New legislation, the American Rescue Plan (ARP), makes it easier for many individuals and their families to qualify for financial assistance when they buy health insurance coverage through the individual health insurance marketplace, Access Health CT.
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Frequently Asked Questions About The Coronavirus (COVID-19)
There are many questions about seeking care for coronavirus (COVID-19), your benefits as a ConnectiCare member, and more. Find many of the answers here.
Vaccine
You can find up-to-date information on vaccines, your coverage and benefits, and more on our vaccine webpage.
You can also check these websites for the latest information on who is eligible for vaccination at this time: Connecticut, Massachusetts, New York City, and New York state.
Additional Resources - American Rescue Plan
New legislation, the American Rescue Plan (ARP), makes it easier for many individuals and their families to qualify for financial assistance when they buy health insurance coverage through the individual health insurance marketplace, Access Health CT.
The American Rescue Plan Act (ARP) expands access to affordable health coverage for Connecticut residents by increasing eligibility for financial assistance to help pay for coverage through Access Health CT. For members who currently receive a premium tax credit, you may receive additional assistance to help pay your monthly premium. For those who were initially found to be ineligible for advance premium tax credits you may now be eligible. The original cap of 400% of the federal poverty level has been removed. Contact your broker, call us at 800-723-2986 (TTY: 711) or contact Access Health CT by phone at 855-805-4325 (TTY: 855-365-2428) or by going to www.accesshealthct.com for help in determining eligibility for a premium tax credit and estimated amount of a tax credit.
In response to the American Rescue Plan Act, Access Health CT will be opening a special enrollment period from May 1 – August 15, 2021.
If you currently have a tax credit you may use your new tax credit to choose a new ConnectiCare plan, or you may keep your current plan and simply pay the lower cost each month.
If you are qualifying for a tax credit for the first time, you may shop on the Access Health CT website for a plan. Only plans purchased through Access Health CT qualify for a tax credit. We can help you. Call us at 800-723-2986.
You would qualify for the special enrollment period only if you are eligible for a premium tax credit under ARP and enroll through Access Health CT. If you are not eligible for financial help under the expanded guidelines of ARP and do not have a qualifying life event, then you would not be eligible to purchase new coverage until next Open Enrollment, which begins November 1, 2021. You should call your broker, call us at 800-723-2986 (TTY:711) or contact Access Health CT by phone at 855-805-4325 (TTY: 855-365-2428) if you need help determining if you are eligible for a special enrollment period.
Yes, but there are some rules around this, please call us at 800-723-2986 (TTY:711).
If you currently have coverage through Access Health CT without a premium tax credit, you may now qualify for a premium tax credit. If you currently have coverage through Access Health CT with a premium tax credit, you may qualify for an increased premium tax credit. You should call your broker, call us at 800-723-2986 (TTY:711) or contact Access Health CT by phone at 855-805-4325 (TTY: 855-365-2428) or by going to www.accesshealthct.com.
First of the month after the date you have submitted a change, starting May 1, 2021.
Coronavirus Symptoms and Testing
If you have symptoms of coronavirus (COVID-19), call your doctor. Based on the details of your symptoms, your doctor will let you know whether it’s recommended that you get tested. If you are fully vaccinated, check the most up-to-date CDC guidance for information on testing. Talk to your doctor if you’re not sure.
Call your primary care provider (PCP) and describe your symptoms. Unless it’s an emergency, stay home. Do not go to public places and avoid public transportation. Your PCP will evaluate your symptoms and give you directions on what to do next. If your PCP thinks you should be tested, he or she will arrange for it and direct you where to go.
Times like these point out the importance of having a PCP. If you don’t, make it a priority to find one and establish your relationship. Start your search using “Find a doctor” on connecticare.com.
As always, if you are experiencing severe symptoms, call 911 or go to your local emergency department. Severe symptoms include very high or very low body temperature, shortness of breath, confusion, or feeling like you may pass out. If you decide to go to the emergency department, try to call ahead and let them know you are coming. This will let them safely prepare for your arrival. Additional information is available from the CDC.
You need an order for testing to diagnose COVID-19 from a medical professional who is following guidance from the Centers for Disease Control and Prevention (CDC) and state department of health.
Most standard health insurance plans do not cover non-diagnostic tests for employment or public surveillance purposes. For example, testing to travel, avoid state quarantine requirements, or return to work or school is not covered under most ConnectiCare plans.
During the public health emergency, ConnectiCare will cover COVID-19 diagnostic testing without cost share when:
- A licensed medical professional decides the test is medically necessary for a member under the professional’s care, and
- Orders a test in order to diagnose and, if necessary, treat a member.
