Coronavirus (COVID-19) Frequently Asked Questions

New legislation, the American Rescue Plan (ARP), makes it easier for many individuals and their families to qualify for financial assistance when they buy health insurance coverage through the individual health insurance marketplace,  NY State of Health.

General FAQs

If you have symptoms of coronavirus (COVID-19), call your doctor. Based on the details of your symptoms, your doctor will let you know whether it’s recommended that you get tested. If you are fully vaccinated, the CDC says you may refrain from testing if you show no symptoms, even if you have been exposed to COVID or recently traveled. Talk to your doctor if you’re not sure. You can find more information about testing here.

Call your doctor. Your primary care doctor will follow guidance from the state department of health to determine what the best next steps are for you. Unless it’s an emergency, stay home. Do not go to public places and avoid public transportation. As always, if you are experiencing severe symptoms, call 911 or go to your local emergency department. Severe symptoms include high or very low body temperature, shortness of breath, confusion, or feeling like you may pass out. If you decide to go to the emergency department, call ahead and let them know you are coming, if you are able. This will allow them to safely prepare for your arrival.

You can find up-to-date information on vaccines, your coverage and benefits, and more on our vaccine webpage. For information on how to get vaccinated, visit your city or state’s COVID-19 vaccine sites: New York City, New York State, New Jersey, Connecticut, Pennsylvania.

You can find trusted information on vaccine safety, doses, and more on the CDC’s webpage.

The best ways to help keep you and your family safe from COVID-19 are to:

  • Get vaccinated
  • Wash your hands often and disinfect frequently touched surfaces.
  • Wear a mask over your nose and mouth when around others. Remember to check your state’s guidance on wearing masks in public spaces. The CDC now recommends that fully vaccinated people wear a mask in certain situations.
  • Avoid crowds and stay at least 6 feet away from people outside of your household.
  • Monitor your health for any COVID-19 symptoms.
  • Stay home if you are sick.

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.

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Benefits

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.
  • See the question above for more details on using telehealth services.
  • During the COVID-19 State of Emergency, Medicare Advantage members do not need a referral from their primary care doctor to visit a specialist.
  • You can find more information about testing here.

Taking care of your mental health is an important part of living a healthy life. Visit our mental health page for resources, information on how to access your benefits, and tips on to support friends and family.

Remember: If your stress feels overwhelming or unmanageable, get help now. Call 888-447-2526 (Montefiore members 800-401-4822) for confidential, 24/7 support.

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Pharmacy

Yes. To reduce face-to-face contact during the coronavirus (COVID-19) outbreak, CVS and Walgreens are providing free home delivery of prescriptions covered by EmblemHealth. Delivery is 1-2 days. Same-day delivery is not available.

To request delivery of your prescription(s):

CVS: You can request delivery in the following ways:

  • Mobile web: This is accessible through the Order Ready Text message when a prescription is ready for pickup. Simply click the link and request delivery (you are required to enroll in text messages from CVS).
  • CVS Mobile App: Like mobile web, but no text messaging is required.
  • Call your local pharmacy: With this option, you may experience longer-than-average wait times; please be patient.

Walgreens: You must be enrolled in Walgreens Express™ delivery program and should opt in to receive text messages. When the prescription is ready for pickup, you will receive a text, which will offer you the delivery option. Learn more.

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.

Home delivery policies may change. This FAQ will be updated as necessary.

For information on long-term medicines (maintenance drugs), see our next FAQ on getting a larger supply of prescriptions during the outbreak.

For members who are under quarantine or want to avoid 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.

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Coverage

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.

Open Enrollment for Individual and Family Plans is now available through December 31, 2021. Explore our affordable plans and enroll soon to make sure you have the coverage you need for 2021. 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.

If you have a Medicare Special Election Period you can join a Medicare plan.

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.

You may be eligible to apply for a Qualified Health Plan (QHP), Essential Plan, Medicaid, or Child Health Plus. NY State of Health announced a special enrollment period available to eligible New Yorkers to be able to enroll in a QHP through NY State of Health. This special enrollment period is available until December 31, 2021. But, if you have a qualifying life event (for example, income change, employment change, family size change), you may enroll at any time during the year for a new health insurance program.

These payments should not be added as income for any NY State of Health consumer.

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Additional Resources - American Rescue Plan

It’s a tax credit that helps eligible individuals and families cover part of their health insurance premium when purchased on the individual health insurance marketplace, NY State of Health. A premium is the amount you pay for your health insurance each month. 

The amount will differ depending on where you live, what your income is and who you have covered.

Call us at 888-432-8026 or contact the NY State of Health at nystateofhealth.ny.gov, by phone at 855-355-5777, or connect with a free enrollment assistor starting April 1 to learn how much you will be able to save.

The state is in the process of implementing the new subsidies and will be implementing them doing so in a phased approach.  If your annual income is below $51,040 for individuals and $104,800 for a family of four, you may be able to start paying less for your health insurance in May.  People with higher incomes including those who have received unemployment benefits this year can start checking in June to see whether these subsidies can help you reduce your health insurance costs.

Yes. New York has announced uninsured individuals can purchase a health plan at lower costs at any time through the end of 2021. Call us at 888-432-8026 or contact the NY State of Health at nystateofhealth.ny.gov, by phone at 855-355-5777, or connect with a free enrollment assistor starting April 1 to learn about affordable health insurance options where you live.

Yes.  New York has announced individuals can purchase a health plan at lower costs at any time through the end of 2021.  Call EmblemHealth at 888-432-8026  or go the NY State of Health online at nystateofhealth.ny.gov, by phone at 855-355-5777, or connect with a free enrollment assistor starting April 1 to learn about affordable health insurance options where you live.

Yes, premium tax credits are available for platinum, silver and bronze plans that are purchased on the NY State of Health. We can help you learn more about your options. Call EmblemHealth at 888-432-8026 or go to the NY State of Health online at nystateofhealth.ny.gov, or call at 855-355-5777.

Please check with your employer if you work for a small employer (100 employees or less) that provides you coverage through the New York State of Health.

No. By June, New York State will be able to calculate your savings and tell your health plan, which will lower your costs in your monthly bill.  However, individuals wishing to start saving on their health insurance starting in May can do so by contacting EmblemHealth at 888-432-8026 or the NY State of Health online at nystateofhealth.ny.gov, by phone at 855-355-5777, or connecting with a free enrollment assistor and answering a few questions.

No, these savings are only available in 2021 and 2022 unless the government decides to extend them. You will receive a credit for any savings you have earned earlier this year when you file your 2021 taxes next year.

If you were insured and paying premium prior to April 1, you will be able to claim the premium tax credit for prior months when you file your taxes for 2021.

Yes, if you involuntarily lost your job or if had your hours reduced and lost your insurance coverage after November 1, 2019, you may be able to receive a temporary 100% federal premium subsidy for COBRA.  If you have COBRA continuation coverage or you want to elect COBRA continuation now, the total cost of your premium could be covered for the subsidy period.  The subsidy period is from April 1 to September 30, 2021, though it could end sooner, depending upon your specific situation. 

Talk to your employer or former employer about whether you are eligible for the COBRA subsidy.

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