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.