Coronavirus: Updates on What's Covered & More
Symptoms, Testing and Treatment
When will a vaccine for COVID-19 be available?
- On December 11, 2020, the FDA issued the first emergency use authorization (EUA) for the Pfizer-BioNTech COVID vaccine for people age 16 and older. On December 18, the FDA issued the second EUA for the Moderna COVID vaccine for people age 18 and older. The Pfizer-BioNTech and Moderna vaccine require two doses.
- While COVID-19 vaccines began to arrive in California on December 14, the vaccine will be in limited supply during the first phase of distribution. The logistics for distributing the vaccine are being handled by federal and state agencies.
- The goal of the U.S. government is to have enough COVID-19 vaccine doses for all people in the United States who choose to be vaccinated by the end of 2021.
Who will get the vaccine first?
- At first, there will be a limited supply of COVID-19 vaccine.
- It is important that the initial supplies of vaccine are given to people in a fair, ethical, and transparent way. The CDC is making COVID-19 vaccine recommendations, including recommendations if there is a limited supply, based on input from the Advisory Committee on Immunization Practices (ACIP).
To find more information about when an individual can receive a COVID-19 vaccination, please go to the following websites:
- ACIP identified four ethical principles to guide the decision-making process for prioritizing distribution when vaccine supply is limited:
- Maximize benefits and minimize harms — Respect and care for people using the best available data to promote public health and minimize death and severe illness.
- Mitigate health inequities — Reduce health disparities regarding the burden of COVID-19 disease and death, and ensure everyone has the opportunity to be as healthy as possible
- Promote justice — Treat affected groups, populations, and communities fairly. Remove unfair, unjust and avoidable barriers to COVID-19 vaccination.
- Promote transparency — Make a decision that is clear, understandable, and open for review. Allow and seek public participation in the creation and review of the decision processes.
- Supplies will increase over time, and all adults should be able to get vaccinated later in 2021.
- A COVID-19 vaccine may not be available for young children until more studies are completed.
Will Health Net members have a cost-share for the vaccine and its administration?
No, Health Net members will not have any member cost share (deductibles, copayments and coinsurance are waived). Members should contact their primary care physicians or PPG for details on where to receive the vaccine.
Is prior authorization required for COVID-19 vaccine?
No, Prior authorization is not required for the COVID-19 vaccine and its administration.
Where should members go to get the COVID-19 vaccine?
Health Net recommends that members contact their primary care provider for information on where to receive the COVID-19 vaccine. It's important to note that there will be a limited supply of vaccine at first, but supplies are expected to increase over time.
Will Health Net members have a cost-share for the COVID-19 vaccine provided by pharmacies?
No. Health Net members will not have any member cost share (deductibles, copayments and coinsurance are waived).
During the COVID-19 crises, should members get a flu shot?
Yes. An annual flu shot is recommended for most people six months and older to help keep them healthy, unless your doctor identifies a medical reason not to take the flu vaccine.
Testing can be ordered only by physicians or other authorized health care providers. Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.
How is Health Net addressing potential technical issues?
We have thorough Business Continuity Plans in place for our IT systems, Call Centers and other operations. Health Net and Centene offices remain open, with essential personnel in place. We have implemented appropriate technology, and work from home capabilities for the majority of our employees under HIPAA/PHI/PII compliance guidelines. There are no changes to business hours.
What is Health Net doing to address possible drug shortages related to coronavirus?
First, we are closely monitoring the spread of the coronavirus to prepare for any impact. We are also actively monitoring for news of any drug shortages. Second, if needed, we may send prescriptions from another one of our pharmacy locations. This will help ensure our members have continued access to medications. Finally, we always encourage members and patients to refill maintenance medications in a timely manner.
Are medications safe? Could they be contaminated or at risk? Are medications from China?
The US Food and Drug Administration (FDA) monitors drug safety. It sends alerts in case of any safety or contamination issues. We check all prescriptions for safety and quality, and will let our members know of any safety concerns. Please continue to take your prescription medications as advised by your doctor.
