COVID-19 Updates for Employers

The health of your employees is our priority

We know that you are doing everything you can to respond to the immense business challenges posed by COVID-19 while also working to help keep your employees safe. At Tufts Health Plan, we are committed to supporting you with accurate, reliable information about access to health care services throughout the pandemic.

Each day, we are carefully monitoring the situation and supporting efforts by the Centers for Disease Control and Prevention (CDC) and health experts to mitigate the risks and keep people safe.

We have also changed some of our coverage and payment policies to enable our members to obtain medically necessary and appropriate testing and treatment that will help fight the spread of this disease. Until further notice, and in accordance with guidance provided by state public health departments and CDC Guidance, the following is in place for all Tufts Health Plan members, except where noted:

  • Effective Dates - Unless otherwise noted, all policies are effective beginning with dates of service on or after March 6, 2020. These policies have been put in place in connection with the COVID-19 crisis and are not intended to be permanent changes. For any policy without an end date listed or for which it states "until further notice," we continue to evaluate Tufts Health Plan policies with the state emergencies and other regulations in mind, and will aim to provide at least four week notice in advance of any termination of the policy.
  • There are no out-of-pocket costs for medically necessary COVID-19 testing, counseling and vaccinations. This coverage applies at in-network providers, urgent care centers, emergency rooms and other facilities, and at out-of-network providers in the event a member cannot easily find an in-network provider to provide timely services.
  • We are waiving member cost shares — including copayments, coinsurance, and deductibles for medically necessary COVID-19 in-person treatment. This coverage applies at in-network providers, urgent care centers, emergency rooms and other facilities, and at out-of-network providers in the event a member cannot easily find an in-network provider to provide timely services.
  • These cost-sharing changes will also apply to members of our self-funded groups that have not opted-out.

Common FAQs

Of course, COVID-19 issues for employers continue to evolve rapidly. Below are answers to questions you may have:

Where should individuals go if they think they are sick?

People with mild, flu-like symptoms should call their health care provider before going to a health care facility.

  • Many providers offer telehealth services. Ask your primary care provider if they do.
  • Until further notice, fully-insured members who access services from Tufts Health Plan network providers via telehealth will have no cost share.¹

Tufts Health Plan Commercial members (not including Direct) can also use our telehealth solution powered by Teladoc, With telehealth from Teladoc, members can access U.S.-based, board-certified providers for general medical needs and diagnoses from anywhere in the world and for $0 copay for plans issued or renewed in 2020. Members can contact a Teladoc doctor 24/7 if they’re concerned about their symptoms or have questions about coronavirus. Until further notice, there will be no member cost for this service for our members, including members of self-funded groups that have elected this benefit and have not opted-out of cost sharing modifications.

People with COVID-19 or with other flu-like symptoms should stay home and follow all quarantine procedures. Their close contacts may also be advised to stay home. If someone has more significant symptoms, they should go to their health care provider, urgent care or the emergency room. But they are advised to call in advance and follow any protocols that the facility has in place.

Where can individuals find additional information about COVID-19 and situation updates?

They should visit the CDC website and click on “Coronavirus Disease 2019.”

Is the screening test for COVID-19 more expensive than the test for the flu?

We are contracting with commercial labs and hospitals as they make the test available and it is not a very expensive test. In this pandemic situation, we are watching claims closely. Specific codes for COVID-19 have just been implemented so we will watch for their use by providers.

The earliest testing for COVID-19 was mostly done by the CDC or state labs and not all of those will be billed back to health plans.

Will Tufts Health Plan know if a member gets tested for COVID-19? Are labs in Massachusetts doing any COVID-19 testing yet or is it all going to the CDC?

Yes, if a claim is submitted using the codes for the COVID-19 test, we are tracking it. Testing is being done by state labs, commercial labs and some hospitals now.

If a member is diagnosed with COVID-19, what associated costs are expected and how much care will be required? Or will it be treated like any flu case?

Approximately 80% of individuals who contract COVID-19 will have mild symptoms. They will be quarantined at home with treatment that is similar to that for a cold or the flu.

Those with significant symptoms may need hospitalization. This may include stays in the Intensive Care Unit with ventilator support. Because there are no specific treatments for COVID-19, it is likely the claims will closely resemble the costs associated with other significant respiratory illnesses, such as severe flu cases in individuals with other medical conditions. We are monitoring this closely and it is expected that some individuals will have prolonged ventilator needs. We are working with provider partners to explore the ability to transition patients to less acute settings, such as dedicated COVID-19 units at acute rehabilitation centers or skilled nursing facilities.

What is Tufts Health Plan doing about potential drug shortages related to the closure of Chinese factories or to COVID-19 outbreaks?

Our pharmacy team works closely with our pharmacy benefit manager, CVS Health, and with our specialty pharmacies to monitor for drug shortages. At this time, there is no specific concern about shortages.

The pharmacy team is also part of our Pandemic Preparedness plan. They will watch for any need to alter usual processes in response to changing needs. For instance, if generic drugs are not available, there are policies to provide brand-name substitutes.

Where can I find out more?

For more information about COVID-19, you can visit the following sites:

  1. Self-insured accounts are excluded unless they opt-in.