What Members Need to Know About COVID-19

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.

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.

At-home COVID-19 PCR (polymerase chain reaction) tests are covered when your physician or attending provider orders them. 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.

Check your symptoms online

Massachusetts

• Current Listing from Massachusetts State Department of Health
• CVS Minute Clinics taking appointments
• Nationwide Search
• Prueba COVID-19

In addition your provider’s office and locations listed above, the state has also set up testing sites around the state, check Stop the Spread for locations and instructions.

Rhode Island

• Current List of RI Testing Site – RIDH
• CVS Minute Clinics taking appointments
• Nationwide Search
• Pruebas para detectar el covid-19 - Hope Clinic

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:

• CDC
• Massachusetts Department of Public Health
• New Hampshire Department of Health & Human Services
• Rhode Island Department of Health
• Connecticut Department of Health

Two COVID-19 vaccines, from Pfizer and Moderna, have received Emergency Use Authorization from the U.S. Food + Drug Administration (FDA)³. The vaccines will be available to all individuals free of charge (as required by the CARES Act). The federal government has pre-purchased hundreds of millions of doses.

• Early supplies of the vaccine are limited.
• Plans are underway at the state level for safe, equitable, and effective delivery. 
• Teams of public health officials are creating priority groups.
• We are hopeful that over the next few months, most high-risk groups will have had an opportunity to be vaccinated.

The vaccine will require two doses, given 21 or 28 days apart depending on the vaccine. You will need to take both doses for the vaccine to be effective.

Read Vaccine FAQs

Be aware of vaccine scams
As COVID-19 vaccine distribution begins, be aware that scams are starting to emerge. It’s important to know what signs to watch for, including:

• You are asked to pay out-of-pocket to get the vaccine or early access to the vaccine
• You are asked to put your name on a vaccine waiting list or to get early access
• Marketers offering to sell or ship doses of the vaccine for payment

Learn more about how to protect yourself and report potential COVID-19 fraud here.

To learn more about your specific state, and for the most up-to-date information, go to:

Massachusetts
https://www.mass.gov/covid-19-vaccine-in-massachusetts

Rhode Island
https://covid.ri.gov/vaccination

New Hampshire
https://www.nh.gov/covid19/resources-guidance/vaccination-planning.htm

Centers for Disease Control
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html

As new treatments are approved for Emergency Authorize Use, they will be subject to the same guidelines as our other COVID-19 treatments.

• Non-Emergency Care Options
• Childhood Immunizations
• Telehealth

Out of Country Travel
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.

• 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. 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.
• You may be charged for other non-COVID 19 related services you receive from the facility or provider.

We are waiving member cost shares for telehealth behavioral health - including copayments, coinsurance, and deductibles. This coverage applies at in-network providers.

• Effective for dates of service on or after January 1, 2021, plans will return to their standard benefit levels and any applicable member copays or other cost share will be applied to all non-COVID telehealth services, with the exception of primary care and behavioral health telemedicine services for members of commercial Rhode Island-issued plans.
• For members with access to Teladoc® there is no change to the policy and telehealth visits through Teladoc will continue to have no cost share. This includes non-COVID -19 related general medicine, behavioral health and dermatology.² Learn more about Telehealth provided by Teladoc.

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.

• Effective for dates of service on or after January 1, 2021, plans will return to their standard benefit levels and any applicable member copays or other cost share will be applied to all non-COVID telehealth services, with the exception of primary care and behavioral health telemedicine services for members of commercial Rhode Island-issued plans.
• Member cost share will continue to be waived for COVID-related, in-network, medically necessary services. A COVID-19 diagnosis must be submitted with the claim for the waived cost share to continue to apply.
• For members with access to Teladoc® there is no change to the policy and telehealth visits through Teladoc will continue to have no cost share. This includes non-COVID -19 related general medicine, behavioral health and dermatology.² Learn more about Telehealth provided by Teladoc.

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.

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:

• Prior authorization is required for coverage of chloroquine and hydroxychloroquine tablets for members initiating a new course of treatment.
• 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. 

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.

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.

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.

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

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

• The Massachusetts Department of Health
• The Rhode Island Department of Public Health
• The New Hampshire Department of Health and Human Services
• The Connecticut Department of Public Health

Member Webinar Series
Please join us each Wednesday for a new webinar focused on maintaining your well-being through the COVID-19 pandemic. View upcoming and past webinars

Health & Wellness Articles

• Dealing with worry and anxiety about the coronavirus
• Tips for restlessness and boredom while stuck at home   
• Steps to protect your kids  
• Tips to stay connected if you are feeling lonely 
• Tips for staying active at home 
• Caring for someone with the coronavirus 
• Guidelines for a healthy diet 
• Thoughts on common questions about testing