COVID-19: Your Guide to Care

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.

Even if you feel well, the CDC now 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.

There is currently no vaccine that prevents COVID-19. The flu vaccine, which offers protection from the flu, will not protect you from COVID-19. Researchers are currently working on the development of a COVID-19 vaccine, but it may take 12 – 18 months before it is commercially available.

Government agencies are receiving reports about scammers offering COVID-19 tests in an attempt to steal personal and financial information.

If you receive a call or email or see an online advertisement from someone offering COVID-19 tests, please do not respond; this is fraudulent activity.

If you are feeling unwell, please call your doctor’s office. Your doctor will determine if you need a COVID-19 test and direct you to the appropriate facility.

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

Viral testing for current COVID-19 infection is covered when ordered by a physician or appropriately licensed health care professional actively treating you, or for Maine members, when in accordance with the State of Maine regulatory guidelines.

For fully insured commercial and Medicare Supplement members, antibody testing for previous COVID-19 infection is covered only when it is an FDA-authorized test, when ordered by a physician or appropriately licensed health care professional, and when medically necessary for your provider to help make decisions about treatment for an immediate medical condition.

For Medicare Advantage members, antibody testing is covered when documentation confirms all of the following:

• Test is being ordered by a treating physician or appropriately licensed care professional
• COVID-19 antibody test is necessary for the member’s medical treatment
• Test is performed at least 21 days after the onset of symptoms for symptomatic members (timing is not applicable for members who have not exhibited COVID-19 symptoms)
• Test is being conducted by a CLIA Certified Laboratory

Testing meeting the above criteria is covered in full with no copayment, deductible, or cost sharing through the COVID-19 emergency period.

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

Testing for employment screening, public screening, student screening, and travel screening are not covered benefits, except for Maine members when in compliance with and required by the State of Maine regulatory guidelines.

COVID-19 treatment

To help remove any potential barriers to care for our members, as of March 31 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 through January 31, 2021. 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.

The coverage below applies to fully insured plans in Connecticut, Maine, Massachusetts and New Hampshire, as well as Medicare Advantage and Medicare Supplement plans (unless otherwise noted).

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.

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.

Telemedicine services will stay covered in full through December 31, 2020 for members on our Medicare Advantage 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.

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.

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. These viral tests are covered in full.

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. Please note: Telemedicine cost sharing will resume on October 1 for behavioral health visits, according to the terms of your plan. Telemedicine will stay covered in full through December 31 for members on our Medicare Advantage plans.

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.

Please note: In the event that providers are requiring copays for telemedicine services before October 1, you will be reimbursed.

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.

There is currently no specific antiviral treatment recommended for COVID-19. People with COVID-19 should talk to their health care provider or pharmacist about what they can do for symptom relief.

If your health care provider thinks you can be treated at home, they may give you special instructions, such as to isolate yourself as much as possible from family while you’re sick and to stay home for a period of time. If you’re very ill, you may need to be treated in the hospital.

If you think you or a loved one may have been exposed to COVID-19, contact your health care provider immediately.

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