Is there a drug to prevent Coronavirus?
Not at this time, but our pharmacists are monitoring the new drug pipeline for any medication or vaccine that may become available.
Where can I get credible information?
You can visit these websites that provide the most current information available:
If a state of emergency is issued, will Refill Too Soon on member prescriptions be lifted?
We will work with our members on a case by case basis to ensure they have access to their medications.
How much medication should I have on hand during this crisis?
You should have at least a one-month supply of the prescription medications you need to manage your medical conditions.
If I don’t have a one-month supply can I get more medication before its refill date?
Yes, Health Net has relaxed the refill limits so you can have more of your medications. Contact your pharmacy to get an added supply. Also, be sure to request a refill several days in advance of your current supply running out. This will allow extra time for the pharmacy to prepare it.
Can I get more than one prescription refilled early?
Yes. As a matter of fact it's best to arrange for all your prescriptions to either be picked up or delivered to you all at the same time. If you have more than one prescription, try to have them refilled on the same date. Health Net has been working with pharmacies to allow them to fill most prescriptions sooner than normal. This helps when trying to get prescriptions filled that have different refill dates.
What is a good way to limit being exposed to other people at the pharmacy?
Use the pharmacy drive-thru. Many pharmacies now have drive-thru windows. If your pharmacy has one, it may be a good option to use. A drive-thru limits coming in contact with other people picking up their medications.
You can also wait in the car for your prescription. If your pharmacy doesn’t have a drive-thru and you need to wait for a prescription to be ready, you might want to sit in your car rather than the pharmacy waiting area. By waiting in your car, you can reduce the time you are exposed to other people. Some pharmacies will bring medications to your car. Note: Because of COVID-19 many pharmacies are changing the hours they are open. Contact your pharmacy to confirm their business hours.
I don’t want to go out unless I really need to – is there a way to avoid going to the pharmacy?
Yes, ask the pharmacy if they deliver medications. During this pandemic, many pharmacies have offered to have medication delivered for free or at a low cost. CVS and Walgreens will deliver for free. Make sure to talk to your pharmacist to confirm if your prescriptions qualify for delivery and if there is a delivery charge.
Are there other options besides going to the pharmacy?
Yes, you can use the mail-order option. Mail order will fill 30-day medication supplies. Or, you may be able to receive a larger amount – up to a 90-day supply for maintenance medications.
How can I change my prescription from a 30-day supply to a 90-day supply?
If you have a maintenance prescription, ask your pharmacist if you are able to get a 90-day supply. Mail order is also an option for filling a 90-day supply.
I have never used a mail-order pharmacy. Is this the right time to start? If so, how does it work?
Yes! Using a mail-order pharmacy or getting prescription delivered helps with social distancing. It lowers the risk of being exposed to COVID-19 and can reduce chances of getting sick. Benefits of mail-order pharmacies include:
- Simple, fast, and free delivery: Many mail-order pharmacies offer free shipping and can deliver prescriptions usually within five business days.
- Time and money saved: Some benefits offer discounts on medications if you get them through a mail-order pharmacy. You can also save on time and transportation costs since you don’t have to make a trip to a pharmacy.
How it works:
- Option 1: Ask your doctor to send an electronic prescription (eRx) to CVS Caremark Mail Service Pharmacy. It should be for a prescription of up to a 90-day supply of your maintenance medication.
- Option 2: You can sign up or sign in at Caremark.com. Select Prescriptions from the navigation bar. From the drop-down menu, select Request a New Prescription. Search for the drug name and strength. Add it to the cart by choosing Request a New Prescription, and complete your order.
- Option 3: If you cannot contact your doctor or you are not able to sign up at Caremark.com, CVS Caremark Mail Service Pharmacy can contact your doctor. To start this process, complete the Start Mail Service request form.
- Option 4: You can call Caremark mail order at the toll-free number 1-888-624-1139 (TTY 711), 24 hours a day, 7 days a week.
