What you need to know about COVID-19

There is now a vaccination available that will give you the best chance of protecting yourself and your loved ones from getting COVID-19 in the future. Some COVID-19 vaccines will have two doses a few weeks in between each shot. 

You will get a COVID-19 Vaccination Reminder Card that will help you keep track of which vaccine you receive and when to get a second dose, if needed. If you receive a vaccine that requires two doses, it is important to get both doses.

The vaccine is being administered to different populations in a tiered approach.  When you are able to get the vaccine, call your doctor with any questions and ask when you can make an appointment with them or at your local pharmacy.  Or, find out where to get your vaccine at cdc.gov/coronavirus/2019-ncov/vaccines or vaccinefinder.org.

Currently, the Pfizer-BioNTech vaccine is recommended for people ages 5 and older. The Moderna and Johnson & Johnson vaccines are recommended for those ages 18 and older.

The CDC announced on March 8 that fully vaccinated Americans can discontinue masking and social distancing with other fully vaccinated people indoors in small groups. Or, visiting with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors.

Fully vaccinated is considered two weeks past final dose, meaning the second dose of the Moderna or Pfizer mRNA vaccine, or, two weeks past the single dose Johnson & Johnson vaccine.

Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.

If you are fully vaccinated and have a known exposure to someone with COVID-19, the CDC says that you may refrain from quarantine and testing if you are asymptomatic. It is recommended to continue to monitor for symptoms for 14 days.

• Fever
• Headaches
• Body aches

This is your body reacting to the vaccine. It is a normal response. It is important to know that it is impossible to get COVID-19 from the vaccine. The vaccines currently in use and others being developed do not contain a live virus. 

No. The COVID-19 vaccine will be at no cost to you. You do not need to get a prior authorization for your vaccine.

According to the CDC, people who are pregnant and part of a group to receive the COVID-19 vaccine may choose to be vaccinated. If you have questions about getting the vaccine, it is recommended to discuss with your doctor to make an informed decision.

The CDC recommends a booster shot of COVID-19 vaccines in the following populations:

For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine:

• You should get a booster if you are:
  • Ages 50 years and older
  • Ages 18 years and older and live in a long-term care setting
• You may get a booster if you are:
  • Ages 18 years and older
• When to get a booster:
  • At least 6 months after completing your primary COVID-19 vaccination series

For individuals who received Johnson & Johnson’s Janssen COVID-19 vaccine:

Fully vaccinated is considered two weeks past final dose, meaning the second dose of the Moderna or Pfizer mRNA vaccine, or, two weeks past the single dose Johnson & Johnson vaccine.

To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial of high transmission.

Wearing a mask is most important if you have a weakened immune system or if, because of your age or an underlying medical condition, you are at increased risk for severe disease, or if someone in your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated. If this applies to you or your household, you might choose to wear a mask regardless of the level of transmission in your area.

Fully vaccinated people who have come into close contact with someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.

A small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it. These are called “vaccine breakthrough cases.” This means that while people who have been vaccinated are much less likely to get sick, it will still happen in some cases. It’s also possible that some fully vaccinated people might have infections, but not have symptoms (asymptomatic infections). Experts continue to study how common these cases are.

If you get COVID-19 after vaccination, your symptoms might be less severe

Fully vaccinated people are much less likely to be hospitalized or die than people with similar risk factors who are not vaccinated.

COVID-19 is a respiratory disease and a type of virus called a coronavirus. It has become a public health emergency. 

• Mild to severe respiratory symptoms
• Fever
• Cough
• Shortness of breath
• Lower respiratory illness

COVID-19 can be contagious before a person begins showing symptoms.

Contact your provider if you develop a fever, have a cough, or have difficulty breathing. Let your provider know if you’ve been in close contact with a person known to have Coronavirus.

For additional information, you can also contact The New York State Department of Health toll-free Novel Coronavirus Hotline at 1-888-364-3065.

• If you think you have COVID-19 or have been exposed to someone who has been diagnosed with COVID-19, call your provider’s office or contact Teladoc for guidance on next steps.

• Call ahead before going in person to any doctor’s office.

• Don’t go to your local emergency room for COVID-19 testing. The ER is only for those who need the most critical care.

Members who have questions about their telehealth benefit should call Member Services at 1-888-FIDELIS (1-888-343-3547); TTY: 711.

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:

• Stay home when you are sick.
• Avoid close contact with people who are sick.
• If you are sick, you should wear a facemask when around other people.
• 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.
• Wear a face covering/mask when in public and/or around others who do not live in your home if you are not fully vaccinated
• Clean public surfaces thoroughly.
• Avoid shaking hands.
• Avoid touching your eyes, nose, and mouth with unwashed hands.

Worry and anxiety can rise about the spread of COVID-19. Concern for friends and family who live in places where the spread of COVID-19 is progressing is natural. Some recommendations to help manage your feelings include the following:

• 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, a sense of hope and positive thinking and use technology to stay connected.
• 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.

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 ordered and/or referred by a licensed health care provider.

Medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment 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.  

We will cover medically necessary COVID-19 diagnostic testing and medical screening services, when such services are ordered and/or referred by a licensed health care provider. Depending on your plan, your copayment, coinsurance and/or deductible cost-sharing may be waived for medically necessary COVID-19 diagnostic testing and medical screening services.

