COVID-19 Updates

Capital Health Plan Vaccine Updates, Updates are current as of 04/19/22
 

How to use your Medicare benefits to access COVID-19 tests

Original Part B Medicare is now covering up to eight over-the-counter COVID test kits per month for Medicare members, including Medicare Advantage members. There is no cost to members. 

The Centers for Medicare and Medicaid Services (CMS) clarified coverage for at-home test kits in an April 4 news release titled “Medicare Covers Over-the-Counter COVID-19 Tests.” 

For Medicare Advantage members, test kits provided via this program are covered outside of their Medicare Advantage coverage and are separate from any tests that might be covered as a supplemental benefit. 

Kits can be obtained by Medicare members from any pharmacy or health care provider that is participating in the new CMS initiative. Participating pharmacies/providers will bill Medicare on behalf of members. A partial list of participating pharmacies can be found HERE.  Members should check with their pharmacy/provider to confirm that they are participating in the program. 

Members should bring their red, white, and blue Medicare card to get the free tests (even if they have a Medicare Advantage Plan or Medicare Part D plan). 

Because there is no charge to Medicare members for up to eight kits per month and claims are submitted to CMS electronically, paper claims will not be accepted by CMS or Prime. Paper claims received by Prime will be completed as inquiries for clients who delegate inquiries. For clients without inquiry delegation, Prime will forward the claim to the client, unless otherwise requested.

This coverage program will remain in place during the federally declared COVID-19 public health emergency (PHE).

How to use your Commercial health plan benefits to access COVID-19 tests

On January 10, 2022, the Biden administration announced that at-home, self-read COVID-19 tests purchased on or after January 15, 2022, will be covered by commercial health insurers for non-Medicare members. This means you will have easy access to these tests and your health plan will cover them up front or reimburse you.

What you need to know

You are now eligible to obtain up to eight at-home COVID-19 testing kits every 30 days for each covered person in your household at your local pharmacy or online as needed, as long as the tests are not used for required employment testing or for resale purposes. Capital Health Plan (CHP) has a network of pharmacies that will bill these at-home COVID-19 tests to CHP and process them at $0 to you.

There are no up-front costs if you purchase COVID-19 testing kits through a pharmacy that submits your claim online.

How it works using your benefit plan
 

1. Go to MyPrime.com or capitalhealth.com to identify a pharmacy that has opted into this program.
2. Purchase the at-home COVID-19 testing kit(s) at your local pharmacy counter and request that they submit the claim to Capital Health Plan.

If you purchase the at-home test kits at the regular checkout counter or through an approved online retailer, you will have to pay for the test kits up front. You can then submit a paper claim form, along with the receipts, to request reimbursement.

How to get reimbursed if test were purchased outside the pharmacy or at a pharmacy retail counter (by submitting a receipt to Capital Health Plan)

State of Florida members covered under CVS Caremark, the direct purchase process described above is not available to you through the CHP pharmacy network.  For more information click here.

1. If you purchase online, through a local retailer, or you did not have the pharmacy submit a claim on your behalf and paid out of pocket for at-home test kits, you may request reimbursement as follows:
   1. 1.  Fill out the attached paper claim request form.
      2.  Submit the paper claim request form for reimbursement along with the receipt from the retailer where the over-the-counter COVID-19 test kit was purchased (following the submission instructions on the form). You will need to reference the UPC code on the box to complete the form.

Please note that Capital Health Plan will reimburse the cost of the COVID-19 at-home test kit on the receipt up to $12 per individual test. If you purchased a test kit and paid more than $12 per test, you are responsible for the amount over $12. There is no reimbursement for COVID-19 test kits that are used for employment purposes or for resale.

Over-the-counter (OTC) at-home COVID-19 testing products available at no cost listed below. The list of approved tests is subject to change. Please visit CHP’s website for the most current list of approved tests.

Check your state health department website for other free testing options.

Thank you for being a Capital Health Plan member. If you have questions, please contact the number on the back of your member ID card.

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Get free at-⁠home COVID-⁠19 tests

https://www.covidtests.gov/

Every home in the U.S. is eligible to order 4 free at-⁠home COVID-⁠19 tests. The tests are completely free. Orders will usually ship in 7-12 days.

