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Coronavirus (COVID-19) Frequently Asked Questions
If you have symptoms of coronavirus (COVID-19), call your doctor. Based on the details of your symptoms, your doctor will follow guidance from the state department of health to determine whether it’s recommended that you get tested.
UPDATE: The following information applies for all our plans. These cost-sharing waivers for telehealth services will expire for Medicare members on Sept. 9, 2020; Medicaid members on Oct. 9, 2020; and Commercial members on Nov. 9, 2020. If you are not sure of your plan benefits for virtual visits, call the number on your member ID card. A Customer Service representative will be happy to help.
If you go to an in-network doctor to get tested for the coronavirus (COVID-19):
- Your diagnostic test and visit to diagnose COVID-19 (whether in-person or a virtual telehealth visit) will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles. Virtual visits include video and/or phone visits.
- You can reach out to AdvantageCare Physicians (ACPNY) at 866-749-2660. Find more information about scheduling an appointment to be tested at ACPNY here. There is no out-of-pocket cost to patients for the diagnostic tests, and it’s also free for any uninsured New Yorker. ACPNY is part of the EmblemHealth family of companies.
- See the update above concerning when these cost-sharing waivers will expire.
If you go to an out-of-network doctor to get tested for the coronavirus (COVID-19):
- Your diagnostic test and visit to diagnose COVID-19 (whether in-person or a virtual telehealth visit) will be covered by your plan. This includes any doctors outside of our network. There will be no cost-sharing, including copays, coinsurance, or deductibles. Virtual visits include video and/or phone visits. Treatment should still be obtained at a facility in our network, unless it is an emergency. If you are admitted to a facility not in our network, your treatment may NOT be covered by your plan. All normal coverage restrictions and cost-sharing charges will apply for care or treatment, including inpatient hospital admissions. Some plans do not cover out-of-network services, so this could include the total cost for services.
If you go to the emergency room to be tested for COVID-19:
- Your diagnostic test and visit to diagnose COVID-19 will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles. Services you get for an emergency room visit will always be covered, if you are admitted to the hospital.
Most standard health insurance plans do not cover non-diagnostic tests for employment reasons (e.g., drug screenings). These tests will generally not be covered just for return-to-work purposes. EmblemHealth will only cover non-diagnostic antibody tests when these services are covered by your benefit plan. If your doctor thinks you have COVID-19, EmblemHealth continues to cover FDA-authorized COVID-19 tests without cost-sharing, including copays, coinsurance, or deductibles.
If your doctor or licensed health care professional sends you to get your antibodies checked for COVID-19 because it is clinically indicated, your visit and FDA-authorized test will be covered. There will be no cost-sharing, including copays, coinsurance, or deductibles.
Given the high demand for testing and antibody testing reliability, we encourage our members to use Quest Diagnostics for their testing. Quest is EmblemHealth’s in-network, preferred lab and testing provider.
You can also reach out to AdvantageCare Physicians (ACPNY) at 866-749-2660. ACPNY is part of the EmblemHealth family of companies.
In partnership with the City of New York and New York State, ACPNY has increased testing at more than 20 new testing sites throughout the city. You can find more information about scheduling an appointment to be tested at ACPNY here. There is no out-of-pocket cost to patients for the tests.
If you need an antibody test for return-to-work purposes, most standard health insurance plans will not cover that service. EmblemHealth only covers non-diagnostic antibody tests when these services are delivered according to the terms of your benefit plan.
This policy is subject to change as we learn more about antibody testing during this rapidly evolving situation.
We have safe and convenient options for members:
- All EmblemHealth members have access to our 24-hour Nurse Hotline (877-444-7988)
- AdvantageCare Physicians (ACPNY) is now offering virtual visits for all patients. ACPNY patients should call 646-680-4227 to use this service.
- For EmblemHealth members with telemedicine as part of their benefit plan, we partner with Teladoc for virtual doctor visits. Visit Teladoc® online or by calling 800-835-2362 to talk with a doctor 24 hours a day, seven days a week.
- During the COVID-19 State of Emergency, Medicare Advantage members do not need a referral from their primary care doctor to visit a specialist.
Yes. During the COVID-19 outbreak, essential workers will have no cost-sharing for in-network outpatient mental health services. This includes copayments, coinsurance, or deductibles. This also includes telehealth—video and/or phone visits—or in-person outpatient mental health services. Outpatient mental health services are visits that occur outside of the hospital.
The CDC now recommends that you wear a face covering when you can’t practice social distancing, such as when you need to get essentials like groceries or medicine.
A face covering should fit snuggly on your face, be held by ties or ear loops, let you breathe comfortably, and be washable or disposable. A cloth face covering with multiple layers of fabric will help prevent an infected person without symptoms from spreading the disease. The cloth face coverings recommended are not surgical masks or N95 masks. Those are needed by health care workers and first responders.
After each use, carefully remove the mask and wash your hands. You can clean a cloth mask in your washing machine for the next time you need it. Visit the CDC webpage for some ideas on homemade masks. Remember to continue practicing social distancing and washing your hands often to prevent catching or spreading COVID-19.
The annual flu vaccine does not protect against the coronavirus. We do encourage members to always get their annual flu vaccine because it is the single best thing you can do to protect yourself and your family from various strains of the flu.
