Information about access to health care services in response to the COVID-19 outbreak
Tufts Health Plan is committed to providing our Tufts Health Direct members with accurate, reliable information about access to health care services during the COVID-19 outbreak.
Please note, in accordance with local stay-at-home advisories, all Tufts Health Plan physical offices are closed until further notice. We encourage our members to call 888.257.1985 (TTY: 711) with any questions related to their health benefits.
Until further notice, the following is in place for all Tufts Health Direct members:
Waiving Member Costs:
- We are waiving member cost share (including copayments, coinsurance and deductibles) for medically necessary COVID-19 testing and treatment. This coverage applies with in-network providers or at in-network facilities, and at out of network providers or facilities in the event a member cannot easily find an in-network provider to provide timely services.
- 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 need a COVID-19 test to travel;
- Members need a COVID-19 test to return to work;
- Members need a COVID-19 test for school, sports, etc.;
- Members feel they need a COVID-19 test to visit other individuals;
- Members 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 would like to know their COVID-19 status.
- There are no out-of-pocket costs for COVID-19 antibody testing when testing is determined by a primary care provider (PCP) or other provider to be medically necessary. Please contact your PCP or other provider to find out whether this testing is appropriate for you. 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 a vaccine for COVID-19 is approved and available, the vaccine will be covered in full. There will be no cost to members.
- There are no out-of-pocket costs for COVID-19 related telehealth services. This applies in-network or out-of-network in the event a member cannot easily find an in-network provider to provide timely services.
- For service received through July 20, 2020: We waived all member cost share (copayments, coinsurance and deductible charges) for any in-network telehealth services or out-of-network telehealth services.
- For services received after July 20, 2020: Out-of-network telemedicine services are not covered unless specifically authorized by the plan.
- For services received after December 31, 2020: Member cost share will be reinstituted for all non-COVID-19 telehealth services.
Coverage changes during the state of emergency:
- Tufts Health Direct members with referral requirements do not need a referral from their primary care provider to see in-network specialists.
- Call member services at 888.257.1985 (TTY: 711) if you have questions about out-of-network coverage.
- Members should continue to see providers in their network whenever possible. Referrals or prior authorization is required for any out-of-network service that is not related to COVID-19.
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)
- Allowing members with multiple maintenance medications to refill each drug early just once
Please note: Members will continue to pay copayments and coinsurance for drugs from retail, specialty and mail-order pharmacies.
Tufts Health Direct also offers access to a 24/7 NurseLine. Call 888.697.6546 to speak to a registered nurse to receive medical advice on appropriate care.
You can also call your provider with questions. If it’s an emergency, call 911.
Contacting Member Services
If you have questions regarding your health plan coverage, please call Member Services at 888.257.1985 (TTY: 711).
Telehealth can help members avoid contact with COVID-19 in medical offices
People with mild, flu-like symptoms or other health issues 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. There are no out-of-pocket costs for COVID-19 related telehealth services. This also includes telephone consultations. Telehealth enables members to make inquiries regarding symptoms or treatment for the Coronavirus in order to reduce the need for members to go to medical offices where the risk of coming in contact with the Coronavirus may be higher.
Do you have a child under age 2? Keep up with their immunizations.
During COVID-19, it’s still important for children to get their immunizations. Make sure you protect your kids from preventable diseases. Measles, mumps and whooping cough are some of the illnesses we can prevent through vaccines. They are serious risks for young children even now.
Call your child’s primary care provider. Make a plan to keep your child on schedule for their immunizations safely. Providers’ offices are taking steps to see kids in a safe and controlled way when they need an in-office visit. Preventive visits and immunizations are covered at no cost to members.
What should individuals do if they think they have been exposed to the virus?
People with COVID-19 or with other flu-like symptoms should stay home and follow all quarantine procedures. People with COVID-19 have had a wide range of symptoms. This may include: a cough, shortness of breath, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. This list is not a full list. 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. Older individuals should be especially cautious during this time.
Where can people find testing for COVID-19?
If you are experiencing covid-19 symptoms or have been exposed to someone that has, you should call your health care provider. You do not need a referral or prior approval (authorization) to get testing or treatment related to COVID-19. Based on where you live, you can find a location near you to get tested for COVID-19. Just click one of the links below to search for a location.
Please call ahead to make an appointment and check the rules for each location before you seek a test. For help understanding any symptoms you may be having, you can also check your symptoms online.
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.
Where can individuals find additional information and updates about COVID-19?
They should visit the CDC website at www.cdc.gov and click on “COVID-19 Disease 2019.” Another excellent source of information is:
Is there help for people who are having trouble paying their premiums?
If you're enrolled in a ConnectorCare plan and are experiencing difficulty paying your monthly premium due to financial hardship caused by the COVID-19 pandemic, you may be eligible for a Health Connector hardship waiver. Learn more at mahealthconnector.org/help-paying-premium.