Coronavirus (COVID-19) Information and Updates

For important updates about flexibilities, expanded benefits and coverage, and helpful information about COVID-19 visit healthaliance.org/coronavirus.

Coronavirus (COVID-19) Information and Updates

As our communities, nation and world continue to navigate the first-of-our lifetime global pandemic, FirstCarolinaCare Insurance Company is working closely with local, state and federal health partners to keep you informed. Teams throughout our nation are taking preventive steps to limit the spread of the novel coronavirus and manage the treatment of COVID-19. We are here to help you understand the guidance that public health officials are providing, and to answer all questions about your plan’s coverage during this ongoing situation. In the FAQ section that follows, you’ll find information and resources regarding the illness, prevention, treatment and coverage.

If you have questions that are not covered below, or if you want to learn more about the actions we’ve taken to respond to the COVID-19 pandemic, feel free to contact us:

Members: call the number on the back of your member ID card.

Group Plan Administrators:  call Client Support at (866) 297-4718 or email FCCClientSupport@firstcarolinacare.com 
 Providers:  Call (800) 481-1092
 Brokers: Call Broker Services at (888) 384-4840 

For the latest information regarding the affects of COVID-19 across the state and in your community, please visit the websites below:

You may also contact public health officials in your state by calling:

  • North Carolina residents can call (888) 675-4567.

Frequently Asked Questions

The following questions focus on COVID-19 and its prevention, how the novel coronavirus spreads and specifics about insurance coverage. For the most in-depth information about the virus and illness, visit the Centers for Disease Control and Prevention (CDC) website.

Symptoms and Basics

What is COVID-19?

It’s a respiratory illness – similar to SARS and MERS – that has sickened nearly 100 million individuals around the world and nearly 25 million here in the United States. Since the virus that causes COVID-19 is a newly identified strain of coronavirus, we still don’t know everything about the illness, but FirstCarolinaCare Insurance Company is keeping track of the latest details and recommendations from health officials like those at the CDC and state and local public health agencies.

What are the symptoms?

The following information is directly from the CDC:

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus.

People with these symptoms or combinations of symptoms may have COVID-19:

  • Fever or chills.
  • Cough.
  • Shortness of breath or difficulty breathing.
  • Fatigue.
  • Muscle or body aches.
  • Headache.
  • New loss of taste or smell.
  • Sore throat.
  • Congestion or runny nose.
  • Nausea or vomiting.
  • Diarrhea.

This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning to you.

Read more from the CDC here.

What should I do if I suspect I have been exposed to the virus that causes COVID-19?

The best way to protect yourself and others is to isolate or take other precautions based on your unique symptoms and other risk factors.   For additional details visit CDC.gov/isolation and precautions.  As always, if you need emergency medical assistance, call 911.

How the Virus Spreads

How does the virus spread?

The virus that causes COVID-19 is thought to spread mainly through close contact from person to person, including between people who are physically near each other (within about six feet). People who are infected but do not show symptoms can also spread the virus to others. Cases of reinfection with COVID-19 have been reported but are rare. We’re still learning about how the virus spreads and the severity of illness it causes.
 How easily a virus spreads from person to person can vary. The virus that causes COVID-19 spreads very easily from person to person. It appears to spread more efficiently than influenza but not as efficiently as measles, which is among the most contagious viruses known to affect people.

For more information about how COVID-19 spreads, visit the CDC’s How COVID-19 Spreads page, which also includes tips on how to protect yourself.

Who is most at risk?

People at increased risk include:

Pregnant people are also at increased risk for severe illness from COVID-19.

Long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19.  In addition to those at increased risk, there are certain groups of people who require extra precautions during the pandemic.

Prevention

Should I get a vaccine?

The federal government has authorized the use of several vaccine products to protect Americans against the novel coronavirus. The CDC, as well as state, local and territorial public health agencies across the country recommend COVID-19 vaccination for everyone age 6 months and older. We urge all members to strongly consider getting vaccinated when it’s available to them.

FAQ sheets and other useful information about each vaccine can be found here: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

FirstCarolinaCare members and members of self-funded group health plans administered by FirstCarolinaCare Insurance Company who are eligible for a primary vaccine or booster shot will be able to receive them with no out-of-pocket costs. 

Individuals can receive a vaccine through a public mass vaccination site or a healthcare provider. Contact your local Public Health agency for more information regarding vaccine availability in your area. Please be prepared to show  your insurance ID card when you go in to receive the vaccine.

As of this time, the federal government is covering the cost of the vaccine. It’s a $0* cost to you.

