Answering your COVID-19 coverage and care questions

COVID-19 testing

There are several resources available through federal and state programs for free COVID-19 testing.

Learn more about COVID-19 testing and coverage

COVID-19 treatment

Harvard Pilgrim has been waiving member cost sharing (deductibles, copays and coinsurance) for COVID-19 treatment from in-network providers and for emergency services related to COVID-19 treatment from out-of-network providers.

Starting August 7, 2021, cost sharing for COVID-19 treatment will resume if your Harvard Pilgrim policy was purchased in Connecticut, Maine or New Hampshire. Cost sharing for COVID-19 treatment will continue to be waived if your policy was purchased in Massachusetts, per state regulation.

If you’re enrolled in a self-insured plan, please contact your employer for coverage details.

Antiviral medications
The FDA has authorized the following two oral antiviral medications under emergency use authorization (EUA) for the treatment of certain cases of COVID-19. When prescribed and dispensed under the requirements of the EUA, one course of therapy can be provided at no charge to the member. Prescriber and pharmacy access is currently extremely limited; speak to your health care provider if you test positive for COVID-19 and believe you qualify for treatment.

• Pfizer’s PAXLOVID™ (nirmatrelvir/ritonavir)
• Merck’s molnupiravir

There are several resources available through federal and state programs for free COVID-19 testing.

Learn more about COVID-19 testing and coverage

At-home COVID-19 PCR (polymerase chain reaction) tests are covered with orders or referrals from your physician or attending provider. Harvard Pilgrim will not cover or reimburse you for these tests when you order them yourself, including when you order using an online self-completed questionnaire.

Yes. Employees who lose group health coverage can apply for coverage through the state health care exchanges. They may also be eligible for premium assistance.

Harvard Pilgrim has been waiving member cost sharing (deductibles, copays and coinsurance) for telehealth services related to COVID-19 treatment.

Starting August 7, 2021, cost sharing for COVID-19 telehealth treatment will resume if your Harvard Pilgrim policy was purchased in Connecticut, Maine or New Hampshire. Cost sharing for COVID-19 telehealth treatment will continue to be waived if your policy was purchased in Massachusetts, per state regulation.

If you’re enrolled in a self-insured plan, please contact your employer for coverage details.

Why is telemedicine a good idea?

With telemedicine, members have access to virtual medical and behavioral health visits via phone or video chat with licensed health care providers. Using telemedicine to avoid crowded waiting rooms reduces your exposure to COVID-19 and other infections and helps to contain the spread of COVID-19.

Services offered through telemedicine include:

• Assessments to determine whether you need to be seen or tested for COVID-19 or other health conditions
• Urgent or routine check-in with a health care provider
• Behavioral health visits
• Non-COVID-19 related appointments that can’t happen in person due to COVID-19 precautions and can be appropriately addressed via telemedicine

First, call your health care provider to see if they offer telemedicine services. Many providers are now offering video or phone visits. You can also visit www.doctorondemand.com (or download the Doctor On Demand app) to be evaluated by a medical or behavioral health professional through virtual visits. Doctor On Demand is available 24 hours a day, 7 days a week.

Remember, if you’ve been exposed to COVID-19 or are experiencing symptoms (fever, cough or shortness of breath) call your health care provider for medical advice first.

Prior authorization is not currently required for testing or treatment after a COVID-19 diagnosis. As of August 7, 2021, prior authorization will be required for treatment if your Harvard Pilgrim policy was purchased in Connecticut, Maine or New Hampshire.

You can fill a 90-day supply of maintenance medicines. Maintenance medicines are those you take regularly, such as birth control, blood pressure or cholesterol medicines.

To get a 90-day supply of maintenance medicines you can use our mail order pharmacy, OptumRx Home Delivery. Most orders arrive within seven days of when you place the order. Your options are to:

Log in to your member account at harvardpilgrim.org and click “Check drug coverage and costs” to order your medicines from OptumRx Home Delivery.

• Use the OptumRx app, available for download from the Apple Store or Google Play.
• Ask your health care provider to e-prescribe your medicine(s) to OptumRx Home Delivery.
• Ask your health care provider to phone your medicine(s) to OptumRx Home Delivery at (855) 258-1561

You can also ask your health care provider for a 90-day prescription for the medicines you take regularly and have them filled at a participating retail pharmacy.

You may also want to check your supplies of over-the-counter pain relief, fever and cough medicines.

Note: Not all employer-sponsored plans offer Harvard Pilgrim’s prescription drug benefits and mail order program. Please check with your employer or refer to your Benefits and Coverage documents

Can I fill my prescriptions early to ensure I have an adequate supply?

If you need an early refill, please contact Member Services for help.

If you need an early refill, please contact Member Services for help.

COVID-19 can cause a range of symptoms. Some are mild (fever, cough, shortness of breath), but the virus can lead to more severe respiratory illness, such as pneumonia, especially in people with co-existing medical conditions. Symptoms may appear 2 – 14 days after exposure.

People with mild to moderate cases of COVID-19 can infect others up to 10 days after they first have symptoms. People with more severe COVID-19, or who are severely immunocompromised, can infect others up to 20 days after they first have symptoms.

Try the CDC’s Coronavirus Self-Checker to help you make decisions about seeking appropriate care.

The CDC offers guidance on what to do if you think you have COVID-19. Call your PCP if you have questions about when to get tested and potential treatment.

Call 911 or your local emergency services number if someone is showing any of these emergency warning signs for COVID-19, or has other severe or troubling symptoms:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

There are two kinds of COVID-19 tests: viral tests and antibody tests.

• Viral tests show whether you currently have a COVID-19 infection.
• Antibody tests show whether you already had a COVID-19 infection.

The viral test is used to diagnose COVID-19. Samples are typically taken with a nasal swab, and the results will show whether or not you currently have a COVID-19 infection. Your health care provider will determine if you need to be tested for COVID-19.

A negative viral test result means that you likely did not have COVID-19 when you had your sample taken. It’s still possible for you to become infected, though. That’s why it’s important to continue taking preventive measures to protect yourself and those around you, regardless of the test you had or the results.

Antibody or serological (blood) tests do not diagnose current COVID-19 infections. The presence of antibodies in your blood may show that you already had an infection. It can take 1-3 weeks after an infection to make antibodies, so recent infections may not show.

Experts do not yet know how much protection antibodies give you against another infection or how long the protection may last. The antibody test requires samples to be taken typically with a finger prick. FDA-authorized antibody testing for COVID-19 is covered only when it is medically necessary for your provider to help make decisions about your treatment for an immediate medical condition.

First, call your provider’s office to see if you can get a telemedicine appointment. If not, you can use Doctor On Demand (for medical and behavioral health) or Optum/United Behavioral Health’s virtual visits platform.

If you are on our Medicare Enhance, Medicare Advantage or Medicare Supplement plans, you can use medical and behavioral health providers who accept Medicare and offer telehealth services. You should ask the provider’s office directly if you have questions about Medicare status and telehealth availability.