You can also contact Health Net Customer Service toll-free at 1-800-522-0088 for help. Please allow 14 days for shipment to arrive from mail order.
What if my medication comes from a specialty pharmacy?
Specialty pharmacies ship medications straight to your home or office. You can have your specialty prescription drug shipped most likely within a few days. Contact the specialty pharmacy for your refills.
What about medications that need prior approval?
Health Net has extended prior approvals scheduled to end in the next couple of months. This helps to ensure that you will get your medications without delay of getting a new approval. Many doctors are sending requests online from their homes. Health Net has waived the need for a signature to make it easier for doctors.
How do I obtain an emergency supply of a prescription?
To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.
On March 19, 2020, the state of California launched a new coronavirus awareness website. According to this website:
- California is expanding the coronavirus testing capacity daily.
- Currently, testing is being prioritized for people who have the coronavirus symptoms AND have one of these risk factors:
- Have had contact with a person who has tested positive for COVID-19, OR
- Are health care providers or work with vulnerable populations (such as a long term care facility), OR
- Traveled to an affected country in the past 14 days, OR
- Are over age 60, have a compromised immune system or have serious chronic medical conditions
What is Babylon?
Babylon is a mobile telehealth/telemedicine app that combines the power of Artificial Intelligence (AI) with human medical expertise. Users can meet with a licensed physician via telephone and/or video for any non-life threatening health issue or behavioral health.
Babylon healthcare providers are available for appointments 24/7. The clinical support team is available 7 days a week, 5 a.m. to 7 p.m. PST. That means if your clinical support need arises after 7 p.m. PST, you can leave a message for a return call on the next day. Or you can schedule a virtual visit within the app.
Please note that Behavioral health appointments are scheduled, not offered on-demand.
How do I use Babylon?*
All members will need to visit the Babylon website or Health Net telehealth web page to select and download the Babylon mobile application. At that time, members will be required to register.
*Babylon is not available on all group plans.
Can a member use Babylon for any health issues that may not be related to COVID-19?
Yes, Babylon is available for general medical and behavioral health issues and can be used for issues not related to COVID-19.
Are behavioral health services available thru Babylon, and if so what happens if there is a crisis situation during a call?
Yes, behavioral health services are available thru Babylon. The Babylon clinical team follows standard crisis protocols.
Can Babylon provide members with a doctor's note, i.e. missed work due to illness?
Yes, Babylon can provide members with this type of documentation.
How often is COVID-19 guidance updated within the Babylon app?
The app is updated on a regular basis to provide the most current information from the Centers for Disease Control (CDC).
If the Babylon provider determines the member needs to be referred for an in-person testing location, how is the referral tracked?
All referrals to in-person testing locations are tracked in the medical record and included in the encounter summary for members to access within in the Babylon app.
What is the member share of cost for telehealth services through Babylon?
Health Net will waive member cost-sharing for all diagnoses, COVID-19 related or not, provided via any telehealth solution, including Babylon. This applies to effective for dates of service starting March 17, 2020 and will continue until further notice when the plan's usual cost-sharing arrangements will resume.
Can the developmentally delayed population access these apps with support of a relative, conservator or staff from the local regional center?
Yes, a relative, conservator, or staff member can assist members who have special needs.
If a member accesses Babylon after the COVID crisis ends, will they be informed of any cost share prior to the appointment?
Yes. Health Net will communicate all cost-sharing changes to members prior to the change being implemented. This timeline will be defined as we learn more about the crisis.
Can I request the same Babylon healthcare provider each time?
If you wish to make an appointment with the same healthcare provider you've used before, please contact their support team at 1 (800) 475-6168. A support agent will book your appointment for you.
If you book through the Babylon App, the healthcare provider available will depend on the date and time requested. Any healthcare provider you book a consultation with will have access to notes related to your care from your previous Babylon appointments, if you have had any.
How will the Babylon appointment start?
You'll get an incoming video call from the healthcare provider within a few minutes of your scheduled appointment time. You don't need to have the Babylon App open to receive the call.
