Important Information About Coronavirus-Related Benefits
Below is information about and links to important information about your benefits coverage related to the coronavirus.
COVID-19 Vaccination Coverage
While the federal government currently pays the ingredient cost of the COVID-19 vaccines, there are administrative costs associated with the vaccine that are charged by providers and facilities. As explained below, the Plan will cover these administrative costs regardless of whether you obtain a COVID-19 vaccine at a pharmacy, doctor’s office, medical facility, or clinic.
Coverage at a Pharmacy
Once COVID-19 vaccines are available from local retail pharmacies, the Plan will cover the vaccine under its Prescription Drug benefit. The Plan will cover 100% of the administrative costs for all COVID-19 vaccines administered at local retail pharmacies.
Coverage at a Doctor’s Office, Medical Facility, or Clinic
The Plan covers vaccines administered at a doctor’s office, medical facility, or clinic at 100% of administrative costs when received from in-network providers and 100% of reasonable administrative costs when received from out-of-network providers. The Plan’s payment of these administrative costs is covered under the Plan’s Wellness Benefit and is not subject to the Plan’s annual deductible.
COVID-19 Vaccines: Fast Facts
- As of the date of the 12/2020 Summary of Material Modifications, the U.S. Food and Drug Administration has issued emergency use authorization for the Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 Vaccine.
- Initially, the federal government will pay the ingredient cost of COVID-19 vaccines and will allocate the initial supply of these vaccines to the states for distribution.
- The states will prioritize distribution to health care workers, frontline workers and other high-risk populations.
COVID-19-Related SMMs and Forms
7/2021 Summary of Material Modifications: Special 14 Day Weekly Income Benefit COVID 19 Quarantine Extended through 9/2021 and Virta Health Diabetes Management Program
Special 14 Day Weekly Income Benefit COVID-19 Quarantine Application Form
12/2020 Summary of Material Modifications: Special 14 Day Weekly Income Benefit COVID 19 Quarantine Extended through 5/2021
5/2020 Summary of Material Modifications: Special 14 Day Weekly Income Benefit COVID 19 Quarantine/Update on Diagnostic COVID 19
3/2020 Summary of Material Modifications: Diagnostic COVID 19 Testing/Telehealth Benefits