Frequently Asked Questions about COVID-19

We will waive your copays, co-insurance and deductibles for medically necessary in-network COVID-19 diagnostic testing. Medica covers rapid diagnostic tests and standard nasal and saliva diagnostic tests. This applies to testing that meets guidelines from Centers for Disease Control and the Food and Drug Administration (FDA), and is ordered by an appropriate medical professional. These changes are retroactive to March 1, 2020, and will extend through April 30, 2021.

Home tests for COVID-19 that are FDA-approved, ordered by a practitioner and medically necessary are eligible for coverage, except when done for a return to work or public surveillance.

Yes. Medica will waive your copays, co-insurance and deductibles for Food and Drug Administration (FDA)-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. Tests must be ordered by a medical professional and considered medically necessary.* Coverage for the antibody test applies both in-network and out-of-network, and will extend to office visits and other charges related to the antibody test when performed at in-network locations. This new coverage will extend through April 30, 2021.

*Not covered as part of a return to work request.

Get answers to your COVID-19 vaccine coverage and availability FAQs (PDF)

We will waive your copays, co-insurance and deductibles for in-network COVID-19 inpatient hospital care for fully insured group members. These changes are retroactive to March 1, 2020, and will extend through June 30, 2021.

NOTE: If you are enrolled through a self-funded employer-sponsored plan, please check with your employer or call Medica Customer service at the number on the back of your Medica ID card for coverage details as coverage may be different.

Yes. Prior authorization requirements will not be required for admissions to long-term care facilities, acute in-patient rehabilitation and skilled nursing and home health care facilities. This change will extend through April 30, 2021.

Maybe. If you have prescription benefits with Medica, and your medication needs to be filled early, submit your refill request to your pharmacy. They will determine if your prescription can be filled early.

Yes, members can request a 90-day supply of some long-term medications used to treat chronic conditions. Medica, at this time, will not authorize requests to fill medications that are not eligible for 90-day refills.

Your options include:

1. Home Delivery (mail order) Prescription Services*
   
   Mail order home delivery of your prescriptions is available with most Medica plans. To learn more and request mail order delivery of your medications, visit mymedica.com and select Pharmacies and Prescriptions.
   
   
2. Retail pharmacy home delivery 
   
   Many retail pharmacies will mail your prescription to your home, free of charge. Check with your pharmacy for details.

*Some home delivery requests may require an in-person office visit and a new prescription from a prescriber.

Yes. Virtual care, or telehealth, is a convenient way to get care for many common medical conditions by connecting with a provider from your computer or mobile device from home, work or wherever you are. Although confirmation and testing of COVID-19 cannot be done via virtual care, if you’re experiencing symptoms, you can get help assessing risk and receive recommendations on next steps.

We expanded the availability of telehealth visits to include:

• Visits from your home
• Visits using additional technologies such as FaceTime or Skype
• Visits using audio only when video is not available

To access virtual care:

• Check with your clinic to see if virtual care is available and learn how to connect with your provider online.
• Check other virtual care options that may be available in your plan’s network at medica.com/FindADoctor. Click on Member through Employer, select their plan and click on Virtual Care Providers.

Call your primary care provider if you have a cough, fever or shortness of breath to find out if you are eligible for testing.

If your primary care provider recommends that you be tested, they will send you directly to a testing center.

My club is closed or I can’t meet the visit requirements.

If your club is closed, you will need to work with your health club. Most fitness centers in the Fit Choices by Medica^SM network have closed and some are suspending memberships in the wake of COVID-19. Health club policies vary, so check with them directly for more information.

If your club is open, you must meet the visit requirement to receive your monthly reimbursement. We are not reimbursing members who do not meet the visit requirement. You may see relief from your health club monthly charges due to closings. Contact your health club for more information.

Are online or at-home workout options eligible for reimbursement?

Some facilities may offer their members online or at-home workout options. Beginning Dec. 1, 2020 through the end of 2021, live online workouts completed through a participating gym or health club will count toward the monthly visit requirement and reimbursement. Only live instructor-led and Zoom classes are eligible. The instructor will take attendance at the beginning and end of class and monitor participation. Members will be required to have their camera on throughout the entire class. Contact your club to learn if they are offering live online workout options.