test. This includes testing you may be required to get before a surgery.
Out-of-Network testing
- If your plan has an out-of-network benefit, cost-sharing applies for a medically appropriate COVID-19 PCR or rapid lab test and visit with an out-of-network provider. When you have COVID-19 symptoms, or have been exposed to it, a PCR or rapid test is medically appropriate. You will pay your out-of-network copays, coinsurance and/or deductibles for the lab test and visit according to your plan’s benefits.
- If your plan does not have an out-of-network benefit, a COVID-19 PCR or rapid lab test performed by an out-of-network health care professional is not covered. You will pay the full cost of your test. You can find a provider in our network by signing in to the member portal and using our Find Care tool.
If you are treated for COVID-19 by an in-network provider—for example, getting care through an office visit, urgent care center, or emergency room, or if you are admitted to the hospital for COVID-19 treatment — you will pay for your copays, coinsurance and/or deductibles, according to your plan benefits.
- If your plan has an out-of-network benefit and you are treated for COVID-19 by an out-of-network provider, you will pay for your copays, coinsurance and/or deductibles, according to your plan benefits. This includes getting care through an office visit, urgent care center, or emergency room, or if you are admitted to the hospital for COVID-19 treatment. Your provider may choose to bill you for the difference between what they charge and what we pay. You usually pay less when you visit a provider in our network.
- If your plan does not have an out-of-network benefit and you receive treatment for COVID-19 from an out-of-network health care professional, you are not covered. You will pay for the full cost. You can find a provider in our network by signing in to the member portal and using our Find Care tool.
- Services you get in an emergency room will always be covered if you are admitted to the hospital. If you are admitted to an out of network hospital in an emergency, you will pay your copays, coinsurance and/or deductibles for an in-network provider according to your plan benefits.
Vaccinations and Boosters
You can find trusted information on vaccine safety, doses, and more on the CDC’s webpage or at COVID.gov.
COVID-19 vaccines and boosters are covered by your plan with no cost-sharing when an in-network health care professional gives you the vaccination. A COVID-19 vaccination or booster is preventative care. You pay $0, if your visit with an in-network provider is only to administer the covid vaccine or booster.
- If your plan has an out-of-network benefit, your COVID-19 vaccines and boosters are covered when an out-of-network health care professional gives you the vaccination. You will pay your out-of-network copays, coinsurance and/or deductibles for the visit and vaccine according to your plan’s benefits. Your provider may choose to bill you for the difference between what they charge and what we pay. You usually pay less when you visit a provider in our network.
- If your plan does not have an out-of-network benefit, a COVID-19 vaccine given by an out-of-network health care professional is not covered. You will pay the full cost of the visit and vaccine. You can find a provider in our network by signing in to the member portal and using our Find Care tool.
Virtual Care
- If your plan has a general telemedicine benefit, like Teladoc or Talkspace, you are covered for care related to COVID-19. Teladoc doctors are not your regular doctors, but they can help you with 24/7 access to virtual health care and medical advice. Talkspace provides convenient online therapy for your mental health. You will pay your normal copays, if you have one, for any virtual care you receive from Teladoc or Talkspace.
- If you have a virtual or telephone (audio-only) visit with an in-network provider, you are covered for care related to COVID-19. You will pay your copays, coinsurance and/or deductibles, according to your plan benefits for an office visit. Medicare members are covered for virtual visits, including by telephone (audio-only) through Dec. 31, 2024, and then coverage will be according to your 2025 plan benefits. Medicaid members are covered for virtual or telephone (audio-only) visits from in-network providers only.
- If your plan has an out-of-network benefit, you are covered for a virtual or telephone (audio-only) visit with an out-of-network provider for care related to COVID-19. You will pay your copays, coinsurance and/or deductibles, according to your plan benefits for an office visit. Your provider may choose to bill you for the difference between what they charge and what we pay. You can find a provider in our network by signing in to the member portal and using our Find Care tool.
- If your plan does not have an out-of-network benefit, you are not covered for virtual care or telephone (audio-only) with an out-of-network provider for care related to COVID-19. You will pay the full cost of your virtual visit. You can find a provider in our network by signing in to the member portal and using our Find Care tool.
Last Updated: 07/06/2023