If you seek testing on your own…
You should know that most providers of COVID-19 tests are required by law to list the cash prices of the tests on their websites. The state of Connecticut publishes information on free testing sites for people who live in towns and cities with outbreaks. Massachusetts also has help finding testing locations, including those that don’t require referrals.
Help staying safe
If you are concerned about anything associated with the coronavirus, it’s important to remember the steps you can take to stay safe and know symptoms to watch for. For tips to protect you and your family, visit our dedicated coronavirus webpage, which is frequently updated. Look on this page and on others for an interactive app called “Project COVID,” where you can ask questions and use a symptom checker.
Note: The situation with COVID-19 testing may change in response to the pandemic and newer advice from medical authorities and regulators. We will update information and share it with you when there are significant changes in polices.
We know that you may need to see your doctor again to be diagnosed with COVID-19. If you need to see your doctor about COVID-19 and be tested again, your visit and test will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles. This policy is in effect during the federal public health emergency.
Health plans are not required under federal law to cover testing that employers choose to require of employees before they can return to or continue to work. ConnectiCare does not cover testing conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance for COVID-19 (SARS-CoV-2), or for any other purpose other than individual diagnosis or treatment of COVID-19.
If individuals seek testing on their own, they should be aware that providers of diagnostic testing for COVID-19 are required by law to list the cash prices for testing on their websites.
As stated above, during the public health emergency ConnectiCare will cover COVID-19 diagnostic testing without cost share when:
- A licensed medical professional decides the test is medically necessary for a member under the professional’s care, and
- Orders a test in order to diagnose and, if necessary, treat a member.
Testing providers may not bill members for any balance over their health plan’s reimbursement for the test.
Food and Drug Administration (FDA) authorized COVID-19 home tests that you buy at a pharmacy or store without a prescription or order from a licensed health care professional are not covered by your plan. Most health insurance plans do not cover COVID-19 tests for reasons other than diagnosis or treatment by a health care professional. For example, tests conducted for return to work purposes or travel are generally not covered.
If your doctor or licensed health care professional sends you to get your antibodies checked for COVID-19 because it is clinically indicated, your visit and FDA-authorized test will be covered. There will be no cost-sharing, including copays, coinsurance, or deductibles.
Given the high demand for testing and antibody testing reliability, we encourage our members to use Quest Diagnostics for their testing. Quest is ConnectiCare’s in-network, preferred lab and testing provider.
If you need an antibody test for return-to-work purposes, most standard health insurance plans will not cover that service. ConnectiCare only covers non-diagnostic antibody tests when these services are delivered according to the terms of your benefit plan.
This policy is subject to change as we learn more about antibody testing during this rapidly evolving situation.
ConnectiCare Coverage
ConnectiCare members with individual (under 65) and group health plans:
You can use telehealth, or virtual visits, to see in-network health care providers for services covered by your plan. Your plan’s deductible, copay, or coinsurance for office visits will apply.
Many plans also include telemedicine through Teladoc®. Note: Telemedicine doctors cannot order lab tests — diagnostic or antibody tests — for COVID-19.
Medicare Advantage members:
You can visit in-network primary care providers (PCPs), specialists, and in-network behavioral health clinicians in person or using telehealth for covered services. Your plan’s deductible, copay, or coinsurance for office visits will apply.*
Many plans also include telemedicine through Teladoc®. Check your plan benefits for more information. Note: Telemedicine doctors cannot order lab — diagnostic, or antibody tests — for COVID-19.
ConnectiCare Medicare members with Choice Dual (HMO D-SNP) plans can call the 24-hour Nurseline at 1-877-489-0963 (TTY: 711). (Nurseline is not available for Choice Dual Basic (HMO D-SNP) members.)
Learn more about covered medical and mental health services on our dedicated COVID-19 care and coverage webpage, which is frequently updated.
*Temporary waivers of copays for in-network PCP and behavioral health clinician visits ended on Dec. 31, 2020. Temporary waiver of cost-sharing for specialist visits by telehealth ended Sept. 9, 2020.
Pharmacy
Yes, the CARES Act passed by Congress repealed the prohibition on using health account dollars to pay or reimburse yourself for over-the-counter medicines, such as pain relievers, cold and flu medicines, and more. And the act added menstrual supplies to the list of items that can be reimbursed from a tax-qualified health account. This was effective Jan. 1, 2020. Check your account administrator’s website (for many ConnectiCare members, that’s HealthEquity) for more information.
