Employer-based plan COVID-19 FAQs

Get answers to common questions about Employer-based plans and COVID-19. Find out about prevention, testing, treatment, vaccinations, coverage, and more.

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Testing

How is COVID-19 testing covered?
We’ll waive your copays, coinsurance and deductibles for medically necessary in-network COVID-19 diagnostic testing. This applies to testing that meets guidelines from Centers for Disease Control (CDC) and the Food and Drug Administration (FDA), and is ordered by an in-network medical professional. Testing isn’t covered as part of a return-to-work requirement, public surveillance program. or travel requirement.

These changes are retroactive to March 1, 2020, and will extend through January 31, 2022.

Is home testing for COVID-19 covered?
Home tests for COVID-19 that are FDA-approved, ordered by an in-network practitioner, and medically necessary are eligible for coverage. They’re not covered as part of a return-to-work requirement, public surveillance program, or travel requirement.

Is antibody testing for COVID-19 covered?
Yes. We’re covering the cost for FDA-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. An in-network provider must order the tests, and they must be medically needed. Coverage will include office visits and other charges related to the antibody test when performed at in-network locations. They’re not covered as part of a return-to-work requirement, public surveillance program, or travel requirement.

This new coverage will extend through January 31, 2022.

If I suspect I have COVID-19, how do I know if I’m eligible to get tested?
Call your primary care provider if you have a cough, fever, or shortness of breath to find out if you meet testing criteria.

If I suspect I have COVID-19, how do I find a clinic that can test me?
If your primary care provider recommends that you be tested, you may be sent directly to a testing center.

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Treatment

Is treatment for COVID-19 covered?
We’ll waive copays, coinsurance, 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 September 30, 2021.

If you’re enrolled through a self-funded employer-sponsored plan, please check with your employer, since coverage may be different. You can also call our Customer Service department at the number on the back of your Medica ID card for details.

Will prior authorization requirements for care requests be waived? 
Yes. Prior authorization isn’t required for admissions to long-term care facilities, acute inpatient rehabilitation, and skilled nursing and home health care facilities. This change is in effect through October 31, 2021.

Will early refills for prescriptions be authorized? 
Maybe. If you have prescription benefits with us, 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.

Can I get a 90-day supply of my prescription medication(s)?
Yes. Members can continue to request a 90-day supply of long-term medications used to treat chronic conditions. At this time, we won’t authorize requests to fill medications that aren’t eligible for 90-day refills. 
How can I get prescriptions without leaving home?
Your options include:

1. Home Delivery (mail order) Prescription Services*

Mail-order home delivery of your prescriptions is available with most of our plans. Some home delivery requests may require an in-person office visit and a new prescription from a prescriber. To learn more and request mail order delivery of your medications, sign in to your account.

2. Retail pharmacy home delivery

Many retail pharmacies will mail your prescription to your home, free of charge. Check with your pharmacy for details.

Are virtual care services available?
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 can’t be done via virtual care, if you’re experiencing symptoms, you can get help assessing risk and recommendations on next steps.

We expanded the availability of telehealth visits to include visits that:

  • Are from your home
  • Use technology such as FaceTime or Skype
  • Use 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. 
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Durable medical equipment

How are durable medical equipment (DME) repairs or replacements of managed during the pandemic? 

From now through January 31, 2022, for all fully and self-insured groups, repairing or replacing DME doesn’t require a new physician’s order, face-to-face visit, or medical necessity documentation. But these items are still needed for new DME requests. This change is consistent with the Centers for Medicare & Medicaid Services guidelines to help all patients get the care they need during the pandemic.

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Vaccination

What can you tell me about the vaccine for COVID-19?
Get answers to frequently asked questions about COVID-19 vaccine coverage and availability in this PDF.
Are the vaccines safe and effective?
Yes. The vaccines went through rigorous safety and clinical trials. The FDA and the CDC have reviewed them, and there have been many vaccine trials around the world. Those trials included voluntary participants from a variety of races, ages, and ethnicities. The vaccines are safe and effective, with up to a 95 percent protection rate from COVID-19.

I’m healthy and at low-risk for COVID-19. Do I need the vaccine? 
Yes. COVID-19 doesn’t discriminate. Even young, healthy people can catch the virus and struggle with severe complications. Getting more people vaccinated will offer the greatest protection for all of us.

How will the cost of the vaccines be covered? 
The government is supplying the vaccine. The vaccine is covered at no out-of-pocket cost to members. 

Will Americans be required to get a COVID-19 vaccine?
While vaccines aren’t mandatory, people over age 16 are strongly encouraged to get vaccinated. Vaccines are the best way to protect yourself and all those you come in contact with.

What can I do to reduce my risk for COVID-19?
Until you have received a COVID-19 vaccine, continue to wear a mask, wash your hands, and adhere to the social distancing guidelines. 

How long does immunity last if you recover from COVID-19?
 
Scientists don’t know how long immunity will last after someone recovers from COVID-19. The research on that is still evolving. Here are some helpful resources that offer up-to-date COVID-19 information.
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Continuing coverage

What options do I have if I lose my group plan coverage?
They  include:

  • Continue on employer’s plan through Continuation/COBRA
  • Enroll in an individual plan through an insurance carrier like Medica
  • Enroll in a Medicare plan through an insurance carrier like Medica (if you’re eligible for Medicare)

Learn more about Continuing Your Health Insurance options 

For Medica Individual and Family coverage options, call 800-670-5935.

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Fit Choices by Medica

Will Fit Choices by Medica reimburse me for online or at-home workouts?
 
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 start and end of each class and monitor participation. Members will be required to have their camera on throughout the entire class. Contact your club to learn if they offer live online workout options.
 
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