Important Updates Regarding Coronavirus COVID-19

Medicaid/CHP/HARP

Essential Plan

Marketplace

Medicare

Immunizations

Covered with no cost-sharing when provided by a participating provider.

Not covered out of network.

Covered with no cost-sharing when provided by a participating provider.

Not covered out of network.

Covered with no cost-sharing when provided by a participating provider.

Not covered out of network.

Covered with no cost-sharing when provided by a participating or a non-participating provider.

Prior Authorization not required.

In-Office Testing

Covered with no cost-sharing when provided by a participating provider.

Not covered out of network.

Covered with cost-sharing effective 10/1/24, when provided by a participating provider.

Not covered out of network.

Covered with cost-sharing when provided by a participating provider.

Not covered out of network.

Covered with cost-sharing when provided by a participating or a non-participating provider.

Prior Authorization not required.

Specimen collection and high throughput testing is not covered. For Medicaid enrollees, there is FFS reimbursement effective 5/12/23, for PCR, antigen, multiplex, and antibody tests For Marketplace enrollees, office visit cost-sharing has been reinstated. All other testing codes will be covered until 9/30/24 across all LOBs.

Over-the Counter Tests

Not covered.

Up to 8 OTC tests per month covered with cost-sharing.

Not covered.

Covered through Medicare FFS (fee for service).

COVID-19 Treatment

Covered with no cost-sharing when provided by a participating.

Out of network coverage requires prior authorization.

Covered with cost-sharing effective 10/1/24, when provided by a participating.

Not covered out of network, unless in an Emergency Department in a hospital setting.

Covered with cost-sharing when provided by a participating provider.

Not covered out of network.

Covered with cost-sharing when provided by a participating provider.

Out of network coverage dependent on plan.

Telemedicine

Telemedicine is covered with no cost-sharing when provided by a participating provider.

Not covered out of network.

Covered with cost-sharing effective 10/1/24, when provided by a participating provider.

Not covered out of network.

Telemedicine rendered via Fidelis Care’s Telemedicine Program is covered with no cost-sharing.   Telemedicine by other participating providers is covered with cost-sharing.

Not covered out of network.

Telemedicine* is covered with no cost-sharing when provided by a participating provider.

Not covered out of network.

* As of 5/12/2023, Medicare will no longer cover codes “99441” through “99443” for telemedicine.