Frequently Asked Questions

FAQs on Coronavirus related test coverage, telemedicine, etc.

Supporting our members

 

What coverage do I have for COVID-19 testing and treatment?

Coverage will be provided in accordance with plan requirements. Some employers are self insured and may offer different coverage.

Please note: You can get a one-time early refill of your covered maintenance prescription medications for up to a 90-day supply at your usual cost sharing (i.e., copays, deductibles and coinsurance).

Connecticut fully insured plans

COVID-19 testing*

Covered in full (no copays, deductibles or coinsurance)

COVID-19 treatment

Your plan cost sharing (i.e., copays, deductibles and coinsurance) will apply

All telemedicine services

Covered in full (no copays, deductibles or coinsurance)

Prior authorizations and referrals (where applicable) Not required for COVID-19 testing

* You can receive an initial COVID-19 test from out-of-network providers when in-network providers are not available.

Maine fully insured plans

COVID-19 testing*

Covered in full (no copays, deductibles or coinsurance)

COVID-19 treatment

Your plan cost sharing (i.e., copays, deductibles and coinsurance) will apply

All telemedicine services

Covered in full (no copays, deductibles or coinsurance)

Prior authorizations and referrals (where applicable) Not required for COVID-19 testing

* You can receive an initial COVID-19 test from out-of-network providers when in-network providers are not available.

Massachusetts fully insured plans

COVID-19 testing*

Covered in full (no copays, deductibles or coinsurance)

COVID-19 treatment*

Copays will not apply; deductibles and coinsurance will apply if your plan has them

All telemedicine services

Covered in full (no copays, deductibles or coinsurance)

Prior authorizations and referrals (where applicable) Not required for COVID-19 testing and treatment

* You can receive initial COVID-19 testing and treatment from out-of-network providers when in-network providers are not available. 

New Hampshire fully insured plans

COVID-19 testing*

Covered in full (no copays, deductibles or coinsurance)

COVID-19 treatment

Your plan cost sharing (i.e., copays, deductibles and coinsurance) will apply

All telemedicine services

Covered in full (no copays, deductibles or coinsurance)

Prior authorizations and referrals (where applicable) Not required for COVID-19 testing and treatment

* You can receive an initial COVID-19 test from out-of-network providers when in-network providers are not available.

Medicare Advantage plans

COVID-19 testing*

Covered in full (no copays, deductibles or coinsurance)

COVID-19 treatment*

Your plan cost sharing (i.e., copays, deductibles and coinsurance) will apply

All telemedicine services

Covered in full (no copays, deductibles or coinsurance)

Referrals (where applicable) Not required for COVID-19 testing and treatment

* You can receive a COVID-19 test or COVID-19 treatment from out of network providers. In-network cost sharing applies.

Medicare Supplement plans

COVID-19 testing

Covered in full (no copays, deductibles or coinsurance)

COVID-19 treatment

Your plan cost sharing (i.e., copays, deductibles and coinsurance) will apply

All telemedicine services

Covered in full (no copays, deductibles or coinsurance)

If you need non-emergency medical or behavioral health care, what should you do?

First, call your provider’s office to see if you can get a telemedicine appointment. If not, you can use Doctor On Demand (for medical and behavioral health) or Optum/United Behavioral Health’s virtual visits platform.

Please note: In the event that providers are requiring copays for telemedicine services, you will be reimbursed.

If you are on our Medicare Enhance, Medicare Advantage or Medicare Supplement plans, you can use medical and behavioral health providers who accept Medicare and offer telehealth services. You should ask the provider’s office directly if you have questions about Medicare status and telehealth availability.

What behavioral health care options are available during the COVID-19 pandemic?

Here are some options if you are looking for support:

  • Behavioral Health Access Center: Call (888) 777-4742 to speak with a licensed care advocate. They answer member calls 24/7 and direct can direct you to resources, including tele-mental health and virtual care options. 
  • Virtual visits: If you are currently in treatment, speak with your behavioral health provider about having virtual visits either by secure video or telephone. Harvard Pilgrim covers outpatient virtual visits (telemedicine) using HIPAA-compliant platforms.

You can use our online provider directory to find behavioral health providers who offer virtual visits. Choose your plan, then select “Behavioral Health Providers” under “Search By Provider Type.” Under “Narrow Your Results,” click the arrow on the right for the option to show just those providers that offer virtual visits. Behavioral health virtual visits are also available through Doctor on Demand.*

  • United Behavioral Health/Optum’s Public Crisis Line: Call (866) 342-6892. Open 24/7, this emotional support help line is free of charge and available to anyone.

*Doctor On Demand is not available to members in our Medicare Enhance, Medicare Advantage and Medicare Supplement plans. Medicare Enhance and Medicare Supplement members must use providers that accept Medicare.

Can I refill my prescriptions early to ensure I have an adequate supply?

Yes, you can refill prescriptions early if you need to.

How can I get a 90-day supply of medicine?

To ensure that you have enough medicine on hand, you can fill a 90-day supply of maintenance medicines. Maintenance medicines are those you take regularly, such as birth control, blood pressure or cholesterol medicines.

To get a 90-day supply of maintenance medicines you can use our mail order pharmacy, OptumRx Home Delivery. Most orders arrive within seven days of when you place the order. Your options are to:

  • Log in to your member account at harvardpilgrim.org and click “Check drug coverage and costs” to order your medicines from OptumRx Home Delivery.
  • Use the OptumRx app, available for download from the Apple Store or Google Play.
  • Ask your health care provider to e-prescribe your medicine(s) to OptumRx Home Delivery.
  • Ask your health care provider to phone your medicine(s) to OptumRx Home Delivery at (855) 258-1561.