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If you meet the current Federal and State of Florida guidelines for the COVID-19 vaccine, please contact your Primary Care Physician's (PCP) office for more information or to schedule your vaccine appointment. You can also locate a vaccination site for further instructions on scheduling an appointment.

We encourage you to continue checking our website for the most up-to-date announcements regarding COVID-19 coverage and recommendations. 

Capital Health Plan Member Testing Options

Capital Health Plan, as an HMO, uses a defined network. This means Capital Health Plan has contracted with facilities, providers and suppliers to provide you with health care services, helping to ensure your premiums and out-of-pocket costs remain affordable. Please note the COVID-19 testing sites listed below that are within the network. These are places where you can seek COVID-19 testing:

• Your Primary Care Physician (PCP) will be able to discuss your testing options, even if you are not experiencing symptoms. Please call your PCP first to make arrangements for testing.
• If you are seeing a Specialist within the network, you may seek testing from their office. Please call your physician first to make arrangements for testing.
• If you are in a hospital, they may also test you. However, only those with a serious emergency should go to the ER, as you could be infected or possibly infect others. For COVID-19 testing, please contact your PCP first for instructions.
• LabCorp is the only laboratory in Capital Health Plan's network and if a doctor orders an antibody test for you, you will go to one of their Patient Service Centers for the blood sample collection. LabCorp also as an at-home testing kit that can be ordered online. This test is for individuals 2 years old and older who have COVID-19 symptoms or meet the testing criteria established by the CDC. View the COVID-19 home collection swab kit for more information and to complete a brief questionnaire to see if you qualify for the test. As a CHP member there is no cost for this test.

Capital Health Plan Service Changes

• Capital Health Plan is now offering telehealth visits! If your Primary Care Physician (PCP) is located at one of our three health centers, please contact your PCP's office to determine if this service is available to you.
• Capital Health Plan's Urgent Care Center is now providing a telehealth option to all Capital Health Plan members! In order to utilize this new service, please contact Urgent Care to schedule your appointment. 
• To make sure our CHP members who need care are able to better focus on their health, there is no cost share for the COVID-19 test and CHP is waiving all member cost share (copays and/or coinsurance) for medical treatment related to a positive COVID-19 diagnosis, including in-patient and outpatient hospital admissions (emergency room and observation). This has been extended through October 18, 2021.

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What You Need to
Know About COVID-19

As concern about coronavirus (COVID-19) grows globally and right here in Florida, Capital Health Plan is ready to do its part to help protect the community. That includes providing members with access to the best advice from health care professionals so they can take appropriate preventive steps.

If you or a family member has recently traveled to an area of risk or if you think you may have been exposed to the virus and have symptoms of respiratory illness, you should call your Primary Care Physician (PCP) for further instructions. It's important to call your PCP ahead of time rather than coming directly into their facility. By calling ahead, they can direct you to the most appropriate care and take precautions to protect other members, patients, and employees.

Symptoms

The symptoms of COVID-19 are similar to those of the common cold or flu, including fever, cough, and shortness of breath. In more serious cases, the virus can cause pneumonia and be fatal. Authorities say those most at risk are the elderly and individuals who already have underlying health conditions.

Guidance for people to prevent getting sick

According to the CDC, these preventive measures are simple but effective ways to help keep the common cold, flu, and coronavirus from spreading. Anyone who has questions about whether their condition puts them at risk for COVID-19 should call their primary care physician. 

Vaccine Safety

COVID-19 vaccines are safe and effective. Millions of people in the U.S. have received the COVID-19 vaccines under the most intense safety monitoring in U.S. history. According to the CDC, the vaccines were evaluated in tens of thousands of participants in clinical trials an dmet the Food & Drug Administration's (FDA) rigorous scientific standards for safety, effectiveness, and manufacturing.

There are several authorized and recommended vaccines available and there are additional vaccines currently in clinical trials across the United States.

