Information on COVID-19 for Employers and Brokers
MVP Health Care® continues to make the health and well-being of our members our top priority during the COVID-19 (coronavirus) pandemic. We are closely monitoring the virus and taking proactive measures to protect the health and safety of our members, in accordance with the guidelines provided by the Center for Disease Control and Prevention (CDC), New York State, and Vermont authorities.
MVP is also dedicated to ensuring our members, employers, and brokers continue to receive the care and support they need. We have contingency plans to ensure operations are maintained. The MVP Customer Care Center will still be open to answer member and provider questions, authorizations will be completed, and claims will be paid.
Does MVP cover the COVID-19 vaccine?
Yes, the COVID-19 vaccine is covered under all MVP health plans and free for all MVP members. There is no co-pay and $0 cost-share when a member receives the vaccine. Self-insured plan members may incur a cost share for the vaccine administration.
Fully insured and self-insured groups who carve-out pharmacy from MVP will follow standard rules, and administration costs for the vaccine administered by a pharmacist will be covered by the group’s pharmacy plan.
MVP is following state, federal, and the Centers for Disease Control and Prevention (CDC) guidance related to the COVID-19 vaccine and its distribution for New York and Vermont members. We will continue to keep provide updates as information and guidance for the COVID-19 vaccine becomes available.
Is the COVID-19 vaccine safe?
Yes, the COVID-19 vaccine is safe. Vaccines are only given to the public once they are considered safe and are approved by the Food & Drug Administration (FDA). Scientific data—including effectiveness and safety—from the COVID-19 clinical trials has been reviewed by the FDA and a separate independent advisory body, the Advisory Committee on Immunization Practices (ACIP). Learn more about the COVID-19 vaccines.
MVP strongly encourages members to get the vaccine including a booster dose once it is available to them.
What should members know about the vaccine for kids ages 5-11?
The most important thing to know is that clinical trial data shows that the COVID-19 vaccine is safe and effective for children ages 5-11. Side effects may occur and could include pain at the injection site, fatigue, and/or headache, which are likely to resolve within 1-2 days and are similar to the side effects seen with other vaccines children routinely receive.
While children are less likely than teens and adults to have severe disease from COVID-19, they are not immune to the disease. Some children have become very sick and required hospitalization, including healthy children who did not have underlying conditions – nearly one third of those children hospitalized have needed care in the ICU. Experts have concluded that the known benefits of receiving the vaccine outweigh the risks of contracting COVID-19.
Children between the ages of 5-11 receive a lower dose of the vaccine than people over the age of 12. The Pfizer vaccine (currently available and approved for use) is a two-dose series, separated by three weeks.
Learn more about COVID-19 vaccines for children ages 5-11 by visiting the Vaccines page on the CDC website.
Parents should also speak with their health care provider to discuss any questions or concerns they may have.
Are adverse reactions to the vaccine covered?
Yes. Treatment for any adverse reactions is medically necessary and covered by MVP. Members should refer to their schedule of benefits or call the Customer Care Center at the number located on the back of their MVP Member ID card for cost share information. Cost share is dependent upon place of service.
COVID-19 Testing and Treatment
Protocol for Members with COVID-19 Symptoms
If an employee has been in close contact with a person known to have COVID-19, showing symptoms of COVID-19, or recently traveled from an area with ongoing community spread of COVID-19, he/she needs to be evaluated by a health care provider.
- Call a primary care doctor’s office or urgent care facility before you go to the location, or Start with Gia℠ and select “emergent or urgent care.”
- Wear a mask before you go into a doctor’s office, urgent care facility, or hospital.
- If an employee is low risk for COVID-19, but still feeling sick, consider using telemedicine alternatives.
- If a member needs a COVID-19 PCR test but can’t make it to a testing location, mobile lab testing through Scarlet Health™ may be a good option for them. After scheduling an appointment, a Scarlet Health professional will conduct a test at the member’s home and deliver it to the lab. Members will receive an email with instructions for how to securely access results online. Test results are available within 2-4 days.
Virtual Care Services and Coverage
Gia® virtual care services are $0 on all plans, except qualified high-deductible health plans (QHDHPs) in 2022. The IRS now requires members enrolled in QHDHPs to pay for virtual care services until their plan deductible is met. After the deductible is met, virtual care services are $0. While costs for care vary, Gia virtual care services are generally lower cost than the in-person alternative. Gia virtual care services include urgent/emergent care, primary care, behavioral health, psychiatry, nutrition, and lactation. Virtual physical therapy is also included on 2022 plans. In-person care or virtual care excluding Gia is subject to co-pay/cost-share per plan details
COVID-19 Test Coverage
MVP does not cover COVID-19 tests performed on solely to assess health status, even if required by parties such as government/public health agencies, employers, common carriers, schools, or camps, or when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status. MVP does not cover occupational testing.
