If you are experiencing life-threatening symptoms call 911.
• What is COVID-19?
• What are the symptoms?
• How is COVID-19 transmitted?
• How can you reduce the risk of getting COVID-19?
• What if I am experiencing symptoms?
• Does Total Health Care cover COVID-19 screening?
• Does Total Health Care cover COVID-19 testing?
• Does Total Health Care cover COVID-19 treatment?
• Is testing covered for all plans?
• What if I am out of state?
• What if I’m out of the country?
On March 10, the first confirmed cases of COVID-19 in Michigan were announced and Governor Whitmer declared a state of emergency to maximize efforts to slow the spread. For more information about COVID-19, visit our information page, or the Centers for Disease Control and Prevention at cdc.gov.
Things to know about COVID-19
According to the Centers for Disease Control and Prevention (CDC), Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus, or SARS-CoV-2, that was first identified during an investigation into an outbreak in Wuhan, China. This flu-like virus is very serious, with confirmed cases and deaths in the U.S. rising.
Total Health Care continues to monitor the CDC’s recommendations and work with the Michigan State Health Department and Department of Health and Human Services to ensure appropriate information is obtained and shared with our members.
As the concern for COVID-19 continues to grow, it’s important to know the symptoms involved:
- Shortness of breath.
Similar to influenza, people at a serious risk for developing severe COVID-19 symptoms are those who suffer from chronic disease and weakened immune systems. Older demographics are also at a more serious risk.
The virus is thought to spread from person-to-person through respiratory droplets produced when an infected person coughs or sneezes.
The best way to prevent becoming ill is to avoid being exposed to the virus in the first place.
To reduce the risk, health experts recommend taking the following everyday precautions:
- Wash hands frequently with soap and water for 20 seconds minimum.
- Clean and disinfect any surfaces you frequently touch (like your phone).
- When sneezing or coughing, always cover your nose and mouth with a tissue, then throw the tissue away and wash your hands.
- Stay home if you are feeling sick (cough, fever, trouble breathing).
- Avoid close contact of any kind with sick individuals.
- Avoid touching your eyes, nose and mouth.
You can find more information on the CDC prevention webpage.
Right now, it is up to state and local health departments to decide which individuals receive COVID-19 tests. If you have symptoms, you must first consult with a physician (a virtual visit can qualify as a screening). Your physician can then help you understand if you qualify for testing and how to proceed.
Use virtual care for screening
We encourage our members to use virtual care if they have any symptoms to avoid overwhelming health care providers and help reduce the risk of spreading or contracting the illness during an emergency room or physician’s office visit.
Check with your doctor’s office to see if they offer virtual care.
As mentioned, your physician will help you understand how to receive testing for COVID-19. You cannot request a test without a screening at this time. Testing for COVID-19 needs to be ordered by a doctor or other health care provider and must be deemed medically necessary. Testing is currently handled by state and local health departments.
Does Total Health Care cover the following COVID-19 services?
Screening is defined as a series of questions a medical professional uses to determine if a COVID-19 test is appropriate.
We encourage our members to use virtual care if they have any symptoms to avoid overwhelming health care providers and to help reduce the risk of spreading or contracting the illness during an emergency room or physician’s office visit.
Check with your doctor’s office to see if they offer virtual care.
- Co-pays and deductibles waived if your screening results in your doctor ordering or administering a COVID-19 test.
- Above is true for out of state as well.
If a COVID-19 test of any kind is ordered by a medical provider that is medically necessary, your member cost share (copays, coinsurance or deductibles) for this test will be waived.
- The test must be ordered by a medical provider for your health plan to cover the costs of the test.
- Your plan will cover the cost of the test as described above, whether the provider is in or out of network.
- Medically necessary is determined and appropriately coded by your ordering provider.
- Medically necessary does not include tests as a condition of employment or returning to work.
- If you are experiencing symptoms, first speak to your health care provider to help you understand if you need testing and how to receive it.
- The state also has online resources you can access that will provide information on testing centers and steps to take.
COVID-19 treatment* is available to our members with no out-of-pocket health plan costs (copays, and deductibles and coinsurance) when received from an in-network provider between the dates of March 11, 2020 and December 31, 2020.
- Out-of-pocket health plan costs are waived for treatment when COVID-19 is the primary diagnosis.
- If you visit an out-of-network provider, your treatment will be covered as outlined by your health plan and cost-sharing will apply if applicable.
- Note that some plans do not have out-of-network benefits. We encourage you to receive care from providers in your plan’s network.
- Covered treatment may be inpatient or outpatient, however, this does not apply to prescriptions. There are currently no official drug treatments for COVID-19.
- Need help finding an in-network provider? Log in to your member account to use your find a doctor tool or call your Total Health Care customer service team.
COVID-19 Treatment Out-of-Network Providers: Standard benefit
- This means standard copays, deductibles and coinsurance applies for inpatient and outpatient treatment from an out-of-network provider.
- Treatment of COVID-19 does not apply to prescriptions. There are no official drug treatments for COVID-19 at this time.
The above is true for all members including Commercial, Medicaid and Individual plans.
If you are out of state and need emergency medical assistance related to COVID-19, testing, diagnosis and treatment of COVID-19 will be covered as outlined above.
- OOC members are covered for Urgent and Emergency care as stated by their plan.
- The usual process will apply. If the member seeks care, they may be asked to pay up front.
- The member should get a detailed receipt and then file a form to get reimbursed from us.
- Cost-sharing is waived for COVID-19 tests deemed medically necessary by a doctor. This means there is no member cost (copay, deductible, coinsurance) for diagnostic testing of COVID-19.
*Note: Total Health Care Medicaid members do not have any out-of-country benefits and services received outside of the United States cannot be reimbursed.
Expanded access to virtual care
We’re expanding your access to $0 virtual care.
In efforts to keep our members safe and healthy, Total Health Care continues expanding access to $0 virtual care services beyond COVID-19 related care.
Between the dates of March 19, 2020 – June 30, 2020, members were provided with access to $0 virtual care for COVID-19 related care. As of July 1, 2020, we are expanding $0 virtual care services to include service types within telehealth, audio, video and Behavioral Health services, not limited to COVID-19 related care.
- Members with high deductible health plans also receive $0 virtual care before deductible.
- Members need to remain in-network to receive $0 cost share.
- Members have had access to $0 behavioral health virtual care since March 19, 2020.
- Plans may vary. Please contact customer service if you have questions about your coverage.