COVID-19 Benefits, Coverage & Cost

What is covered and what is your cost-share?

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 pandemic 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. We encourage our members to call the number on their ID cards with any questions related to their health benefits.

Coverage and cost

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, 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.

  • If you are pregnant, testing is also covered at no cost for expectant parents if it is required prior to admittance to a delivery facility. Each parent must be a Tufts Health Plan member to be covered.
  • Consistent with Federal and State guidance coronavirus 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 for other purposes not primarily intended for a member’s individual COVID-19 diagnosis or treatment.
  • Members are covered for urgent and/or emergency services only when traveling outside of the 50 United States. Coronavirus tests are only covered or reimbursed if they are medically necessary. Diagnostic coronavirus testing required as a condition of travel inside or outside of the United States is not covered. Tufts Health Together, RITogether and Unify members are not covered for any services outside of the United States and its territories.
  • At-home COVID-19 PCR (polymerase chain reaction) tests are covered when your physician or attending provider orders them or gives you a referral. Tufts Health Plan will not cover or reimburse you for these tests when you order them yourself, including when you order using an online self-completed questionnaire.
  • We are waiving member cost shares - including copayments, coinsurance, and deductibles for medically necessary coronavirus in-person treatment. This coverage applies at in-network providers, urgent care center, 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.
  • You may be charged for other non-COVID 19 related services you receive from the facility or provider.

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FOR OUR MEMBERS

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