Over-the-Counter Test Coverage
MVP will cover the cost of certain FDA-authorized over-the-counter (OTC) take-home COVID-19 antigen tests for NYS Medicaid, Child Health Plus, and Essential Plan members, New York and Vermont commercial members, and self-funded plan participants.
- Effective January 21, 2022, Child Health Plus (CHP) members receive two FDA-authorized COVID-19 test kits, per week, with no cost-sharing.
- Effective January 15, 2022, New York and Vermont commercial members and self-funded plan participants may be reimbursed for up to eight retail OTC COVID-19 antigen tests, per covered dependent per 30 days.
- Effective January 3, 2022, Essential Plan (EP) members may receive up to two FDA-authorized OTC COVID-19 test kits per week until the end of the Public Health Emergency.
- Effective December 13, 2021, NYS Medicaid members may receive two retail OTC COVID-19 antigen tests per week (maximum of eight tests per month) at an in-network pharmacy department with no cost-share by presenting their MVP Member ID card. Coverage is limited to certain FDA-approved tests.
- Effective December 1, 2021, through January 14, 2022, Vermont commercial members may be reimbursed for up to eight retail OTC COVID-19 antigen test kits per covered dependent per month (maximum of 16 tests per covered dependent per month).
For a complete list of OTC tests available for coverage for commercial, CHP, and EP members, and self-funded plan participants visit the FDA website.
Medicaid, CHP, and EP members have the following OTC tests covered*. Tests must be purchased at an in-network pharmacy:
- BinaxNOW™ COVID-19 Antigen Rapid Self-Test
- CareStart COVID-19 Antigen Home Test
- FlowFlex™ COVID-19 Antigen Home Test
- iHealth COVID-19 Antigen Home Test
- InteliSwab™ COVID-19 Rapid Test
- QuickVue® At-Home OTC COVID-19 Test
Currently, there is no regulation or requirement for Medicare insurers to cover OTC at-home tests.
Mobile PCR Test Coverage
COVID-19 PCR testing is available through Scarlet Health® mobile lab test collection for members who are unable to make it to a testing site. With a scheduled appointment, a Scarlet Health professional will conduct a test at the member’s home and deliver it to the lab. Members will receive an email with instructions for how to securely access results online. Test results are available within 2-4 days.
If you need a doctor to order a lab test for you, the easiest thing to do is download Gia® by MVP from the Apple App Store or Google Play Store. Then start a consultation and ask your Gia doctor to order your lab tests through Scarlet Health.
*This information is subject to change. Covered tests for Medicaid, CHP, and EP are determined by New York State Department of Health (NYS DOH), and list will be updated as information from NYSDOH becomes available.
OTC COVID-19 Test Cost and Reimbursement
New York and Vermont commercial members and self-funded plan participants may purchase tests at an in-network pharmacy (online or in store, in NY, VT, and any other state), at $0 charge if a claim is processed by the pharmacist online to MVP for most OTC tests. Tests paid for out-of-pocket (whether at in-network or out-of-network pharmacies when a claim is not processed) are eligible for reimbursement up to $12 per test.
Medicaid, CHP, and EP members are only eligible to receive approved OTC tests purchased from an in-network pharmacy. COVID tests purchased online will not be reimbursed. There is no out-of-pocket cost when the claim is processed by the pharmacist to MVP. Members should have their MVP Member ID card ready when purchasing tests.
OTC COVID-19 tests are not subject to plan deductibles.
Please note: some pharmacies may not be able to process claims for at-home COVID-19 tests at the pharmacy counter at this time. If this happens, members can pay for the test, then submit a request for reimbursement.
How to submit for reimbursement if paying out-of-pocket
Commercial members and self-funded plan participants can submit requests for reimbursement. Members will need to include receipts with the date of purchase, price of purchase, and name of OTC test.
Members with prescription drug coverage through MVP should complete the CVS Caremark Over-the-Counter At-Home COVID-19 Test Reimbursement Form, and members without prescription drug coverage through MVP should complete the MVP Claim Reimbursement Form.
Please note: some self-funded groups with pharmacy carved out will need to use the MVP Claim Reimbursement Request form.
For more information on reimbursement for commercial members and self-funded participants, visit caremark.com/covid19-otc.
