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 vaccines are safe and effective, and we encourage you to get vaccinated.

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 COVID-19 vaccines approved by the U.S. Food and Drug Administration (FDA) pursuant to their emergency use authorization.

People age 12 and older are now eligible to receive the COVID-19 vaccine, which is available at mass vaccination sites and select retail pharmacies. It may also be available through certain hospitals, medical practices and local boards of health. Visit www.vaccinefinder.org or check your state government’s website to find out where the COVID-19 vaccine is available in your area:

• Connecticut
• Maine
• Massachusetts
• New Hampshire

COVID-19 vaccines from Pfizer, Moderna and Johnson & Johnson have received emergency use authorization from the FDA. It is important to get the first vaccine that is available to you, as they all offer strong protection against hospitalization and death due to COVID-19.

No. All three vaccines protect you against severe illness due to COVID-19, which may lead to hospitalization and death. Their effectiveness numbers are slightly different for many reasons, namely:

• They were tested among different populations and in different countries.
• The Johnson & Johnson vaccine was tested when there was widespread transmission of more contagious and deadly variants of the virus.
• The Johnson & Johnson vaccine was tested when there was a different, and perhaps higher, level of transmission in the community, which may have impacted the test results.

To remain healthy, it’s important to get the first vaccine that you are eligible to receive in your state or community. This will help protect you, and potentially your loved ones, from the virus.

Note: The CDC and FDA lifted a pause on the Johnson & Johnson COVID-19 vaccine on April 23, 2021, after a thorough safety review that followed reports of rare and severe blood clots, combined with low levels of blood platelets, in individuals who received the vaccine. Learn more

The Johnson & Johnson COVID-19 vaccine requires only one dose.

The Moderna and Pfizer vaccines require two doses; if you receive one of these vaccines, you should get the second dose at the recommended time. You should get whichever vaccine is available in your community.

If you receive the Moderna or Pfizer vaccine, it is important to get the two recommended doses. If you only receive one dose, your body may not develop the immunity that protects you from the coronavirus that causes COVID-19, leaving you more vulnerable to infection by the variant strains of the virus. This will help protect you, and potentially your loved ones, from the virus.

The CDC’s website provides up-to-date 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, or severe headaches/pain that start six or more days after your vaccine, 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, and the FDA continues to actively monitor for safety. We encourage you to visit the CDC website for information about COVID-19 vaccine safety and benefits, frequently asked questions and more.

COVID-19 vaccines approved for Emergency Use Authorization are currently available to and recommended by the CDC for women who are pregnant or breastfeeding.

The New England Journal of Medicine evaluated data from more than 35,000 pregnant individuals who received the mRNA (messenger RNA) vaccines, and found no obvious safety concerns.

The vaccines may also protect your newborn infant from COVID-19 if you are infected during pregnancy. Two recent Israeli studies (Perl et al. & Shlomai et al) find that COVID-19 antibodies pass robustly from mothers to their infants in breast milk for six weeks after vaccination and that no infants breastfed by their COVID-19-positive mothers had evidence of infection.

If you are pregnant and receive a COVID-19 vaccine, consider using v-safe, a tool from the CDC and FDA that uses text messaging and surveys to provide personalized health check-ins after you receive your vaccination.

If you have questions about getting the vaccine while pregnant or breastfeeding, we encourage you to speak to your health care provider.

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. 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.

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

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’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.

Visit your state government’s website for information on where to get tested.

Connecticut

Maine

Massachusetts

New Hampshire

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.

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.

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.