Member Coronavirus Information

COVID-19 is a respiratory disease that is caused by a new virus called a coronavirus, which has become a public health emergency. The number of cases continue to increase nationally and globally.

The symptoms of coronavirus include mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. COVID-19 can be contagious before a person begins showing symptoms.

Influenza (the flu), a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the United States in the Fall/Winter months. Everyone 6 months of age and older should get a flu vaccine annually.

If you have been exposed or begin showing symptoms of the virus or flu, contact your healthcare provider or health department immediately. 

We all have a role to play in protecting our communities and families from the spread of coronavirus. It is similar to other communicable viruses. You can also follow these tips to prevent infection:

• Wash your hands thoroughly and frequently. Use soap and water for at least 20 seconds.
• Use an alcohol-based hand sanitizing rub (must contain at least 60 percent alcohol).
• Wear a face covering/mask when in public and/or a round others who do not live in your home if you are not fully vaccinated
• Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow.
• Promptly dispose of tissues in a wastebasket after use.
• Clean public surfaces thoroughly.
• Stay home when you are sick.
• Avoid shaking hands.
• Avoid close contact with people who are sick.
• Get a flu vaccine annually.

Yes. When medically necessary diagnostic testing, medical screening services and/or treatment is ordered and/or referred by a licensed healthcare provider, we will cover the cost of medically necessary COVID-19 tests, screenings, associated physician’s visit(s), and/or treatment. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing, medical screening services, and/or treatment.

No. We will not require prior authorization, prior certification, prior notification and/or step therapy protocols for medically necessary COVID-19 diagnostic testing, medical screening services, and/or treatment when medically necessary services are ordered and/or referred by a licensed health care provider.

Medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment and the associated physician’s visit will be covered when ordered, referred and/or performed in the following In-Network locations:

• Physician’s/Practitioner’s Office
• Independent Laboratory/Diagnostic Facility
• Urgent Care Facility
• Emergency Department Facility

Are you unsure if you have been exposed to or at-risk of being infected with COVID-19? Schedule a virtual care visit with a provider. It is a good option for non-urgent care to limit potential exposure in a physician’s office or other healthcare facility.

No. We will cover medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment at no charge to you, when such services are ordered and/or referred by a licensed health care provider. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment, along with the associated physician’s visit.

Any medically necessary treatment related to COVID-19 would be considered a covered benefit. We are committed to ensuring access to COVID-19 treatment services in accordance with federal and state law.

Yes, members will be able to refill prescriptions prior to the refill date.

There is now a vaccination available that will give you the best chance of protecting yourself and your loved ones from getting COVID-19 in the future. Some COVID-19 vaccines will have two doses a few weeks in between each shot. You will get a COVID-19 Vaccination Reminder Card that will help you keep track of which vaccine you receive and when to get a second dose, if needed. If you receive a vaccine that requires two doses, it is important to get both doses.

The vaccine is being administered to different populations in a tiered approach. When you are able to get the vaccine, call your doctor with any questions and ask when you can make an appointment with them or at your local pharmacy. Or, find out where to get your vaccine at cdc.gov/coronavirus/2019-ncov/vaccines or vaccinefinder.org.

While it is not a requirement, getting your COVID-19 vaccine will give you the best chance of protecting yourself and your loved ones from getting COVID-19 in the future.

Even if you have already had COVID-19, you should still get the vaccine. It may be possible to be infected more than once so getting the vaccine is a safe choice.

Currently, the Pfizer-BioNTech vaccine is recommended for people ages 12 and older. The Moderna and Johnson & Johnson vaccines are recommended for those ages 18 and older.

The CDC currently recommends the COVID-19 vaccine for pregnant women. If you have questions about getting the vaccine, it is recommended to discuss with your doctor to make an informed decision.

Fully vaccinated is considered two weeks past final dose, meaning the second dose of the Moderna or Pfizer mRNA vaccine, or, two weeks past the single dose Johnson & Johnson vaccine.

To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial of high transmission.

Wearing a mask is most important if you have a weakened immune system or if, because of your age or an underlying medical condition, you are at increased risk for severe disease, or if someone in your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated. If this applies to you or your household, you might choose to wear a mask regardless of the level of transmission in your area.

Fully vaccinated people who have come into close contact with someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.

The Delta variant is highly contagious, nearly twice as contagious as previous variants.

Some data suggest the Delta variant might cause more severe illness than previous strains in unvaccinated persons.

Unvaccinated people remain at the greatest risk for severe illness, hospitalization, and death.

Fully vaccinated people with Delta variant breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period of time.

Vaccines are highly effective, including against the Delta variant.

What do we know about breakthrough cases for people who are fully vaccinated? A small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it. These are called “vaccine breakthrough cases.” This means that while people who have been vaccinated are much less likely to get sick, it will still happen in some cases. It’s also possible that some fully vaccinated people might have infections, but not have symptoms (asymptomatic infections). Experts continue to study how common these cases are.

If you get COVID-19 after vaccination, your symptoms might be less severe.

Fully vaccinated people are much less likely to be hospitalized or die than people with similar risk factors who are not vaccinated.

The safety of the COVID-19 vaccine is a top priority! The Food and Drug Administration (FDA) carefully reviews all safety data from clinical trials and authorizes emergency vaccine use only when the expected benefits outweigh potential risks. COVID-19 vaccines were tested in large clinical trials to make sure they meet safety standards.

You may run a fever after you get the vaccine. This is normal as your body builds immunity and fights off future COVID-19 exposures. You may feel sick after getting vaccinated. You could develop a fever, headache or body aches. This is your body reacting to the vaccine, which is a normal response. It is important to know that it is impossible to get COVID-19 from the vaccine. The vaccines currently in use and others being developed do not contain a live virus.

No. The COVID-19 vaccine will be at no cost to you. You do not need to get a prior authorization for your vaccine.

Please call the administering facility/provider you received your first dose from to ask about your vaccine information and verify your second appointment/location.

The provider should have scheduled a second appointment with you at the same facility when you received the first dose. However, you can receive your second dose from another provider/facility and you should present your COVID-19 Vaccination Record Card.

Yes. South Carolina’s Medicaid Transportation program provides non-emergency transportation for members. View the Member Handbook (PDF) for information about transportation in your area.

Worry and anxiety can rise about the spread of COVID-19. Concern for friends and family who live in places where COVID-19 is spreading or the progression of the disease is natural.

• Take care of your body. Take deep breaths, stretch, or meditate.
• Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.
• Share the facts about COVID-19 and the actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.
• For more information, see the CDC’s suggestions for mental health and coping during COVID-19