Commercial members may use their HSA, FSA, HRA, or MVP CareFund debit card to pay for OTC tests if their plan covers OTC items. A Claim Reimbursement Request form may then be submitted for reimbursement attached with receipts with the specific test noted and UPC codes from the test box. Once members receive their reimbursement, they must refund the spending account used to purchase the OTC tests. Members should contact their administrator to determine how to refund the money to their account.
COVID-19 Treatment Coverage
A cost-share will apply for COVID-19 treatment for most MVP Commercial health plans in New York. Self-funded plan members should check with their employer to see if they have adopted the waived cost-share guidance. MVP will cover COVID-19 treatment for most Commercial health plans in Vermont through March 31, 2022.
MVP covers COVID-19 treatment at no cost-share for MVP Medicare and Medicaid health plans.
When traveling abroad (outside of the United States), MVP provides benefits for emergency services if your condition is an emergency medical condition. This includes any symptoms resulting from COVID-19 with sufficient severity to place your health in serious jeopardy or cause serious bodily impairment or disfunction. Emergency coverage is subject to applicable plan deductibles and cost shares. Members should refer to their Certificate of Coverage for specific coverage details.
Health Care Site of Service Cost Differences
Your employees often have less expensive, more convenient options than the hospital emergency room. The chart below details estimated costs based on site of service for an upper respiratory infection.
Hospital Emergency Room $1,150 Urgent Care $173 Gia℠ $0 The costs above show averages of all rates in the MVP service area. They do not represent a specific region or county in the MVP service area, or any single MVP participating provider’s contracted rates.
Health Plan Enrollment & Coverage Information
New York Open Enrollment Extension
The opportunity for uninsured individuals to enroll in a Qualified Health Plan has been extended until the public health emergency has ended.
Individuals may continue to enroll directly with MVP or enroll through NYSOH until the end of the public health emergency. Enrollment must be completed by the 15th of the month for coverage effective the 1st of the following month. For example, enrollment must be completed by March 15 for coverage effective April 1.
Individuals who qualify for financial assistance or subsidies should contact NYSOH.
Vermont Open Enrollment Extension
The extended Open Enrollment Period for Vermont individual plans has concluded.
You may enroll in a Qualified Health Plan if you qualify for a Special Enrollment Period due to a life change event such as loss of prior health coverage, marriage, or birth of a child. Learn more. If you’re unsure whether or not you qualify, please contact MVP at 1-800-TALK-MVP (825-5687).
Prescription Medication Refills
MVP Commercial members will be able to obtain an early refill on a 30-day supply of maintenance medications at an in-network retail pharmacy. MVP Medicaid members may be eligible for an early refill of a 30-day supply of a maintenance medication at an in-network retail pharmacy. Medicaid members who are quarantined or whose provider suggests self-quarantine may contact CVS to request a 90-day supply of maintenance medications during the COVID-19 pandemic. MVP Medicare members may request a 90-day supply of medications at an in-network pharmacy (mail or retail). Members should speak with their pharmacist to enter the applicable emergency supply override code into their dispensing systems to trigger the early refill override.
Controlled substances and specialty medications will be exempt from this early refill override process. Please remember that most specialty medications may be obtained from the CVS Specialty Pharmacy, which already mails prescriptions to homes.
Members taking maintenance medications are encouraged to take advantage of the ability to receive a 90-day supply of medication through the CVS Caremark mail order pharmacy to have medications mailed directly to their homes. Some retail pharmacies will also mail prescriptions to a home address. Members should ask their pharmacist if this is an option.
Ancillary Product Changes Due to COVID-19
Flexible Spending Account Changes
The Consolidated Appropriations Act (CAA) and the American Rescue Plan Act (ARPA) extend many relief measures that were created by the Families First Coronavirus Response Act (FFCRA) and the Cares Act. The CAA and ARPA provide temporary relief for Medical FSAs, Dependent Care FSAs, and Limited Purpose FSAs. Employers are not required to apply these amendments. However, they can be used to provide employees with additional flexibility. If you would like to make a change to your FSA per the CAA or the ARPA, please review the available options and complete the FSA Amendment Form for Employers. Once completed, please return the form to your MVP Account Manager.
Ambulance Claim Coverage
Effective March 13, 2020, Vermont members will have no cost-share for an ambulance claim if they have been diagnosed with COVID-19 or they have symptoms of COVID-19 (cough, shortness of breath, fever).
Employer Group Information
Employer Group Billing Policy
MVP is committed to making sure you have the health insurance coverage you need during the COVID-19 State of Emergency. While you are no longer able to defer premium payments, if you have experienced financial hardship please call your broker, MVP Account Representative, or MVP Premium Billing Representative to discuss your options.
Information regarding COVID-19 is subject to change.