Care and Services Available for COVID-19 (Coronavirus)


COVID-19 vaccinations and boosters

Who's eligible. Everyone ages 5 and older is encouraged to receive a COVID-19 vaccine. The FDA has authorized, and the CDC has recommended, vaccines and booster shots from Pfizer-BioNTech, Moderna, and Johnson & Johnson Janssen for anyone ages 16 or older. Children ages 5 and older get an age-appropriate dose of the Pfizer-BioNTech COVID-19 vaccine.

Vaccine coverage. COVID-19 vaccines reduce the risk of severe disease, hospitalization, and death, and slow spread of the virus. Your Group Health Plan covers the cost of administering vaccines with no cost share (such as co-pays, deductibles, coinsurance) for members as per their ACA Preventive Care benefit.

Booster coverage. A COVID-19 booster shot is an additional dose of the vaccine that is given after the protection provided by the original shot(s) has begun to decrease over time. Your Group Health Plan covers the cost of administering booster shots.



Testing

COVID testing. Your plan covers the cost for medically appropriate diagnostic and antibody testing of COVID ordered by an authorized health care professional at no cost to the member. In addition, your plan covers up to eight over-the-counter (OTC), FDA-approved tests per calendar month as required by the Biden Administration².

If you have FutureScripts (OptumRx) coverage:

  • To pay $0: Visit any Walmart, Sam’s Club, Rite Aid, or Walgreens location, get your OTC COVID test kit off the shelf and check out at the pharmacy counter. Be sure to present your member ID card and ask to have the OTC test submitted to OptumRx.
  • Order online for $0: Log in at myibxtpabenefits.com. Select Pharmacy in the My Benefits box, then Pharmacy Mail Order/ Home Delivery, then Order Now. If you have not accessed the Pharmacy Mail Order/ Home Delivery function previously, you may be required to register your account. There is a minimum order amount required to get free shipping.
  • Get reimbursed if you pay out of pocket. If you purchased an OTC COVID test after January 15, 2022, you can submit for a reimbursement of up to $12 per test. Complete the OptumRx Over-the-Counter Test Reimbursement Form and include your receipts. You will need to submit a separate claim form for each family member.

If you have pharmacy coverage through another company, please contact the phone number on your prescription drug card for information on how OTC COVID test coverage applies.

Additional details can be found in these FAQs. These coverages are in accordance with federal mandates through the end of the public health emergency¹. This coverage does not include tests that are needed for return to work, a condition of employment, return to school, or travel.



Telemedicine

Visit a doctor from anywhere.¹ Telemedicine services for a COVID-19 related diagnosis from your primary care doctor are covered at no cost through the end of the public health emergency². Telemedicine services from your doctor for a non-COVID diagnosis are available — cost sharing applies based on your health plan.

MDLIVE. You can also schedule a telemedicine appointment with a doctor 24/7 with MDLIVE¹ at no cost, depending on your plan. MDLIVE doctors can assess your symptoms and help with next steps. Register or login at mdlive.com/ibxtpa.



Symptoms & care

Check your symptoms. If you think you’ve been exposed to COVID-19 and develop symptoms, call your doctor. Visit the Centers for Disease Control and Prevention (CDC) for more details on symptoms, including those for people who already received a COVID-19 vaccination.

Treatment. Your Group Health Plan may waive members cost share for in- network, acute in-patient treatment of COVID-19, otherwise cost sharing applies. Please review the terms of your health benefits plan for additional information



Your emotional health

Virtual visits for mental health.¹ If you have mental health benefits through your Group Health Plan, you can talk to an in-network mental health counselor online or on the phonet and standard cost sharing will apply. If the visit is to diagnose COVID-19, cost-sharing will be waived until the end of the public health emergency. Visit myibxtpabenefits.com to find a provider.



Staying healthy

Wear a mask. Public officials and health experts are urging us to wear masks indoors or in large crowds, regardless of vaccination status. COVID-19 and its variants spread from droplets released into the air when we cough, sneeze, or talk.

Practice social distancing. Limit close contact with anyone outside of your household. Even if you're wearing a mask, it is still recommended you stay at least six feet from others when in public, or at least two arms length apart.

Wash your hands regularly. Viruses also spread from touching recently contaminated surfaces and then touching your face. Washing your hands is one of the most importance defenses against the spread of COVID-19 and other illnesses. Keep hand sanitizer on you for when you don't have access to soap and water.







Need to find a doctor?

Login at myibxtpabenefits.com to find a doctor.

¹ The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that member cost-sharing (deductible, co-pays and coinsurance) is waived both in and out-of-network for the testing and diagnosis of COVID-19 through the public health emergency.

² The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that member cost sharing (deductible, co-pays and coinsurance) is waived both in and out-of-network for the testing and diagnosis of COVID-19 through the public health emergency. For High Deductible Health Plans, in-network cost sharing waivers detailed above will remain in effect through the public health emergency unless prohibited by law.