(Updated 01/18/2022) With all that is happening, we felt it important to give you some quick answers to some Frequently Asked Questions pertaining to the COVID-19 virus itself, how this pandemic affects individuals, questions that relate to us as a medical carrier, and questions about stop-loss/reinsurance.
Frequently Asked Questions:
About COVID-19
- What are the symptoms of Coronavirus?
The most common symptoms of COVID-19 are fever, tiredness, shortness of breath, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people recover from the disease without needing special treatment. Around 1 out of every 5 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention.
- How soon after exposure will symptoms occur?
2-14 days after exposure.
- How is the disease spread?
- Between people in close contact with one another (6 feet).
- Through respiratory droplets produce when an infected person coughs or sneezes.
- These droplets can land in mouths and noses of people who are nearby or possible inhales into the lungs.
- Can someone spread the virus without being sick?
- People are thought to be most contagious for two days before having symptoms and three days after symptom begin.
- Some people without symptoms may be able to spread virus.
- What to do if you are sick?
- Get tested. While waiting for results, stay away from others, including those living in your household.
- Stay home except to get medical care. Get rest and stay hydrated.
- Separate yourself from other people. As much as possible, stay in a specific room.
- Call ahead before visiting your doctor and tell them you have or may have COVID-19. This will help the healthcare provider take steps to keep other people from getting infected.
- Wear a mask over your mouth and nose if you must be around other people or animals (even at home).
- Wash your hands often and avoid touching your eyes, nose, and mouth with unwashed hands.
- Do not share personal household items, and wash items thoroughly after using them.
- Stay home until instructed to leave if infected.
- Can the virus that causes COVID-19 be transmitted through the air?
Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air.
- Can COVID-19 be caught from a person who has no symptoms?
The main way the disease spreads is through respiratory droplets expelled by someone who is coughing. However, many people with COVID-19 experience only mild symptoms or no symptoms at all and may still be able to spread the virus.
- Is there a vaccine for the virus?
The Pfizer vaccine has received FDA approval for individuals five and older. The Moderna and Johnson & Johnson COVID-19 vaccines have been authorized for adults. The Advisory Committee on Immunization Practices (ACIP) has recommended the vaccine for everyone five and older. EMI Health medical plans will cover approved COVID-19 vaccines at 100 percent when received from a participating provider or pharmacy. Vaccines received from a non-participating provider will be covered 100 percent up to the plan's maximum allowable charge (MAC). See more on the COVID-19 vaccine by visiting this link.
For Individuals & Families
- Steps to protect yourselves
- Get vaccinated.
- Wash your hands often.
- Use hand sanitizer that contains at least 60% alcohol.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Avoid contact with people who are sick.
- Put distance between yourself and other people.
- Stay home if you are sick.
- Cover coughs and sneezes.
- Wear a mask over you mouth and nose when in public.
- Clean and disinfect.
- How is EMI Health covering COVID-19?
Testing:
EMI Health will waive member co-pays, deductibles, and other cost sharing for medically necessary Coronavirus (COVID-19) diagnostic testing, up to the plan's maximum allowable charges, when ordered by a physician and performed by an accredited lab or medical facility. EMI Health will also cover one Serology test, which is a test looking for the presence of COVID-19 antibodies. EMI Health does not cover any test performed for surveillance, employment, school, or travel purposes.
In accordance with recent federal guidance, beginning January 15, 2022, EMI Health plans will also cover up to eight over-the-counter home tests per covered person per month. If EMI Health administers the pharmacy benefit for those plans, eligible tests will be covered upfront with no out-of-pocket expense to the member when they are obtained at a participating pharmacy.
President Biden announced recently that the federal government is purchasing 500 million at-home COVID-19 testing kits, to be sent free of charge to Americans who request them through https://www.covidtests.gov/.
Treatment:
EMI Health will cover member co-pays, deductibles, and other cost sharing for treatment related to an active Coronavirus (COVID-19) infection, up to the plan's maximum allowable charges, received between April 1, 2020 and September 30, 2021. This does not apply to Minimum Essential Coverage (MEC) plans.
