Frequently asked questions about the coronavirus (COVID-19)

There are many questions about members seeking care for coronavirus (COVID-19). Find answers for your employees here.

Vaccine

The Food and Drug Administration (FDA) has approved two vaccines for COVID-19, and more may be approved in the coming months. State governments are creating distribution plans based on CDC advice. You can check the following websites to see if you are in a category of people who are eligible to receive a vaccine:  Connecticut, Massachusetts, New York City, and New York state.

Members can see if they are in a category of people eligible to receive a vaccine by visiting the website for their state or city: Connecticut, Massachusetts, New York City, and New York state.

We will continue to inform and guide our members when it comes to COVID-19 prevention and care, including when appointments can be made at vaccination sites.

Members are encouraged to review their contact information using the secure member site on connecticare.com. If their doctor has a patient portal, they will want to register so they can be notified when vaccines become available.

FDA-approved COVID-19 vaccines will be covered under member plans. Members will pay $0 out-of-pocket for both doses of the vaccine they receive. This applies whether they visit health care providers in or out of our network.

No. Members will pay $0 out-of-pocket for both doses of the vaccine. This applies for vaccination visits to health care providers in or out of our network.

The two current FDA-approved vaccines are similar in effectiveness. Both vaccines will be covered by ConnectiCare plans. Members can find trusted information on the COVID-19 vaccine, including safety, doses, and more, on the CDC’s website. They can also stay up to date by visiting the website for their state or city: ConnecticutMassachusettsNew York City, and New York state.

Both current FDA-approved vaccines require two doses. It’s important for members to get both doses of the vaccine at the right time based on CDC guidance

No. Members will pay $0 out-of-pocket for both doses of the vaccine. This applies whether they visit health care providers in or out of our network.

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Coronavirus (COVID-19) testing

Members should speak to their doctor before being tested for COVID-19. Only diagnostic testing, if a doctor, pharmacist, or other licensed clinical health care professional orders the test after a clinical review, is covered. There are no limits on the number of diagnostic, medically necessary tests a member can receive. 

Diagnostic testing is covered for all members, with no cost-sharing (no copay, deductible, or coinsurance). More information on testing can be found here, member COVID-19 FAQ.

Members can visit their doctor or use the “Find a Doc” tool on connecticare.com to find a designated facility for testing. In some states, members may also be able to be tested at a local pharmacy. Diagnostic testing is covered for all members, with no cost-sharing.  

Members can find more information about the different kinds of tests on the FDA’s website

Rapid and PCR COVID-19 tests with an order from a doctor, pharmacist, or other licensed health care professional after a clinical review, also known as diagnostic testing, are covered with no cost-sharing. Testing for return to work or school is not covered. 

Antibody tests should be requested in consultation with a health care professional. 

According to the CDC, antibody test results should not be used to diagnose someone with an active COVID-19 infection. If a member’s doctor or licensed health care professional orders a COVID-19 antibody test because it is clinically indicated, the visit and FDA-authorized test will be covered. There will be no cost-sharing, including copays, coinsurance, or deductibles. 

Members should speak to their doctor before being tested for COVID-19. Only diagnostic testing, if a doctor, pharmacist, or licensed health care professional orders the test after a clinical review, is covered. Testing is only covered when medically necessary. 

FDA-approved COVID-19 home tests that are sold at a pharmacy or store without a prescription or order from a licensed health care professional are not covered. 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. 

There are no limits on the number of diagnostic, medically necessary tests a member can receive. 

Yes, licensed pharmacists may, temporarily, order and administer FDA-authorized diagnostic COVID-19 tests.

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Telemedicine and Telehealth

Members may have telehealth visits with in-network doctors and mental health clinicians for covered services. Their plan’s cost shares for office visits apply to virtual visits. They may also to use their plan’s telemedicine provider – Teladoc. Their plans’ cost shares for telemedicine services apply.

Telehealth is subject to certain conditions and may not be clinically appropriate for all covered services or offered by all health care providers. Self-funded plans may have different telehealth benefits.

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Fixed Funding Solutions and self-funded plans 

Under a federal law passed by Congress, Fixed Funded Solutions plans must cover the medically-appropriate diagnostic lab test and related visit – doctor (including telehealth visit), urgent care, or emergency room – at no member cost share (no copayment, coinsurance or deductible) when ordered by a doctor or licensed health care provider. The test must be for the purpose of diagnosis or treatment, and the test sample must be sent to an approved lab. These expenses will be considered claim costs under the plans.

