COVID-19: Your Guide to Care

The COVID-19 vaccine helps your body develop immunity and protects you from the coronavirus that causes COVID-19. It is important to note that you cannot catch COVID-19 from the vaccine itself. The COVID-19 vaccines are safe and effective, and we encourage you to get vaccinated when you are eligible.

After you receive any vaccine, your body starts building immunity, which can sometimes cause mild side effects. This is normal and a sign that the vaccine is working. COVID-19 vaccine side effects are similar to those that other common vaccines can cause, such as temporary soreness in your arm, fever, chills, tiredness and headache.

No, members will not have to pay cost sharing for the emergency use authorization COVID-19 vaccines.

Each state has published recommendations for which groups of individuals should receive priority for the initial limited supply of the COVID-19 vaccine. If you fall into one of these prioritized high-risk categories, you may be eligible to receive the vaccine now. As the supply of COVID-19 vaccines increases, distribution will expand to include more individuals. In the meantime, check your state government’s website for the most current information:

• Connecticut
• Maine
• Massachusetts
• New Hampshire

Since vaccine priority is related to your age, medical conditions and work, we recommend that you check with your state government’s website for more information:

• Connecticut
• Maine
• Massachusetts
• New Hampshire

Once the vaccine is widely available, the plan is to have it available in doctors’ offices, select retail pharmacies, hospitals and federally qualified health centers. Check your state government’s website for the latest information:

• Connecticut
• Maine
• Massachusetts
• New Hampshire

When the vaccine becomes available to the general public, each state will provide information about vaccination sites. Check your state government’s website for the latest information:

• Connecticut
• Maine
• Massachusetts
• New Hampshire

COVID-19 vaccines from Pfizer-BioNTech and Moderna have received emergency use authorization from the U.S. Food and Drug Administration. If you are eligible to be vaccinated, you cannot choose which vaccine you receive. It is important to get the first vaccine that is available to you, as they offer strong protection against hospitalization and death due to COVID-19.

The Moderna and Pfizer-BioNTech vaccines require two doses; if you receive one of these vaccines, you should get the second dose at the recommended time.

People who are currently eligible for vaccination cannot choose which vaccine they receive, and you should get whichever vaccine is available in your community

Temporary soreness in your arm, fever, chills, tiredness and headache are all normal. The CDC provides more details on what to expect after getting the vaccine.

Like many other vaccines, you may experience side effects while your body is building immunity. Temporary soreness in your arm, fever, chills, tiredness and headache are all normal and should go away after a few days. If you have worrisome side effects that do not go away after a few days, contact your primary care provider.

We don’t yet know. Because the virus is so new, researchers need time to monitor its response to determine how long the vaccine will protect you from the virus.

We understand that you may have concerns about receiving the COVID-19 vaccine. A safety review was part of the FDA emergency use authorization process. We encourage you to visit the CDC website for information about COVID-19 vaccine safety and benefits, frequently asked questions and more.

For those who have been fully vaccinated, the CDC provides guidelines for what you should and should not do during the remainder of the pandemic to keep yourself and others safe.

At your vaccine appointment, you will receive a COVID-19 vaccination record card. The card will show your name and date of birth, as well as which COVID-19 vaccine you received, where you received it and the date of your vaccination appointment. If you need to return for a second dose of the vaccine, the card will serve as a reminder; be sure to bring the card to your second appointment.

Please do not post pictures of your vaccination record card on social media or share proof of your immunization publicly. This is considered sensitive information that may put you at risk for vaccine scammers and identity theft.

We encourage you to hold on to your vaccine card and keep it with your personal records. The CDC offers tools to help you keep your vaccine records up to date.

The coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by a newly identified strain of coronavirus, SARS-CoV-2, that was first detected in Wuhan, China.

The virus is thought to spread mainly:

• Between people who are in close contact with one another (within about 6 feet).
• Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

It may also be possible that a person can get COVID-19 after touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes; this is not thought to be the main way the virus spreads, however.

Help protect yourself with these tips:

• Avoid close contact with people who are sick
• Avoid touching your eyes, nose and mouth
• Stay home from work or school if you are sick
• Wash your hands often with soap and warm water, and for at least 20 seconds. Do this especially:
  • Before eating
  • After using the bathroom
  • After coughing, sneezing or blowing your nose
• If soap and warm water aren’t available, use hand sanitizer with at least 60% alcohol
• Cover coughs and sneezes with tissue, and put the tissue in the trash
• Clean and disinfect doorknobs, phones and other surfaces and objects you frequently touch
• Get rest, eat healthy, drink fluids and be physically active to keep your immune system strong
• Review the CDC’s travel guidance if you have recently been or plan to travel overseas

Call your health care provider if you have a fever with a cough or difficulty breathing, and:

• You have been in close contact with someone who has coronavirus
• You live or recently traveled somewhere that has an ongoing spread of coronavirus

Your health care provider will work with your state’s public health department and the CDC to determine if you need to be tested for coronavirus.

The CDC recommends wearing a non-medical cloth face mask that covers your mouth and nose when you leave your home while conducting essential business, such as grocery shopping or going to work.

It’s estimated that 25% of COVID-19 infections may be caused by individuals who are not showing symptoms and are unaware that they have the virus. The CDC says that wearing face masks could slow the transmission of the virus, and prevent people who have COVID-19 but are not yet showing symptoms from unknowingly spreading it to others. Most importantly, you should continue to stay at home whenever possible and practice good social distancing to protect yourself and others.

If you do not have a mask, check out the CDC’s page Use of Cloth Face Coverings to Help Slow the Spread of COVID-19. You can also find tutorials on YouTube that show you how to make homemade face masks using bandanas, scarves and other materials.

