Who's eligible. The CDC recommends COVID-19 vaccines for everyone 6 months and older and boosters for everyone 5 years and older. The FDA has authorized, and the CDC has recommended, vaccines and booster shots from Pfizer-BioNTech, Moderna, and Johnson & Johnson Janssen for anyone ages 5 or older. Children ages 6 months and older get an age-appropriate dose of the Pfizer-BioNTech or Moderna 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.
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:
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.
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.
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
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.
Wear a mask. Public officials and health experts still recommend that people wear masks indoors in places where community COVID-19 levels are high. COVID-19 and its variants mainly spread from droplets released into the air when we cough, sneeze, or talk.
Increase space and distance. The closer you are to a greater number of people, the more likely you are to be exposed to the virus that causes COVID-19. There are a few steps you can take, in addition to checking local COVID-19 community levels, in order to help you avoid possible exposure to the virus. You may want to consider how well-ventilated an area will be, keep distance between yourself and others, or simply avoid crowded areas. Whenever possible, avoiding contact with people who have COVID-19, whether or not they feel sick, can reduce your risk of catching the virus from them.
Wash your hands regularly. Viruses can spread from touching recently contaminated surfaces and then touching your face. Washing your hands is one of the most important 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.
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.
