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CONSUMER ALERT: COVID-19 and Your Health Insurance

COVID-19 Vaccine

As you know, we are experiencing a crisis due to the COVID-19 pandemic. Many of us have been doing our part to stay home and keep our distance from family and friends to try to help save lives and avoid the spread of this terrible disease. The development of a vaccine is an important strategy in reducing COVID-19 related illness and will help to stabilize the global economy. On a federal level, Operation Warp Speed was created in an effort to accelerate development of therapies and enable faster approval and production of safe and effective vaccines in the treatment of COVID-19.

Operation Warp Speed is a partnership between the public and the private sector to accelerate the testing, supply and distribution of safe and effective vaccines and therapeutics. The typical process of vaccine development takes years from the initial stage of research and development to clinical trials to manufacturing and distribution. With Operation Warp Speed, the United States Government is funding large scale manufacturing of the most promising candidates concurrently during the phase III clinical trial – before vaccines are authorized or approved. Vaccines are being produced during the clinical trial period with the intention of throwing them away if they are deemed to be unsafe or ineffective.

Is there a vaccine available for COVID-19?

The Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine for use in persons 16 years of age or older. The COVID-19 vaccines have been rigorously tested for safety before being authorized for use in the United States.

Will I be able to get a vaccine for COVID-19?

Availability of the COVID-19 vaccine will be limited at first. The Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC) are currently developing guidelines and policies regarding distribution. Each state will develop their own tiered priority decision support tool.

With the anticipated limited vaccine supply, priority will be given to those who are at increased risk of exposure to COVID-19. The idea behind the tiered distribution is an anticipated limited vaccine allocation initially. With this is mind, there is consideration for many variables including the level and length of exposure in populations such as essential workers, the likelihood of mitigating community spread, mortality and morbidity and expected immunologic response to the vaccine.

The first tier priority group includes the highest risk population such as healthcare personnel, hospitals, long-term care facilities, outpatient, home health, pharmacies, emergency medical services, law enforcement and public health workers. The second tier includes non-healthcare personnel such as food processors, water and agriculture, transportation, education, and essential workers.

Will there be any out-of-pocket costs associated with receiving the vaccine?

No, there will be no out-of-pocket cost for the vaccine. The COVID-19 vaccine is funded by the federal government and will be available at no cost to Americans. This applies to any vaccine that receives either approval or emergency use authorization.

Will I feel sick after receiving the COVID-19 vaccine?

Clinical trial data indicates that local reactions such as pain, redness and swelling at the injection site are common side effects. Some people may also experience low-grade fever, chills, muscle aches, fatigue and/or headache which are self-limiting or temporary.

Will I have to continue to wear a mask and social distance and follow lockdown restrictions once I have been given the COVID-19 vaccine?

Yes, even if you are immunized against COVID-19 it will still be important to maintain vigilance when it comes to wearing a mask and social distancing. It is important to remember that many people will have to become immune before it is possible to control the spread of this disease. Keep in mind that it takes a few weeks to build up an immunity to COVID-19 after vaccination. This means it is possible to be infected with the SARS-CoV-2 virus either prior to or after receiving the vaccine.

COVID-19 and Your Health Insurance

The name of the disease is COVID-19. We now know the virus causing COVID-19 is SARS-CoV-2. This virus has the potential to cause severe illness and pneumonia.

If you have been exposed to, or are experiencing symptoms of the virus, it is essential to know as soon as possible whether you have the virus to limit exposure to others and to obtain any needed medical attention or treatment. This alert addresses the following three issues:

NO COST FOR MEDICAL SERVICES RELATED TO TESTING FOR COVID-19

If you think you may have COVID-19, your health insurance must pay for the cost of visiting your doctor and the test as a preventive measure. Generally, you must pay a portion of the cost to visit your medical provider; however, the cost of your provider visit and testing related to COVID-19 is covered by Prominence Health Plan.

FOR PROVIDERS OF HEALTHCARE

Healthcare providers, including but not limited to, primary care providers (PCPs), specialists, urgent care centers, and emergency departments should not collect out-of-pocket costs when the purpose of the visit is to be tested for COVID-19. Providers should also not impose out-of-pocket costs for COVID-19 testing and for administration of a COVID-19 immunization as one becomes available.

COVERAGE FOR OFF-FORMULARY PRESCRIPTIONS IF PHARMACY SUPPLIES ARE DISRUPTED

You should be able to get a replacement prescription if your usual prescription is not available due to shortage of supply. If a prescription supply is disrupted due to supply chain issues, Prominence Health Plan must allow a member to obtain an alternate prescription that is generally not covered by the policy of health insurance to ensure that the member does not miss out on prescribed medications. The cost to the member must be the same as the cost for the member’s usual medication.

Dr. Traci Biondi, Interim Chief Medical Officer of Prominence Health Plan, with a message of reassurance for our members:

How does COVID-19 spread?
  • Between people who are in close contact (approximately six feet) with someone who is ill.
  • Respiratory droplets produced when an infected person coughs or sneezes.
  • Possible transmission occurs when a person touches a surface that has the virus on it and then touches their mouth, nose or eyes.
What are the symptoms of COVID-19?

People who have been diagnosed with COVID-19 have reported symptoms that may appear in as few as two days or as long as 14 days after exposure. The most common symptoms are muscle aches/pains, cough and low grade fever, which sometimes leads to more severe trouble breathing.

How can I protect myself from getting COVID-19?

If you are traveling overseas, follow the CDC’s guidance.

Steps you can take to prevent the spread of flu and the common cold will also help prevent COVID-19.

  • Wash your hands often with soap and water. If not available, use hand sanitizer.
  • Cover your mouth and nose with a tissue when coughing or sneezing.
  • Avoid touching your eyes, nose or mouth.
  • Avoid contact with sick people.
  • Stay home if you are sick, and contact your healthcare provider.

In an effort to prevent the spread of this disease, the CDC and the Nevada State Medical Association recommend the use of telemedicine to avoid physical contact and reduce face-to-face care for respiratory illness.

If you are experiencing symptoms of COVID-19 or you feel you may need to be tested for COVID-19 due to your travel/contact history, please call the numbers below prior to visiting a medical facility:

  • Teladoc: 1-800-TELADOC (835-2362) available 24/7/365 to all Prominence Health Plan members.
  • Nevada Statewide Hotline: 1-800-860-0620 available Monday – Friday.
  • Washoe County: Please call the Washoe County Health District hotline at 775-328-2427, open 7 days a week from 8 a.m. – 5 p.m.
  • Southern Nevada: Please call (702) 759-INFO (4636) for more information. Currently, the Information Line is available Monday – Friday, 9 a.m. – 5 p.m.
  • Carson/Douglas: Please call the Nurse Hotline at 775-445-8100.
  • General information about COVID-19 in Nevada
  • For more information in Texas
2020-12-18T14:20:44-05:00