If you haven't received a call after a few minutes, read what to do if your appointment is late. We recommend turning on notifications so we can send you appointment reminders. To turn on notifications, follow these steps in your phone's general settings:
- Go to Notifications > Babylon
- Make sure notifications are turned on
You will receive a push notification reminding you about your appointment five minutes before it starts.
How do I prepare for my telehealth appointment?
- Go somewhere quiet where you feel comfortable discussing your health. This could be at home or work, just as long as you won't be disturbed.
- Try to avoid:
- Being in a public place
- Being on a bus or train
- Doing other things during the call
- The healthcare provider might ask you to move if there's a lot of background noise, so you may want to keep headphones handy.
- The healthcare provider will end the call if they think it's unsafe or inappropriate to continue, like if you take the call while driving or you’re not fully dressed.
- Make note of the main points you want to discuss and any relevant details, like:
- How long you've experienced these symptoms
- What makes you feel better or worse
- Any medication you take, whether for your current symptoms or another health condition
- Don't worry about taking notes. Your healthcare provider will write up a summary that you can view after the appointment.
Is Telehealth a covered benefit for Medical and Behavioral Health issues, even if the plan design does not currently include that benefit? If so, then what provider network do members use (Babylon, Doctor on Demand, etc.)?
Yes, telehealth is a covered benefit for both medical and behavioral health issues for all plans during this time. Health Net currently uses Babylon for telehealth services. Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition). Member cost share is waived for telehealth services until further notice.
Will Health Net allow access to telehealth services to increase access to care?
To limit members' risk of COVID-19 infection, Health Net encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for all services.
For Commercial and Medi-Cal members, Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements until further notice, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).
Cost and Coverage
What is Health Net doing to ensure vulnerable individuals continue to receive needed health care services, while practicing appropriate social distancing?
Health Net is waiving all COVID-19 related prior authorizations and member cost sharing for screenings, tests and treatment. This specifically applies to all Commercial employer group business and Individual and Family Plan members. In addition, Health Net covers all telehealth services that are associated with COVID-19 for its members, as well as all covered healthcare services that can be administered virtually until further notice.
Also, Health Net assembled a COVID-19 taskforce to identify, and is reaching out to members who are at high risk for COVID-19. The purpose of the outreach is to connect with identified high-risk members and confirm they have access to the support and services they need. The taskforce began making outbound calls to this membership at the beginning of April.
In addition to the above, our parent company, Centene Corporation is:
- Facilitating the sourcing, ordering, and shipping of personal protective equipment (PPEs) to our provider partners that enable them to meet the urgent needs of patients. Centene is already in the process of expediting the distribution of approximately 2 million pieces of PPE including safety goggles, facemasks, hand sanitizers and disaster kits, and will continue these efforts in coming weeks.
- Partnering with our providers to deploy resources to service areas that have been most impacted by newly created quarantine and isolation centers.
- Providing data and support that enable providers to reallocate resources based upon utilization changes caused by the COVID-19 pandemic.
- Working to ensure that our community Safety Net providers and organizations have long-term sustainability beyond the immediate crisis.
- Providing assistance in securing small business loans to specifically help behavioral health providers and community-based behavioral health organizations, long-term service support organizations and other Safety Net providers gain access to government-sponsored small business loans, and telehealth technology.
Will Health Net cover COVID-19 serological tests?
During this emergency period, Health Net's benefit plans cover medically necessary serologic (antibody) testing, using AMA approved CPT codes and CDC guidance for appropriate use of FDA approved antibody tests.
Will Health Net cover testing if a member is not showing any COVID-19 symptoms?
Health Net complies with the DMHC "essential worker" COVID testing guidelines. Essential workers may seek a voluntary (no symptoms) COVID test, by obtaining their in-network doctor's order, and getting the test from an in-network diagnostic testing location.
Essential workers may be eligible for more frequent COVID diagnostic testing, as outlined under the DMHC all plan letter regarding essential worker testing. The essential business will establish frequency guidelines, based upon the needs and exposure of their workforce.