* Providers may charge a fee for the administration of the vaccine, and the cost of this administration fee will be covered without applying copays, coinsurance or deductibles for most FirstCarolinaCare plans and self-insured plans administered by FirstCarolinaCare. Cost-sharing may apply for members covered under short-term, limited-duration plans or certain grandfathered group health plans. If you have questions about your specific coverage, please call the number on the back of your member ID card.

Do vaccines for the flu and/or pneumonia help protect against COVID-19?

It remains as important as ever to protect yourself and your family against severe illness from the flu or pneumonia.   Please discuss your options for vaccination with your healthcare provider.  You may be able to receive multiple vaccinations during the same visit.

What can I do to lower my risk of getting the virus?

To lower your risk of getting a severe respiratory illness, it is important to take steps to protect yourself and others.  To learn more about assessing your risk and minimizing the impact of these diseases, visit cdc.gov/prevention.

  • *Virtual visits are a great way to avoid unnecessary travel to a doctor's office and are in line with the practice of social distancing. Your plan may offer Virtual Visits with a doctor. Check your plan materials for more information. Member cost-sharing may apply. Additionally, your plan may also offer the services of our Nurse Advice Line at no cost to you. Certain self-funded employer group plans may offer alternative platforms for virtual doctor visits and telephone help lines. For more information on telehealth services, please see the question below, “Does my insurance cover any types of telehealth and/or virtual doctor visits?” As always, please visit a hospital emergency department for all serious conditions and call 911 for all emergencies.

Should I – and my family – be wearing facemasks in public?

According to the CDC, masking and social distancing are preventive actions that may be done at any level, but the CDC especially recommends considering these practices during times when COVID-19 occurrence is at medium or high levels in the community. Visit this link to learn more.

Should I postpone or cancel my travel plans?

If you’re comfortable traveling, there is no need to cancel your plans unless you are sick with, or at particularly high risk for, spreading COVID-19.  We encourage you to consider becoming fully up-to-date on vaccinations, testing before and after travel, and wearing a mask in crowded areas or in public transportation settings.  To learn more about travel requirements, click here.

Treatment

What is the recommended treatment for those with the virus?

If you think you’ve developed COVID-19, call your healthcare provider for medical advice. Older patients and individuals who have severe underlying medical conditions or are immunocompromised should contact their healthcare provider early, even if their illness is mild. If you have severe symptoms, such as persistent pain or pressure in the chest, new confusion or inability to arouse, or bluish lips or face, contact your healthcare provider or emergency room and seek care immediately. Your healthcare provider will determine if you have the signs and symptoms of COVID-19 and whether you should be tested. As always, if you need immediate emergency help, call 911.

For those who test positive for COVID-19, your healthcare provider will seek the latest CDC advice regarding treatment. This may range from simple supportive care that lessens symptoms to care that aides vital organ functions.

What is the Test to Treat program – and where can I find more information about it?

The Test to Treat program – led by the federal government – gives you a way to quickly access free, lifesaving treatment for COVID-19. Through this program, you’re able to get tested for COVID-19, and – if you test positive and treatments are appropriate for you – you’re able to receive a prescription from a healthcare provider and have that prescription filled, all at one single location. You can visit any one of the thousands of local community sites throughout the country. For more information, and to find a site near you, visit U.S. Department of Health and Human Services or call (800) 232-0233 (TTY 1-888-720-7489).

Important note: If you have COVID-19 symptoms and test positive, do not wait to get treated. You must take the oral COVID-19 medications within five days of your first COVID-19 symptoms.

Coverage

Please note that the content provided within this website is only intended as general summary information and does not constitute your policy of insurance or summary plan description. The information on this website does not guarantee coverage or verify eligibility for benefits. The information provided on this website is designed to support, not replace, the relationship between FirstCarolinaCare Insurance Company and the members of the plans it offers and administers. Please see your member materials or contact the number on the back of your ID card for additional details specific to your health plan’s coverage for diagnostic laboratory testing associated with COVID-19. Should a member require subsequent medically necessary treatment for COVID-19 related medical conditions, FirstCarolinaCare Insurance Company will cover such treatment pursuant to the terms and conditions associated with the member’s health plan for the plans that FirstCarolinaCare Insurance Company itself offers. For self-funded employer plans that FirstCarolinaCare Insurance Company acts solely as the administrator, the employer / plan sponsor has the responsibility to make such determinations regarding what benefits are provided for COVID-19 treatment (subject to applicable law). This website’s content is subject to change without notice to the Member. In any situation where the official printed publications of FirstCarolinaCare Insurance Company or a self-funded plan sponsor differ from the text contained in this website, the official printed documents take precedence. 