You can also ask your health care provider for a 90-day prescription for the medicines you take regularly and have them filled at a participating retail pharmacy.

You may also want to check your supplies of over-the-counter pain relief, fever and cough medicines.

Note: Not all employer-sponsored plans offer Harvard Pilgrim’s prescription drug benefits and mail order program. Please check your plan benefits or with your employer.

Information about COVID-19

 

What is coronavirus disease 2019 (COVID-19)? 

The coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by a newly identified strain of coronavirus, SARS-CoV-2, that was first detected in Wuhan, China.

What are the symptoms of COVID-19?

COVID-19 can cause a range of symptoms. Some are mild (fever, cough, shortness of breath), but the virus can lead to more severe respiratory illness, such as pneumonia, especially in people with co-existing medical conditions. Based on information that is currently available, symptoms may appear 2 - 14 days after exposure. People can infect others up to 14 days after exposure.

How does COVID-19 spread?

The virus is thought to spread mainly:

  • Between people who are in close contact with one another (within about 6 feet).

  • Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

It may also be possible that a person can get COVID-19 after touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes; this is not thought to be the main way the virus spreads, however.

Is there a test for COVID-19?

Yes, the CDC has developed a test. Your health care provider will work with your state’s public health department and the CDC to determine if you need to be tested for COVID-19.

Tips for protecting yourself

 

Is there a treatment for COVID-19?

There is currently no specific antiviral treatment recommended for COVID-19. People with COVID-19 should talk to their health care provider or pharmacist about what they can do for symptom relief.

If your health care provider thinks you can be treated at home, they may give you special instructions, such as to isolate yourself as much as possible from family while you're sick and to stay home for a period of time. If you're very ill, you may need to be treated in the hospital.

If you think you or a loved one may have been exposed to COVID-19, contact your health care provider immediately.

Are covered medications available for COVID-19 treatment yet? What about chloroquine and hydroxychloroquine?

No. The U.S. Food and Drug Administration (FDA) considers chloroquine and hydroxychloroquine experimental treatments for COVID-19. These medications are currently limited to clinical trials or closely monitored emergency use. Remdesivir is a third drug that has been in the news; it is currently being studied and not yet FDA approved.

Is a vaccine available? Will the flu vaccine protect me from COVID-19?

There is currently no vaccine that prevents COVID-19. The flu vaccine, which offers protection from the flu, will not protect you from COVID-19. Researchers are currently working on the development of a COVID-19 vaccine, but it may take 12 - 18 months before it is commercially available.

Should I wear a face mask?

If you are well, the CDC does not recommend wearing a face mask to protect yourself from respiratory diseases, including COVID-19.

Properly fitting face masks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of face masks is also crucial for health workers and people who are taking care of someone in close settings, such as at home or in a health care facility.

Additional information

 

Where can I get the latest information about COVID-19?

Centers for Disease Control and Prevention (CDC)

Connecticut Department of Public Health

Maine Center for Disease Control and Prevention

Massachusetts Department of Public Health

New Hampshire Department of Health and Human Services

 

Who can I call at Harvard Pilgrim with questions?

Benefits and coverage questions:

(888) 333-4742
Monday, Tuesday and Thursday 8 a.m. – 6 p.m.
Wednesday 10 a.m. – 6 p.m.
Friday 8 a.m. – 5:30 p.m.  

Medicare Advantage Plan:

(888) 609-0692
8 a.m. – 8 p.m.
Oct. 1 – March 31: 7 days a week
April 1 – Sept. 30: Monday - Friday

Medicare Supplement Plan:

(877) 907-4742
Monday, Tuesday and Thursday 8 a.m. – 6 p.m.
Wednesday 10 a.m. – 6 p.m.
Friday 8 a.m. – 5:30 p.m. 
TTY: 711

Health plan support and clinical coordination: Call (866) 750-2068 to speak to a nurse care manager

Hours of operation are 8:30 a.m. - 5:00 p.m., Monday through Friday. If you are not feeling well, please contact your primary care provider to discuss active symptoms.

If I find myself without health insurance coverage during this time, can I get coverage through the state health care exchanges?

Yes. Employees who lose group health coverage can apply for coverage through the state health care exchanges. They may also be eligible for premium assistance.

Information for Our Brokers & Employers

 

For fully insured businesses that are unfortunately having to lay off employees (temporarily or otherwise) or cut their hours due to the COVID-19 pandemic: Can they continue to cover these employees on their policies?

  • Small groups (fewer than 20 employees): We will provide benefits to small employers in accordance with “mini COBRA” under state continuation.
  • Large groups (more than 20 employees): We will provide benefits to large employers in accordance with federal COBRA.

In either case, the employer’s policy must be active and up-to-date with premium payments. Other conditions apply. Please speak with your Harvard Pilgrim account executive to learn more. 

Through May 15, 2020, we will also reduce the number of hours (from 20 to 0) that employees who are currently covered must work to stay eligible for coverage, assuming at least one employee of the company continues to actively work at least 20 hours per week.

What about self insured businesses?

Employees of self insured businesses who lose their group coverage can elect COBRA in accordance with applicable law. COBRA eligibility decisions under self-insured plans are made by the employer as the plan administrator. Neither Harvard Pilgrim nor its affiliates are the plan administrator.