For non-essential workers, voluntary and return to work testing is not covered. For medically necessary COVID testing, all non-essential workers and their families must obtain an in-network doctor's order for a COVID test, and seek diagnostic services from an in-network provider. We strongly encourage all services be provided by an in-network provider. Please follow the CDC guidelines related to frequency of testing.
How often can the member get a COVID test?
In compliance with the DMHC "essential worker" testing guidance, essential businesses may determine that more frequent testing is required (i.e., hospital workers). Health Net will cover more frequent COVID diagnostic testing for verified "essential workers."
For non-essential workers, Health Net follows the CDC guidelines for COVID testing.
What if in order for the member(s) to go back to work/continue working, they must get tested regularly (weekly, bi-monthly, monthly) does Health Net cover the testing since it is required by their employer?
Health Net will comply with the DMHC guidelines regarding "essential worker" testing. Yes, we will cover essential worker COVID testing. Essential workers should get an in-network doctor's order for COVID testing, and seek diagnostic testing from an in-network provider. Essential worker testing frequency will be established by the essential business, in accordance with the DMHC all plan letter.
Non-essential worker return to work testing is not covered. However, medically necessary COVID testing is covered. Non-essential workers should get an in-network doctor's order for a COVID test, and seek diagnostic testing from an in-network provider. We strongly suggest members obtain COVID tests from an in-network provider.
Will Health Net deny voluntary testing required by the member's employer? Or what if it is not required by the employer, will Health Net still deny the testing?
Health Net will comply with the DMHC guidelines for "essential worker" testing. Health Net will cover voluntary testing for essential workers.
Health Net will not cover return to work testing for non-essential workers. However, Health Net covers medically necessary COVID testing, and follows the CDC and CDPH guidelines. Members should get an in-network doctor's order for a COVID test, and seek in-network COVID testing services.
Does Health Net have a list of approved testing locations?
No, Health Net does not maintain a list of approved testing locations. Employees should seek an in-network doctor's order for a COVID test, who will direct the member to the most convenient testing location. In some cases, their physician will be able to provide the service at their facility.
If a member paid out of pocket for COVID-19 testing, what is the process for members to be reimbursed?
Members who paid out-of-pocket for COVID-19 test should submit a claim form to Health Net. Members may find a claim form on www.healthnet.com or by calling the Customer Contact Center at the telephone number listed on their ID card.
Who should I contact to be screened and tested for COVID-19 and where can I be tested?
For guidance on COVID-19 testing and screening, call your physician or other authorized health care provider.
If your physician or other health care provider determines that you meet COVID-19 testing criteria, your physician will direct you on where to obtain the test.
Is Health Net waiving cost-share requirements for screening and testing?
All member cost-share requirements (copayment, coinsurance and/or deductible amounts) related to the screening and testing for COVID-19 will be waived across all products.
Health Net covers screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.
Can providers balance bill members for fees related to screening and testing for COVID-19?
Balance billing is strictly prohibited by state and federal law and Health Net's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.
Is Health Net requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?
Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.
Updated 2/11/21: Will Health Net be able to offer coverage options if I have been laid off and lose my work-based insurance?
Standard Policy COBRA and state continuation protocols apply provided that one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.
Covered California is offering a Special Enrollment Period (SEP) through May 15, 2021, due to the COVID national emergency. This SEP qualifying event is available if you enroll through Covered California as well as enrollment on our off exchange plans.
If you are interested in IFP coverage, please call Health Net Direct Sales at 1-877-878-7983. Our representatives will assist you to determine your eligibility for subsidies, as well as provide information for IFP plans through Covered California, off-exchange IFP plans, and Medi-Cal.
What if as a Health Net member I require proof of insurance to re-enter the country?
Members may download proof of coverage or their ID card from our website. We encourage all members to register on our website and update their current contact information, including email and cell phone number.
What is Health Net doing to mitigate risk to its operations?
As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.
These and other measures further reinforce existing contingency plans Health Net has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.
While this pandemic is unprecedented, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.