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.

Yes. When medically necessary diagnostic testing, medical screening services and/or treatment is ordered and/or referred by a licensed health care provider, we will cover the cost of medically necessary COVID-19 tests, screenings, associated physician’s visit(s) and/or treatment. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing and medical screening services. 

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.

You may be able to receive transportation by contacting United Way-211 to access local community resources for transportation, which may include the Lyft Vaccine Alliance Program.

In addition, Lyft and Uber offer free rides to anyone going to a vaccination site to get vaccinated. Using the Lyft or Uber app, you can select a vaccination site near you and follow simple directions to redeem your ride. The ride will take you to and from a nearby vaccination site free of charge. The feature will run until July 

The Delta variant is highly contagious, nearly twice as contagious as previous variants.

• Some data suggest the Delta variant might cause more severe illness than previous strains in unvaccinated persons
• Unvaccinated people remain at the greatest risk for severe illness, hospitalization, and death
• Fully vaccinated people with Delta variant breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period of time
• Vaccines are highly effective, including against the Delta variant.

Yes. COVID-19 tests are available at no cost to Fidelis Care Medicaid Managed Care, Child Health Plus (CHP), HealthierLife – Health and Recovery Plan (HARP), Qualified Health Plan and Essential Plan members if you go to an in-network pharmacy. You do not need a prescription from your doctor. Test Kits eligible for coverage can be found by clicking here.

Fidelis Care is currently working with our pharmacy partners to ensure COVID-19 tests are available at no cost if you go to an in-network pharmacy. If you purchased an at-home COVID-19 test at the pharmacy, we will reimburse you for the cost of the test after you complete the member reimbursement process. The reimbursement will be limited up to the amount set by New York Medicaid or federal guidance (up to $24, per test Kit, per covered individual).  At-Home COVID-19 tests are packaged in sets of two tests in a single box. The single box is also referred to as a “Kit.”

Yes, if you purchased an at-home COVID-19 test at a pharmacy, we will reimburse you for the cost of the test after you complete the member reimbursement process. Reimbursement will require proof of purchase and is subject to the benefit’s four test Kits per month coverage limit. The reimbursement will be limited up to the amount set in New York Medicaid or federal guidance (up to $24, per test Kit, per covered individual).  At-Home COVID-19 tests are packaged in sets of two tests in a single box. The single box is also referred to as a “Kit.”

Yes, we will cover four (4) At-Home COVID-19 test Kits (8 tests), obtained over-the-counter, per covered individual in a 30-day period, consistent with New York Medicaid or federal guidance.

Yes. COVID-19 tests are available at no cost to Fidelis Care Medicaid Managed Care, Child Health Plus (CHP), HealthierLife – Health and Recovery Plan (HARP), Qualified Health Plan and Essential Plan members if you go to an in-network pharmacy. You do not need a prescription from your doctor. Test Kits eligible for coverage can be found by clicking here.

Fidelis Care is currently working with our pharmacy partners to ensure COVID-19 tests are available at no cost if you go to an in-network pharmacy. If you purchased an at-home COVID-19 test at the pharmacy, we will reimburse you for the cost of the test after you complete the member reimbursement process. The reimbursement will be limited up to the amount set by New York Medicaid or federal guidance (up to $24, per test Kit, per covered individual).  At-Home COVID-19 tests are packaged in sets of two tests in a single box. The single box is also referred to as a “Kit.”

Yes, if you purchased an at-home COVID-19 test at a pharmacy, we will reimburse you for the cost of the test after you complete the member reimbursement process. Reimbursement will require proof of purchase and is subject to the benefit’s four test Kits per month coverage limit. The reimbursement will be limited up to the amount set in New York Medicaid or federal guidance (up to $24, per test Kit, per covered individual).  At-Home COVID-19 tests are packaged in sets of two tests in a single box. The single box is also referred to as a “Kit.”

Yes, we will cover four (4) At-Home COVID-19 test Kits (8 tests), obtained over-the-counter, per covered individual in a 30-day period, consistent with New York Medicaid or federal guidance.

YES, Wellcare will cover COVID-19 testing when performed in an official testing location, and/or when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional.

NO, Members will not have any liability for these official tests.

• We continue to carefully monitor the pandemic and evaluate how best to serve our members during these unprecedented times. At this time Wellcare By Fidelis Care is not reimbursing members for COVID-19 at-home testing kits purchased independently online, or from a retailer.
• CMS is launching an initiative in early spring 2022 that provides payment directly to eligible pharmacies and other entities that are participating in this initiative to enable people with Medicare to get up to eight free over-the-counter COVID-19 tests a month. All Medicare beneficiaries with Part B will be eligible to get eight free over-the-counter COVID-19 tests per month through this initiative, whether enrolled in a Medicare Advantage plan or not.
• In the meantime, we encourage our members to receive COVID-19 tests at official testing sites by health care professionals at no cost.

• Every home in the US is eligible to order 4 free at-home COVID-19 tests. The tests are completely free. Orders will usually ship in 7-12 days.
  • You can order your tests now at https://www.covidtests.gov/
• Access COVID-19 tests through healthcare providers at over 20,000 free testing sites nationwide. A list of community-based testing sites can be found at https://www.hhs.gov/coronavirus/community-based-testing-sites