Members of Fixed Funding Solutions plans can have telehealth visits with in-network providers for covered services. Their plans’ office visit cost shares also apply to telehealth visits. Plan members who use Teladoc for telemedicine services are responsible for their share of the costs of the visits, as outlined in their benefit summaries. Telemedicine and telehealth visits do not have to be related to COVID-19. Teladoc also does not order lab tests for COVID-19 but will refer members back to their own doctors.

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Prescriptions

ConnectiCare is encouraging members to take advantage of 90-day supplies and home delivery of maintenance medicines that are covered by their plans. Express Scripts also gives members access to pharmacists 24 hours a day, seven days a week, in case they have questions about their medications.

Here are ways members can sign up for 90-day refills:

  • Online – Members can visit express-scripts.com and sign in. If they don’t have an account, they can create one in just a few minutes. They’ll need their ConnectiCare member identification (ID) cards handy. After signing in, members can click “Home” in the Express Scripts window and will see a list of available prescription refills. They can select the items they want to order and follow the instructions to complete their request.
  • By phone - To start using Express Scripts by phone, members should have their prescription number(s) ready and call: Medicare - 1-877-866-5828 | All other plans - 1-877-866-5798.
  • Mobile app - Members can download the Express Scripts mobile app from the App Store, Google Play, or Amazon apps.
  • By fax or e-prescribe (doctors’ offices only) - Members can ask their doctors to e-prescribe or contact Express Scripts at 1-888-327-9791 for faxing instructions.

Members may contact their pharmacies to ask about home delivery services, but they will be responsible for any delivery charges a pharmacy chooses to impose.

Note: members do have the option for home delivery of many maintenance medicines through Express Scripts. 

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 Employer furloughs, lay-offs, reduction in work hours 

Generally, employers determine who is eligible for benefits under their health plans and are responsible for COBRA. In administering plans, ConnectiCare often relies on employers’ eligibility determinations as to who is an employee with benefits.

For fully-insured plans, the requirement that employees work full time (or part time if allowed by their employer) will be relaxed during the public emergency. In addition, during this time period, rules will also be relaxed if there is a provision in the employer’s policy about a reduction in or elimination of work hours affecting eligibility as long as employment has not been terminated. This relaxation applies to enrollees who, immediately before the date they were furloughed or had a reduction of hours, were working at the employer’s premises and can no longer work due to the COVID-19 pandemic.

In all cases, employers must continue to send premium payments to ConnectiCare for all covered persons for ConnectiCare to continue coverage. Coverage must be offered on a uniform, non-discriminatory basis to all employees, and employee premium contributions must be the same or less prior to the furlough.

For self-funded plans administered by ConnectiCare, payment of administrative fees, claims costs and stop-loss premium is required to continue our administration of benefits for employees who have been furloughed or subject to reduction in or elimination of hours but not terminated.

As of May 4, 2020, the COBRA election period was extended to 60 days from the end of the outbreak period (see more on the “outbreak period” below) instead of post 60 days from receiving a COBRA notice. See more information in the ”COBRA extension” section below.

In administering the employer’s plan, ConnectiCare will generally rely on the employer’s decisions about employee benefit eligibility. As noted elsewhere, for fully-insured plans, the requirement that employees work full time (or part time if allowed by their employer) have been relaxed during the public emergency. In addition, during this time, rules have also been relaxed if there is a provision in the employer’s policy about a reduction in or elimination of work hours affecting eligibility, as long as employment has not been terminated. In all cases, employers must continue to send premium payments to ConnectiCare for all covered persons for ConnectiCare to continue coverage. Coverage must be offered on a uniform, non-discriminatory basis to all employees, and employee premium contributions must be the same or less prior to a furlough or reduction in hours. If employers have questions about COBRA, or other lines of insurance, they should contact their benefits advisors.

That decision is up to the employer. The law permits employers to select between 0-90 days for rehire waiting periods for benefit eligibility. Employers should consult their brokers, consultants and/or legal counsel on the risks of waiving waiting periods mid-year. Self-insured employers should also consult their stop-loss carriers to ensure that such a waiver is permitted.

In administering an employer’s plan, ConnectiCare will generally rely on the employer’s decisions about employee benefit eligibility. See answers to other questions for more detail.

Note, an employer may elect to continue coverage under COBRA so long as one person remains actively employed. The employer must follow the normal notice and election procedures. If there are no active employees, a plan is terminated, and COBRA is not an option.

Individuals who don’t have options through their employers may be able to apply for coverage through the state exchange during a special enrollment period (SEP). Note that there are time limits for applying for coverage based on the specific SEP (e.g., loss of employment-based) coverage. Individuals should consult with a licensed broker or agent for assistance.