As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Health Net regularly reviews and updates its emergency business continuity protocols.
As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations.
Covered California offers extended enrollment due to COVID-19 national emergency.
During this challenging time, we want to help individuals and families access the care they need.
Covered California is offering a Special Enrollment Period (SEP) through May 15, 2021, to help uninsured people get health care coverage in 2021. Health Net will make this SEP for Individual & Family Plans (IFPs) available through Covered California as well as enrollment on our off-exchange plans.
Here's what you need to know:
- Any uninsured individual or family can use this SEP to apply for 2021 health care coverage.
- This SEP is for new enrollment only and not available for plan changes.
- Financial help is available through Covered California to those who qualify.
- To enroll in one of our off-exchange plans, go to MyHealthNetCA. Proof of a qualifying event is not needed to enroll. Or, you can use the existing 2021 IFP enrollment forms to apply by mail.
- Effective dates of coverage are:
Enroll By Effective Date February 28 March 1, 2021 March 31 April 1, 2021 April 30 May 1, 2021 May 15 June, 1 2021
After May 15, 2021, the regular special enrollment period qualifying events apply.
- First month's payment is required to activate coverage.
- The impact of COVID-19 on small businesses may be causing individuals to lose their health coverage through their employer. Individuals can use this SEP to enroll with Health Net to regain health care coverage.
To maintain health care coverage, members' premium payments are due by the first of the month. Current grace period rules apply until further notice.
Payment and Financial
What happens if my income changes?
You should report your income changes to Covered California so your eligibility for increased subsidies or new eligibility for subsidies can be determined. This can potentially help reduce your payment responsibility going forward. Off-exchange members are permitted to enroll into a Covered California plan if they become eligible for subsidies.
In some cases, you can qualify for Medi-Cal, which offers low-cost or free health coverage to eligible Californian residents with limited income.
Will employers be able to continue benefits if the entire workforce is laid off?
Standard Policy COBRA and state continuation protocols apply if one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.
Update 2/12/21: If I am on a temporary leave of absence, can I keep my benefits intact for a few months without being paid a salary?
Through the end of the public health emergency, Health Net is temporarily relaxing its requirement that employees be actively working to be eligible for coverage and will allow employers to cover their reduced-hour employees, as long as employers pay the monthly premium. Employers must offer this coverage on a uniform, non-discriminatory basis.
Is Health Net waiving cost-share requirements for COVID-19 related treatments?
Effective immediately, Health Net will waive member cost sharing for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members.
Is Health Net waiving prior authorizations for COVID-19 related treatments?
Effective immediately, Health Net and its delegated entities will waive prior authorizations for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members. Inpatient admission notification is still required as soon as possible to Health Net and the member's assigned delegated participating physician group (PPG) or IPA, if available.
What is the payment grace period to pay my monthly premiums?
Individual and Family Plan members who receive Advanced Premium Tax Credits (ATPC), also referred to as subsidies, have a 90-day grace period. Members who do not receive APTC have a 30-day grace period.
You should report your income changes to Covered California so your eligibility for increased subsidies or new eligibility for subsidies can be determined. This can potentially help reduce your payment responsibility going forward. Off-exchange members are permitted to enroll into a Covered California plan if they become eligible for subsidies.
Will there be any delays on processing claims?
Health Net intends to provide the same level of service and claim processing support as it does during normal circumstances.
Social and Emotional Support
How is mental health covered as related and unrelated, to COVID-19? If done through telemedicine, is it at a $0 copay?
Health Net will waive member cost share (deductible, copayment and coinsurance) for all telehealth services (including behavioral telehealth services), whether COVID-19 related or not, until further notice. Behavioral health services provided in person will be covered in accordance with the member's plan benefits, and applicable cost sharing will be applied.
If you are enrolled in a PPO plan, and use an out-of-network provider, the out-of-network provider may bill you for the difference between the provider's charge and what the plan pays. This is known as balance billing.
Is coping assistance offered to members impacted by COVID-19?
Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.