ConnectiCare covers 90-day supplies of long-term medications (or maintenance drugs) through Express Scripts mail order. Members can get their medications delivered right to their home if they’re quarantined or concerned about visiting pharmacies during the outbreak. Express Scripts also gives members access to pharmacists 24 hours a day, seven days a week, in case they have questions about their medications.
Sign up online – Visit express-scripts.com and sign in. If you don’t have an account, you can create one in just a few minutes. Have your ConnectiCare member identification (ID) card handy. After you sign in, click “Home” in the Express Scripts window and you will see a list of available prescription refills. Select the items you want to order and follow the instructions to complete your request.
By phone – To start using Express Scripts by phone, have your prescription number ready and call:
- Medicare – 1-877-866-5828
- All other plans – 1-877-866-5798
Mobile app – Download the app on your mobile device from the App Store, Google Play, or Amazon apps.
By fax: Have your doctor call 1-888-327-9791 for faxing instructions. (Faxes can only be accepted from a doctor’s office.)
Pregnancy and Children
We know that information about COVID-19 may be concerning, especially if you are pregnant or just had a baby. EmblemHealth, our parent company, asked a medical expert to answer some frequently asked questions about pregnancy and COVID-19.
Yes, children can get COVID-19. While most children have mild symptoms, some children have gotten very sick. It’s important to lower your child’s chances of exposure as much as possible.
The CDC recommends children 2 years and older wear masks. Children under 2 should not wear a mask. Be sure to teach your child not to touch or remove their mask when social distancing is not possible. Children should also follow guidelines to stay at home, wash their hands often, and practice social distancing. Make it fun: Play a game to see who can wash their hands first before meals, make a DIY mask with a fun print, or make an “obstacle course” to get kids moving indoors.
Call your child’s doctor. Many offices have special hours to only care for well and sick children or have virtual visits available. Your child’s doctor is your best resource and can let you know if your child should be tested. If your child is having trouble breathing or experiencing other troublesome symptoms, call 911.
Additional Questions
Talk to your doctor’s office about the safety measures they are taking and your situation. You should also talk to your doctor about any immunizations – such as the flu shot – and preventive care screenings that you may be due for and how to get them. Your doctor can help you decide the best options for your care.
Both Connecticut and Massachusetts currently require people to wear a mask or cloth face covering over their nose and mouth when out in public and unable to maintain a safe distance (at least six feet). There are some exceptions for age and health restrictions. But people who can wear a face covering should do so.
A face covering should fit snuggly on your face, be held by ties or ear loops, let you breathe comfortably, and be washable or disposable. A cloth face covering with multiple layers of fabric will help prevent an infected person without symptoms from spreading the disease. The cloth face coverings recommended are not surgical masks or N95 masks. Those are needed by health care workers and first responders.
After each use, carefully remove the mask and wash your hands. You can clean a cloth mask in your washing machine for the next time you need it. Visit the CDC webpage for some ideas on homemade masks. Remember to continue practicing social distancing and washing your hands often to prevent catching or spreading COVID-19.
The CDC recommends that wearing two masks may be more effective at protecting you from COVID-19. Wearing a surgical mask under a well-fitting cloth mask adds an extra layer of protection and makes sure that the masks are contoured to your face. Visit the CDC website for more information on mask wearing.
Whether you choose to wear one or two masks, remember to continue taking important precautions:
- Wash your hands often and disinfect frequently touched surfaces.
- Wear a mask over your nose and mouth when around others.
- Avoid crowds and stay at least six feet away from people outside of your household.
- Monitor your health for any COVID-19 symptoms.
- Stay home if you are sick.
- Get vaccinated when you are eligible.
Yes, you need to get a primary care provider’s (PCP’s) referral to visit certain specialists.
Note: this applies to members of group plans and individual plans, those purchased through Access Health CT and SOLO plans. Referrals are not required for members of Medicare Advantage Passage Plan 1 (HMO).
The annual flu vaccine does not protect against the coronavirus. We do encourage members to always get their annual flu vaccine because it is the single best thing you can do to protect yourself and your family from various strains of the flu.
It is best for you to check directly with the office of the doctor who is going to perform your surgery or procedure. The staff will also be able to tell you about any testing needed in advance and the safety procedures at the hospital or ambulatory surgery center.
Taking care of your mental health is an important part of living a healthy life. Visit our mental health page for resources, information on how to access your benefits, and tips on to support friends and family.
While we believe the information in this communication is accurate as of the date published, it is subject to correction or change during the rapidly evolving response to the COVID-19 outbreak.
Last update 08/13/2021
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