COVID-19 Coverage in Rhode Island

Last updated May 11, 2023

COVID-19 coverage update

The Rhode Island State of Emergency is set to end May 11, 2023, but could be extended. If so, we will update this page accordingly.

The COVID-19 public health emergency ends on May 11, 2023. Effective May 12, 2023, over-the-counter, at-home COVID-19 tests will no longer be covered under the pharmacy or medical benefit. In addition, Tufts Health Plan will cover COVID-19-related services, when medically necessary and in accordance with applicable law and plan documents, for commercial members as follows:

• COVID-19 vaccines
  • In network: Covered in full¹
  • Out of network: Member cost sharing applies²
• COVID-19 tests administered by providers
  • In network: Covered in full¹
  • Out of network: Member cost sharing applies²
• COVID-19 treatment and COVID-19 related telemedicine
  • In network: Member cost sharing applies
  • Out of network: Member cost sharing applies
• Prior authorization
  • Tufts Health Plan is also reinstating prior authorization for services that require it

Please note: Member cost sharing includes copayments, deductibles and coinsurance. Only POS and PPO plans have out-of-network benefits. Also, COVID-19 coverage outlined above may vary if you’re enrolled in a self-insured group health plan. Please contact your employer for coverage details.

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," or "the end of the Rhode Island State of Emergency," we 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.

Additional coverage information

• There are no out-of-pocket costs for COVID-19 vaccinations until further notice.
• 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. 
• Members are covered without cost share for COVID-19 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. 
• 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. 
• If you receive non-COVID related treatment or services from a provider or facility, you may need to pay cost sharing, depending on your plan type.

Prescription drug coverage

The following pharmacy policies are in effect until the end of the Rhode Island State of Emergency:

• Early refill of prescription medication without waiting to finish 80% of the day supply from your last dispensed prescription.
• Refill for up to a 90-day supply to the extent consistent with clinical guidelines, except for controlled substances (subject to CMS rules).
• 90-day supply of maintenance medicines (excluding controlled substances), you can ask your pharmacist to dispense a 90-day supply, if you have that supply remaining on your prescription. You will need to contact your prescriber for a new prescription if you do not have a 90-day supply remaining, or if you would like to have a 90-day supply delivered by mail order. 

Antiviral medications

The FDA has authorized the following two oral antiviral medications under emergency use authorization (EUA) for the treatment of certain cases of COVID-19. When prescribed and dispensed under the requirements of the EUA, one course of therapy can be provided at no charge to the member. Prescriber and pharmacy access is currently extremely limited; speak to your health care provider if you test positive for COVID-19 and believe you qualify for treatment.

• Pfizer’s PAXLOVID™ (nirmatrelvir/ritonavir)
• Merck’s molnupiravir

1. Covered in full for high deductible health plans and non-high-deductible health plans, in accordance with IRS regulatory guidance.
2. Effective May 12, 2023, federal law requires COVID-19 vaccines to be covered in full when provided by in-network providers and covered in full at the out-of-network benefit level when in-network providers are unavailable.