Between April 1, 2020 and September 30, 2021, treatment will be covered at 100%, up to the plan's maximum allowable charges for an active COVID-19 infection. When services are received from in-network providers and facilities within the coverage window, the provider will not balance bill you. If services are received from out-of-network providers and facilities, the provider is encouraged to write off amounts above the plan's maximum allowable charge, but may not be legally obligated to do so.
Ongoing treatment due to complications of COVID-19 are subject to the normal benefits of the plan.
Effective October 1, 2021, treatment of COVID-19 will be covered as any other condition, according to the terms of the plan, and regular cost sharing will apply.
- Who can get tested?
As testing becomes more widely available, there are increased options available to the public. Remember, to be covered by your health plan, the test must be requested by a physician and performed by an accredited lab or medical facility or fall within the federal guidance for OTC tests.
- What do I need to do to get tested?
- If you live in Utah, visit testutah.com to see if you qualify for a free test.
- See your healthcare provider either in person or through Telemed and have your provider order a test at an authorized testing facility.
- Request your free tests at https://www.covidtests.gov/.
- Purchase an OTC at-home test from a participating pharmacy.
- Where can I get tested?
- Qualified Urgent Care facilities.
- Qualified local hospitals.
- Qualified physician offices.
- State Health Department.
- testutah.com (Utah only).
- U of U Hospital (Utah only).
- Approved facilities from Intermountain Healthcare (Utah Only).
- National testing location search provided by Cigna
- If you are covered through our BCBSAZ partnership, COVID-19 testing sites in Arizona can be found here. Once you have identified a site location near you, use the provider search to verify contract status.
- What are the rules for getting a medically-necessary COVID-19 test?
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- Symptoms of COVID-19 or close contact with a person diagnosed with COVID-19.
- Test will need to be done at an approved laboratory location.
- Only the COVID-19 test will be covered at no cost share. Any other tests will have applicable cost sharing applied.
- EMI Health will cover the cost of physician-ordered testing for patients who meet CDC guidelines.
- Will EMI Health pay for the cost of the testing?
Yes, when ordered by a physician and the test is done at an accredited laboratory, or an OTC at-home test that falls within the federal guidance. This includes Serology testing used to determine if you have COVID-19 antibodies. Serology testing is typically covered one time only. EMI Health does not cover any test performed for surveillance, employment, or travel purposes.
- Are Telehealth visits covered?
Yes, but any copays and deductibles will apply. WellVia TeleMedicine is available to most EMI Health members with no copay.
- How long will it take to get the test results?
Varies by test and location but estimates are 24-48 hours.
Medical Carrier
- What is EMI Health doing to address COVID-19?
EMI Health is working to provide information to providers, care managers and customer service professionals to ensure they have the latest information about the virus so we can work together to inform and support our members who have questions or concerns.
- What codes are being used for billing the COVID tests?
Current guidance is to use CPT 86328, 86769, 87426, 87428, 87634, 87635, 87636, 87637, G2023, G2024, U0001, U0002, U0003, U0004, or U0005. Guidance continues to evolve.
- What are the costs of COVID-19 tests, and how will this impact rates? Will EMI Health be holding rates at the same level as current – how will this we be handled at the renewal?
Pricing for COVID-19 testing varies by vendor. There will be no change to existing rates. Renewals will be handled as they have been in the past.
Dental Carrier
- Do EMI Health dental plans cover infection control efforts?
Infection control, including personal protective equipment (PPE) and oral rinses, is an integral part of the dental treatment you receive—not an extra service—therefore, your EMI Health dental plan does not pay separately for infection control.
Of course, we recognize that dental offices are incurring additional expenses associated with the pandemic. In fact, all organizations are to some degree, including yours and ours. EMI Health is dedicated to controlling costs for our clients and members, especially during this time when so many are facing financial challenges.