Currently, testing is only being done on patients whose doctor (following guidance from the Centers for Disease Control and Prevention (CDC) and state departments of health) recommends them to be tested. If you are concerned about the coronavirus, it’s important to remember the steps you can take to stay safe. For tips to protect you and your family, visit our dedicated EmblemHealth coronavirus webpage, which is continuously updated.
Call your doctor or surgeon to see if it is still scheduled. Some hospitals and facilities are holding off on performing elective surgeries, so it is best for you to check directly with the doctor who is going to perform your surgery.
If you already paid your copay at your first preoperative (pre-op) appointment for a physical or bloodwork but were unable to have your surgery due to coronavirus (COVID-19), and that copay was not refunded, you will not have to pay another copay at the pre-op appointment before your rescheduled surgery.
For members who are under quarantine or concerned about visiting pharmacies during the outbreak:
EmblemHealth covers 90-day supplies of long-term medications (or maintenance drugs) through Express Scripts mail order so members can get their medications delivered right to their home. Express Scripts also gives members access to pharmacists 24 hours a day, seven days a week, in case they have questions about their medications.
Sign up online -- If you already have a myEmblemHealth account, sign in to access your pharmacy benefits. Under “pharmacy,” click on “continue to Express Scripts.” Click “Home” in the Express Scripts window and you will see a list of available prescription refills. Select the items you want to order and follow the instructions to complete your request.
By phone -- To start using Express Scripts by phone, have your prescription number ready and call:
Medicare – 877-866-5828
Medicaid – 877-866-4165
All other plans – 877-866-5798
Mobile app – Download the app on your mobile device from the App Store, Google Play or Amazon apps.
By Fax --You can also ask your doctor to fax your new prescription with a fax cover sheet directly to Express Scripts at 800-837-0959 or use ePrescribe.
In addition, our partner, Medly Pharmacy, offers in-home delivery, in some cases on the same day, in New York City, Long Island, and New Jersey. They offer service in a half-dozen languages, including Spanish, Cantonese, Mandarin, and Russian. To connect with a Medly Pharmacy agent, call or text Medly at 800-595-0643 or visit their website.
If you want an early refill for your prescription due to the COVID-19 outbreak, it will help to tell your pharmacist to enter the Submission Clarification Code (SCC) 13. By entering SCC 13, the pharmacist is overriding your standard prescription fill in their system. It will make the process go smoother. Some pharmacies are not as familiar with this new code; that’s why we are telling you about it. If your early refill is rejected even after entering this code, please ask your pharmacist to contact the Express Scripts Pharmacy Help Desk at 800-922-1557.
EmblemHealth wants every New Yorker to have the security of health insurance to ensure they can get the care they need, especially in these uncertain times.
New York State has opened a special enrollment period through December 31, 2020 to help uninsured New Yorkers get coverage as the coronavirus spreads. If you need coverage, visit the NY State of Health, the Official Health Plan Marketplace, at nystateofhealth.ny.gov or call 855-355-5777 to complete an application and enroll in coverage. If you have coverage available through your employer and have not taken advantage of it, check with your employer about special enrollment options.
Centers for Medicare & Medicaid Services has opened a special enrollment period through May 31, 2020 for people eligible for Medicare plans.
EmblemHealth can help you apply for health insurance—including Medicare, Medicaid, Child Health Plus, Essential Plan and Qualified Health plans. Shop plans or all us at 800-447-9169 (TTY: 711) For assistance in Mandarin or Cantonese call 866-650-2668. For assistance in Spanish call 833-336-2536.
If you’ve recently had a change in income or lost your job, we can help you see if you qualify for a new health insurance program that may be a better fit for you. You may be eligible for other lower-cost or even free health insurance that keeps you covered. You can visit emblemhealth.com or call 888-432-8026 for a new health insurance program. You can also go directly to the NY State of Health Marketplace, visit nystateofhealth.ny.gov, or call Marketplace Customer Service at 855-355-5777 to update your application.
If you can’t afford your current premium, you may be eligible to switch to lower-cost or even free health insurance. We can help! Visit emblemhealth.com or call us at 888-432-8026.
During the COVID-19 national emergency, EmblemHealth is extending the time within which our members must pay their premium (the amount you pay for your health insurance each month). The special COVID-19 grace period varies by health insurance programs, so be sure to speak with our Customer Service representatives to understand how this applies to your coverage.
If you do not pay your past-due premium within the extended grace period, and your health insurance is terminated, you will be responsible for paying any claims for health care services you received after your coverage ended.
These payments should not be added as income for any NY State of Health consumer.
Unemployment benefits will not be counted toward your income eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).
Most health insurance coverage is not a factor in the new Public Charge rule. Only federally funded Medicaid is included, and even for this program there are several exempt groups of people who are excluded under the rule, including pregnant women and children under 21. Additionally, asylees, refugees, and visa holders who are victims of trafficking and other crimes, among others, are entirely exempt from the Public Charge rule.
The following programs are not included in the Public Charge rule:
- Essential Plan at any level – even if the premium is free
- Child Health Plus at any level – even if the premium is free
- Qualified Health Plan at any level – even if the premium is free with premium tax credits
Most standard health insurance plans do not cover non-diagnostic tests for employment reasons (e.g., drug screenings), so these tests will generally not be covered solely for return-to-work purposes. EmblemHealth will only cover non-diagnostic antibody tests when these services are covered by your benefit plan. Through the emergency period, EmblemHealth continues to cover FDA-authorized COVID-19 tests for diagnostic purposes without cost-share, including copays, coinsurance, or deductibles.