What you need to know about COVID-19
Coronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. People of all ages can be infected. Older adults and people with pre-existing medical conditions like asthma, diabetes and heart disease may be more likely to become severely ill if infected. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.
What Is The Coronavirus?
COVID-19 is a respiratory disease that is caused by a new virus called a coronavirus, which has become a public health emergency. The number of cases continue to increase nationally and globally.
What Are The Symptoms?
The symptoms of coronavirus include mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. COVID-19 can be contagious before a person begins showing symptoms.
What Else Causes Similar Symptoms?
Influenza (the flu), a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the United States at this time. Everyone 6 months of age and older should get a flu vaccine.
I May Have Symptoms. What Do I Do?
If you have been exposed or begin showing symptoms of the virus or flu, contact your healthcare provider or health department immediately.
How Else Can I Get Healthcare Services?
If you have the symptoms noted above, you can also access our Nurse Advice Line. To learn more, please call us at 1-877-658-0305 (TTY: 711). We can also answer general questions you may have about Coronavirus.
Protect yourself and your community.
We all have a role to play in protecting our communities and families from the spread of coronavirus. It is similar to other communicable viruses. You can also follow these tips to prevent infection:
- Wash your hands thoroughly and frequently. Use soap and water for at least 20 seconds.
- Use an alcohol-based hand sanitizing rub (must contain at least 60 percent alcohol).
- Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow.
- Promptly dispose of tissues in a wastebasket after use.
- Clean public surfaces thoroughly.
- Stay home when you are sick.
- Avoid shaking hands.
- Avoid close contact with people who are sick.
- Get a flu vaccine.
Does My Plan Cover COVID-19 Testing/Screening Services?
Yes. When medically necessary diagnostic testing or medical screening services are ordered and/or referred by a licensed health care provider, we will cover the cost of medically necessary COVID-19 tests and the associated physician's visit. If applicable, your plan's copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing and/or medical screening services.
Is Prior Authorization Required For COVID-19 Testing/Screening Services Under My Plan Coverage?
No. We will not require prior authorization, prior certification, prior notification and/or step therapy protocols for medically necessary COVID-19 diagnostic testing and medical screening services, when medically necessary services are ordered and/or referred by a licensed health care provider.
Where May I Receive COVID-19 Testing/Screening Services Under My Plan Coverage?
Medically necessary COVID-19 diagnostic testing and/or medical screening services and the associated physician's visit will be covered when ordered, referred and/or performed in the following In-Network locations:
- Physician's/Practitioner's Office
- Independent Laboratory/Diagnostic Facility
- Urgent Care Facility
- Emergency Department Facility
Are you unsure if you have been exposed to or at-risk of being infected with COVID-19? Schedule a virtual care visit with a provider. It is a good option for non-urgent care to limit potential exposure in a physician's office or other healthcare facility.
Will I Be Responsible For Any Out-Of-Pocket Costs For COVID-19 Testing/Screening Services?
No. We will cover medically necessary COVID-19 diagnostic testing and/or medical screening services at no charge to you, when such services are ordered and/or referred by a licensed health care provider. If applicable, your plan's copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing and/or medical screening services along with the associated physician's visit.
If I Need Treatment For Coronavirus, Is That Covered By My Plan?
Any medically necessary treatment related to COVID-19 would be considered a covered benefit. We are committed to ensuring access to COVID-19 treatment services in accordance with federal and state law.
Will I Be Able To Refill My Prescriptions Before The Refill Date?
Yes, members will be able to refill prescriptions prior to the refill date.
Are There Strategies For Coping With The COVID-19 Outbreak?
Worry and anxiety can rise about the spread of COVID-19. Concern for friends and family who live in places where COVID-19 is spreading or the progression of the disease is natural.
- Take care of your body. Take deep breaths, stretch or meditate.
- Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.
- Share the facts about COVID-19 and the actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.
- For more information, see the CDC's suggestions for mental health and coping during COVID-19.
For more information, including travel advisories, please visit cdc.gov.