Testing & Costs

Capital Health Plan, as an HMO, uses a defined network. This means Capital Health Plan has contracted with facilities, providers and suppliers to provide you with health care services, helping to ensure your premiums and out-of-pocket costs remain affordable. Please note the COVID-19 testing sites listed below that are within the network. These are places where you can seek COVID-19 testing:

• Your Primary Care Physician (PCP) will be able to discuss your testing options, even if you are not experiencing symptoms. Please call your PCP first to make arrangements for testing.
• If you are seeing a Specialist within the network, you may seek testing from their office. Please call your physician first to make arrangements for testing.
• If you are in a hospital, they may also test you. However, only those with a serious emergency should go to the ER, as you could be infected or possibly infect others. For COVID-19 testing, please contact your PCP first for instructions.
• LabCorp is the only laboratory in Capital Health Plan's network and if a doctor orders an antibody test for you, you will go to one of their Patient Service Centers for the blood sample collection. LabCorp also as an at-home testing kit that can be ordered online.

There are two types of tests that your doctor may recommend for COVID-19 testing: viral swab tests and antibody tests.

• A viral swab test tells you if you have a current infection.
  • LabCorp offers at at-home swab test kit. This type of COVID-19 test is for individuals who have COVID-19 symptoms or meet the testing criteria established by the CDC. The COVID-19 home collection swab kit, to detect an active COVID-19 infection, is available through Pixel by LabCorp online. 
  • LabCorp does not administer the viral swab testing at the Patient Service Centers; you will have to seek the test from one of your in-network doctors.
• An antibody test may tell you if you have had a previous infection.
  • An antibody test may not be able to show if you have had a current infection, because it can take 1-3 weeks after the infection to make antibodies. We do not know yet if having antibodies to the COVID-19 virus can protect someone from getting infected with the virus again, or how long that protection might last.
    • An antibody test should not be used as the sole basis to diagnose or exlcude infection.
  • An antibody test must be ordered by a physician. Do not go directly to a LabCorp Patient Service Center directly for testing.

The CDC does not recommend testing people who are not showing signs of COVID-19 (cough, fever, difficulty breathing). For members with symptoms that meet the criteria, you will not have to pay for laboratory costs related to COVID-19 testing. We believe that cost should not be a barrier to testing for our members who may have been affected by this virus. Capital Health Plan will not charge member cost-sharing (including, but not limited to, copayments, deductibles, and coinsurance) for all medically necessary laboratory testing for COVID-19.

In the event you are diagnosed with COVID-19, additional services including hospital admission (Emergency Room and Observation) for both in-patient and outpatient may be waived. Additional services including hospital admission (if applicable) will be covered and charged according to your normal plan coverage rules.

Prescriptions

It is a good idea to fill your prescriptions through a mail-order service, especially during the COVID-19 outbreak, not only because you can avoid standing in line at the pharmacy but also because with most prescriptions you can get a 3-month supply.

Capital Health Plan members are allowed to obtain early refills up to a 30-day supply of routine medications at any participating pharmacy nationwide. This means you can get your medications filled earlier than normal, if necessary. Controlled substance medications are not included in this early refill. Members who are impacted by this should work directly with the prescribing physician and their pharmacy.

Telehealth Visits

Capital Health Plan is now offering telehealth visits! If your Primary Care Physician (PCP) is located at one of our three health centers, please contact your PCP's office to determine if this service is available to you. Additionally, Capital Health Plan's Urgent Care Center is now providing a telehealth option to all Capital Health Plan members! In order to utilize this new service, please contact Urgent Care to schedule your appointment.

If you do not have a PCP at one of our three health centers, it's easy to get care and advice through our telehealth provider Amwell -- without an in-person visit. Amwell allows a patient to have live, on-demand video visits with a physician that is available 24 hours a day. To take advantage of this service, please visit Amwell online or download their app for Apple or Android devices. 

Resources

Please visit the Florida Department of Health’s dedicated COVID-19 webpage at www.FloridaHealth.gov/COVID-19. This remains the best and most up-to-date resource for information and guidance regarding COVID-19 in Florida.

For other questions related to COVID-19 in Florida, please contact the Florida Department of Health’s dedicated COVID-19 Call Center by calling 1-866-779-6121 or emailing [email protected]. The Call Center is available Monday through Friday, 8:00 a.m. to 5:00 p.m.

For additional information on the latest news on the coronavirus from state, federal, and world health authorities, visit:

• Florida Department of Health COVID-19 Information
• Centers for Disease Control COVID-19 Information
• World Health Organization General Information
• Healthwise COVID-19 Information