Last updated: August 3, 2020   

Coronavirus Update

Information about access to health care services in response to the COVID-19 outbreak

Tufts Health Plan is committed to providing our members with accurate, reliable information about access to health care services in response to the COVID-19 (“Coronavirus”) outbreak.


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 below.1

Health care and plan information

Symptoms & Possible Exposure

People with COVID-19 or with other flu-like symptoms should stay home and follow all quarantine procedures. Their close contacts should 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. For more information, see the Symptom Checker. 

Older individuals should be especially cautious during this time. Updated news and information for our Medicare Preferred members can be found here.

Where to Find Testing for COVID-19

The symptoms of COVID-19 include: fever, cough, shortness of breath, muscle aches (myalgias), chills, runny nose or stuffy nose, sore throat, headache, or diarrhea. As we learn more about the virus, we know that some people with COVID-19 have only experienced one or two mild symptoms.

Please contact your healthcare provider before going to their office.

If you need immediate medical attention (for example, if you are very short of breath), call your Emergency Department or Urgent Care Center before going and tell them about your symptoms.

Home testing kits, or other tests that are self-ordered by members, are not covered for reimbursement.

Check your symptoms online

Massachusetts

Rhode Island

Antibody Testing

Members are covered without cost share for COVID-19 testing, including antibody testing, when testing is determined by a primary care physician (PCP) or other treating provider to be medically necessary in accordance with current CDC and state public health department guidelines, which are being continuously updated.

Please contact your PCP or other healthcare provider to determine whether testing is appropriate for you. For Medicare members, COVID-19 testing may be ordered by any state-authorized health care professional. We will continue to update this guideline as new guidance is issued.

We understand that people have many questions regarding potential use of antibody testing. As of May 15, the U.S. Centers for Disease Control & Prevention (CDC) website states, "we do not know if the antibodies that result from SARS-CoV-2 infection will provide someone with immunity from a future infection. If antibodies do provide immunity, we don’t know what titer or amount of antibodies would be protective or the duration that protection would last." The Massachusetts Department of Health guidelines issued May 13 state, "At this time, antibody testing should not be used to guide release from isolation or for return to work purposes and are not indicated for diagnostic purposes."

We encourage you to learn more about testing on the following websites:

Costs & Coverage - COVID-19 Related
  • There are no out-of-pocket costs for medically necessary coronavirus 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. They will not be covered solely for the following reasons:
      • Members who need a COVID-19 test to travel;
      • Members who need a COVID-19 test to return to work;
      • Members who need a COVID-19 test for school, sports, etc.;
      • Members who feel they need a COVID-19 test to visit other individuals;
      • Members who believe they have had or possibly had exposure to COVID-19 positive individuals—except if they have been identified as a close contact by the State, a State agency or a healthcare provider
      • Members who would like to know their COVID-19 status.
  • There are no out-of-pocket costs for COVID-19 antibody testing. 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.
  • 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.
Costs & Coverage - Behavioral Health

We are waiving member cost shares for telehealth behavioral health - including copayments, coinsurance, and deductibles. This coverage applies at in-network providers and at out-of-network providers in the event a member cannot easily find an in-network provider to provide timely services.

Beginning July 20, 2020 pre-COVID coverage and cost share will apply for out-of-network telemedicine.

Claims

We are working as quickly as possible to update our systems to reflect the policies noted above. In the meantime, you may receive a bill or EOB that shows a member responsibility. Tufts Health Plan will automatically reprocess all claims with dates of service on or after March 6 to reflect these policy changes.


Virtual health care

Telehealth

Until further notice, fully-insured members who access services from Tufts Health Plan network providers via telehealth will have no cost share. Learn More about Telehealth.

24 Hour Nurse Lines

Depending on your health plan benefits, Tufts Health Plan also offers access to 24/7 Nurse Line, where members can speak to a registered nurse to receive medical advice on appropriate care.

  • Tufts Health Plan Commercial members should call 866.201.7919.

  • Tufts Health Direct, Together and Unify members should call 888.697.6546.

You can also call your provider with questions. If it’s an emergency call 911.


Prescriptions and medications

Prescription Drugs

We are making it easier for you to get increased access to the prescription drugs you will need during this period of emergency by:

  • Allowing for early refill of prescription medication without waiting to finish your current fill

  • Allowing refill for up to a 90-day supply to the extent consistent with clinical guidelines, except for controlled substances (subject to CMS rules)

Hydroxychloroquine and Chloroquine Coverage & Availability

Hydroxychloroquine and chloroquine coverage:

  • Prior authorization is required for coverage of chloroquine and hydroxychloroquine tablets for members initiating a new course of treatment. Coverage is limited to 28 tablets for approval related to COVID-19.
  • No action is required for members who have previously been taking these drugs. They may obtain the prescribed supply up to their benefit limit.

Hydroxychloroquine​ and chloroquine drug shortage:

  • Hydroxychloroquine and chloroquine are currently in short supply. 
  • If you take hydroxychloroquine or chloroquine regularly for rheumatoid arthritis, lupus or another chronic condition, and are running out of the drug, we encourage you to call your pharmacist to try to locate additional supplies. 
  • The Tufts Health Plan Pharmacy team and CVS Health do not have access to the inventories that are available in specific pharmacies, or the ability to find additional drug supplies. 
  • If you are unable to find an additional supply, we encourage you to call the doctor who prescribed the drug to learn about alternative medication options before you run out. 
Assisted Reproductive Technology (ART)

The following applies to all Tufts Health Plan products:

  • Tufts Health Plan will extend authorized cycles and testing intervals for members receiving infertility treatments. Note: Prior authorization for infertility services and testing intervals valid as of March 5, 2020 are extended for cycle initiations that occur no later than August 1, 2020.
  • Tufts Health Plan will not count a canceled cycle, due to COVID-19 exposure, illness or factors outside a provider’s control, towards a member’s lifetime maximum cycle limit for all products where ART services are a covered benefit with lifetime limits. Note: These situations will be reviewed on a case-by-case basis.


Information and resources

Contacting Member Services

If you have questions regarding your health plan coverage, please call the Member Services phone number on your member ID card.

Remember, depending on your health plan benefits, Tufts Health Plan also offers access to 24/7 Nurse Line, where members can speak to a registered nurse to receive medical advice on appropriate care.

  • Tufts Health Plan Commercial members should call 866.201.7919.

  • Tufts Health Direct, Together and Unify members should call 888.697.6546.

Our policy in case the company needs to close down due to a pandemic

Tufts Health Plan has an extensive policy in place to ensure the continued service of our members and clients if we are required to close our physical locations in any of our markets. Most of our employees are currently working remotely to ensure continued service to our members, providers, employer groups and brokers. Please reference our corporate continuity plan (CCP) summary for our organization for more information, or your account service team.  We will continue to keep you abreast of any changes to this policy as it develops. You can view the CCP Summary here.

CDC and State Departments of Health

Where can individuals find additional information and updates about coronavirus?

They should visit the CDC website at www.cdc.gov and click on “Coronavirus Disease 2019.” Other excellent sources of information include the following:

 

  1. The end dates for policies vary and may be updated as needed. 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 our policies with the state of emergencies and other regulations in mind, and we will aim to provide at least four weeks notice in advance of any termination of the policy.
  2. Self-insured accounts are excluded unless they opt-in.

HELPFUL RESOURCES

FOR OUR MEMBERS

Links to help you find the information you need.

Learn More