If employers have questions about COBRA, or other lines of insurance, they should contact their benefits advisors.

Coverage end dates in cases of employee termination are outlined in a group’s agreement with ConnectiCare. For information on a specific group, please contact your account manager or account executive. As long as a plan remains active, employees would be eligible for COBRA, if applicable, or state continuation of coverage if they are terminated, or they can seek coverage through the exchange. Depending upon their financial situations, terminated employees may be eligible for subsidized coverage through the exchange or Medicaid. Employees of employers that close permanently are not eligible for COBRA. Depending on the state where coverage was written, terminated employees may be eligible for individual coverage on state exchanges or other individual coverage. Depending upon their financial situations, terminated employees may be eligible for subsidized coverage through the exchange or Medicaid.

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COBRA Extension 

On May 4, 2020, the U.S. Department of the Treasury and the Department of Labor (DOL) published a rule extending certain COBRA timeframes due to the COVID-19 outbreak. The rule extended the COBRA election period to 60 days from the end of the outbreak period (yet to be determined) instead of 60 days from receiving a COBRA notice. This ruling applies to employers with 20 or more employees who are subject to COBRA.

The qualified beneficiary who elects COBRA within the extended time period will be enrolled retroactively and required to pay multiple months of COBRA coverage in order to be enrolled. The individual would owe premium for COBRA coverage for the entire period beginning with the date they lost job-based coverage.

If employers have additional questions about COBRA, or other lines of insurance, they should contact legal counsel or their benefits consultants. For employers with fewer than 20 employees (for fully-insured and Fixed Funding Solutions plans): terminated employees may qualify for other continuation coverage. Please consult the plan documents for more information.

The outbreak period is the period from March 1, 2020, until 60 days after the announced end of the national emergency, which has been extended to April 21, 2021, or such other date announced by the U.S. Internal Revenue Service (IRS) and DOL in the future.

There is no change to the documentation needed. For example, a COBRA election notice or termination of employment letter from an employer on employer letterhead.

For ConnectiCare large groups: ConnectiCare handles COBRA in one of two ways:

  • In some cases, ConnectiCare bills COBRA-covered individual(s) directly and will terminate their coverage if they fail to meet deadlines for premium payment. ConnectiCare will reinstate retroactively coverage of individuals who pay premium within the extended deadline.
  • In other cases, an employer pays ConnectiCare premiums on behalf of COBRA-covered individual(s). If premium payment is not made on behalf of COBRA-covered individual(s), ConnectiCare terminates COBRA coverage for the affected individual(s). ConnectiCare will reinstate COBRA coverage retroactively if premium payment is received within the extended deadline.

For ConnectiCare small groups that are subject to COBRA: If premium payment is not made by an employer on behalf of COBRA-covered individual(s), COBRA coverage is terminated for the affected individual(s).

The COBRA coverage can be retroactively reinstated if ConnectiCare receives premium payment within the extended deadline. For small groups that have fewer than 20 employees, ConnectiCare will provide benefits in accordance with applicable “mini COBRA” under state continuation. For Fixed Funding groups, it will be at the employer’s discretion whether to provide “mini cobra” to former employees.

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Appeals of adverse coverage decisions

In 2020, a federal regulation for group health plans governed by ERISA (the Employee Retirement Income Security Act) paused time limits for participants to file appeals of decisions not to cover medical services or treatment. The time limits are normally 180 days for an internal (to the health plan) appeal and 120 days for an external review of a medical necessity appeal decision. The regulation applies for the duration of the national emergency period that began March 1, 2020, in response to the COVID-19 outbreak.

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Health savings, flexible spending and dependent care accounts 

Yes, the CARES Act passed by Congress repealed the prohibition on account owners paying or reimbursing themselves for OTC medicines, such as pain relievers, cold and flu medicines, and more. The act also added menstrual supplies to the list of items that can be reimbursed from a tax-qualified health account. These changes were effective Jan. 1, 2020.

On May 19, 2020 the IRS announced account holders will be able to make mid-year changes on their contribution amounts — either increasing or decreasing the amount — and they’ll also be able to carry over slightly more money into next year. These changes are at the employer’s discretion. We encourage employers and employees to consult their legal or benefits advisors with questions.

  • Employees can now roll over $550 into the next plan year on their healthcare FSA.
  • They can enroll in an FSA, increase contributions, decrease contributions or stop paying into the account all together.
  • These changes apply only for the 2020 calendar year.

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Resources for tax and legal questions

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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.

Our Call Center is currently experiencing extremely high volume and longer wait times. For questions related to COVID-19, visit our COVID-19 FAQs