Do not attempt to purchase higher-grade N95 masks. These are reserved for hospitals and health care workers who are facing severe shortages in PPE (personal protective equipment).

And remember—wash your hands frequently and avoid touching your face. If you must leave your home for essential items, avoid crowded places and continue to practice social distancing by maintaining a distance of at least six feet from others.

Social distancing is one of the most important ways to help slow the spread of COVID-19 and “flatten the curve.” This public health practice includes:

• Staying at least six feet away from other people
• Avoiding group gatherings and not playing sports in parks
• Working from home and not going into the office
• Shutting down schools and promoting online learning or classes
• Connecting with loved ones virtually instead of in person
• Canceling or postponing large group gatherings such as conferences, concerts or sporting events

“Flattening the curve” means using practices such as social distancing to slow the rate of COVID-19 infection. This will help ensure that health care providers and hospitals have enough room, supplies and other resources to care for those who are ill.

Quarantines are for people who have been exposed to an illness but do not have symptoms. They are kept away from other people so they don’t unknowingly infect anyone.

You may be asked to self-quarantine if you have recently returned from traveling to a part of the country or the world where COVID-19 is spreading rapidly, or if you have knowingly been exposed to an infected person. Health experts recommend a self-quarantine period of 14 days.

With isolation, people who are sick with an infectious disease are separated from people who are not sick to keep the sickness from spreading. Isolation can take place at home or at a hospital or other care facility.

COVID-19 testing

Members are covered without cost sharing for COVID-19 testing, until further notice.

Please contact your provider to find out whether testing is appropriate for you. For Medicare members, COVID-19 testing may be ordered by any state-authorized health care professional.

Consistent with federal and state guidance, COVID-19 tests will only be covered or reimbursed if they are medically necessary, as determined by a health care provider, in accordance with current CDC and state public health department guidelines. COVID-19 tests that are not ordered or referred by a provider are not covered benefits. Testing will not be covered solely for general workplace health and safety, public health surveillance, or other purposes not primarily intended for a member’s individual COVID-19 diagnosis or treatment, except for Maine members when in compliance with and required by the state of Maine regulatory guidelines.

We will update this information as new guidance is issued.

Members should always use participating providers/laboratories for all COVID-19 testing.

COVID-19 treatment

To help remove any potential barriers to care for our members, as of March 31, 2020, Harvard Pilgrim has waived member cost sharing (deductibles, copays, coinsurance) for COVID-19 treatment provided by in-network providers. Cost-sharing for emergency services related to COVID-19 treatment administered by out-of-network providers will also be waived.

This enhanced policy applies to all Harvard Pilgrim fully insured commercial, Medicare Advantage and Medicare Supplement members, and will be in effect until further notice. Harvard Pilgrim will reassess our policies as circumstances warrant.

If you were treated for COVID-19 prior to March 31, 2020, you will not be responsible for the associated charges. Your claim(s) will automatically be reprocessed and covered in full.

Yes. The waiver of cost-sharing for treatments of COVID-19 applies to high-deductible health plans administered by Harvard Pilgrim.

If you’ve been exposed to COVID-19 or are experiencing symptoms, such as fever, cough or difficulty breathing, contact your health care provider. Your health care provider will determine if you need to be tested for COVID-19. If a viral test is recommended, your provider will direct you to a testing facility. You can also visit your state or local health department’s website to look for the latest local information on testing.

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.

As of October 1, 2020, we will cover telemedicine in full (no copays, deductibles or coinsurance) only for COVID-19 treatment. Telemedicine cost sharing will resume for other kinds of virtual visits (e.g., urgent care, routine care and behavioral health), according to the terms of your plan. This policy applies to commercial plans in Connecticut, Maine, Massachusetts and New Hampshire, as well as Medicare Supplement plans.

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 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.

See all your behavioral health care options.

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.

Testing: Prior authorization isn’t required, but please contact your health care provider for guidance before proceeding to a testing facility. Your provider will determine if you should be tested and will direct you to a testing facility.

Treatment: Prior authorization isn’t required for treatment.

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. Based on information that is currently available, symptoms may appear 2 – 14 days after exposure. People can infect others up to 14 days after exposure.

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.

Here are some behavioral health options:

Call the Emotional Support Help Line at (866) 342-6892. Through our partner, United Behavioral Health/Optum, this 24/7 complimentary service is available to anyone. The help line is staffed by caring clinicians who can provide emotional support resources, including coping tips and techniques. Additional information is available at liveandworkwell.com.

Schedule a virtual visit. Virtual visits (or telemedicine) enables behavioral health clinicians to provide treatment via secure video conferencing, a private virtual platform (such as Facetime or Skype) or telephone.

As a result of COVID-19, many providers who were not previously offering virtual visits are doing so now. Contact your behavioral health provider to see if they offer virtual visits You can also use our online provider directory to find behavioral health providers who offer virtual visits:

• Select your plan
• Click “Behavioral Health” on the right side of the page
• Narrow your results by selecting the type of behavioral health provider
• Under “Filter your Results” select “Virtual Visits/Telemedicine”

Behavioral Health telemedicine services are also available on Doctor On Demand. Doctor On Demand is not available to members in our Medicare Enhance, Medicare Advantage and Medicare Supplement plans. Medicare Enhance and Medicare Supplement members must use providers that accept Medicare.

Call the Behavioral Health Access Center at (888) 777-4742 to speak with a licensed care advocate. They answer member calls 24/7 and can direct you to resources, virtual care options.

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.

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

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

Centers for Disease Control and Prevention (CDC)

Connecticut Department of Public Health

Maine Center for Disease Control and Prevention

Massachusetts Department of Public Health

New Hampshire Department of Health and Human Services