This coverage FAQ is based on the latest information from applicable resources which may include but are not limited to state regulations and guidance, state and federal law and CDC guidelines.

If I get tested for COVID-19, will my health plan cover the test?

If you get tested by a healthcare professional, our health plans will cover – with no member cost-share – appropriate diagnostic laboratory testing for COVID-19 when the test is ordered by a physician for clinical/medical reasons, such as if you have symptoms or known exposure to the novel coronavirus. Cost-sharing is also waived in these above instances for COVID-19 testing-related visits, whether the visit takes place in a healthcare provider’s office, an urgent care center, an emergency department or through telehealth.

If you are tested for employment purposes, our health plans will not cover the testing or testing-related visit(s).*

Beginning on January 15, 2022 and continuing through the remainder of the public health emergency, over-the-counter (OTC) at-home COVID-19 diagnostic tests are covered for some members. Please see the FAQ titled “will my health plan cover over-the-counter COVID-19 diagnostic tests for home use?” for more information. 

These processes, guidelines and limits may change as the pandemic evolves. Please call the number on the back of your health plan ID card if you have any questions about your coverage.

*Some self-funded employer group plans administered by FirstCarolinaCare may cover employment-based screenings. Consult with your plan administrator for more details about this coverage.

Will my health plan cover over-the-counter COVID-19 diagnostic tests for home use?

Beginning January 15, 2022 and through the remainder of the public health emergency, individuals who purchase over-the-counter (OTC) COVID-19 diagnostic tests are able to receive reimbursement from their health plan. As testing is critical to help reduce the spread of the COVID-19 virus, we have developed the following guidelines for members to receive reimbursement for these tests.

These processes, guidelines and limits may change as the pandemic evolves. Please call the number on the back of your health plan ID card if you have any questions about your coverage.

Who is eligible for coverage of OTC COVID-19 diagnostic tests?

Eligibility for reimbursement for OTC COVID-19 diagnostic tests applies to all Fully-Insured and Self-Funded* employer group members and Individual commercial members beginning January 15, 2022. 

The coverage may not apply to Medicare Advantage, Medicare Supplement and Short-Term, Limited-Duration plan members. For members on these plans, OTC COVID-19 diagnostic tests are widely available at pharmacy and retail locations nationwide.  Other free testing resources may be available in your community.  To find a testing location near you, visit hhs.gov/coronavirus/community-based-testing-sites

What type of COVID-19 tests or testing does my health plan coverage apply to?

This coverage applies to FDA-authorized at-home COVID-19 diagnostic tests which display results directly to the consumer in their home and are purchased over-the-counter at these preferred pharmacies listed here: Preferred Pharmacies for COVID-19 Over-the-Counter Diagnostic Tests. We will cover up to eight (8) tests per member per month.

Tests that are administered by a healthcare professional, or that require processing at a laboratory, are subject to the coverage requirements previously outlined by your health plan.

Testing for employment purposes, including OTC tests purchased to satisfy employment-based screening requirements, are not covered by our health plans.*

*Some self-funded employer group plans administered by FirstCarolinaCare may cover employment-based screenings. Consult with your plan administrator for more details about this coverage.

Where can I purchase OTC COVID-19 diagnostic tests? 

We encourage you to purchase these diagnostic tests at any of these preferred pharmacies listed here: Preferred Pharmacies for COVID-19 Over-the-Counter Diagnostic Tests. At the time of purchase, you will need to present your health plan ID card at the pharmacy counter. Doing so will allow you to purchase the test at $0 cost to you. Check back for additional pharmacies added to the list of preferred pharmacies for COVID-19 OTC diagnostic tests.

Please be aware that supply chain disruptions beyond our control may limit the availability or cost of tests through any given retailer at any given time. We encourage members to check with the retailer for product availability and be aware that numerous options exist. 

What if I purchase an OTC COVID-19 diagnostic test at a pharmacy or retail site other than the preferred network listed above?

If you choose to utilize a retailer other than those on our list of preferred pharmacies for COVID-19 OTC diagnostic tests or if there is difficulty processing your claim during the retail transaction, please keep your original sales receipt and the original UPC proof of purchase panel from the OTC COVID-19 test box. OptumRx can reimburse members for tests purchased on or after January 15 if you submit the OptumRx COVID-19 Over-the-Counter Test Reimbursement Form

Please be aware that costs for OTC COVID-19 diagnostic tests vary. OptumRx will reimburse up to $12 per test or the purchase price of the test, whichever is less.

*This reimbursement form is not to be used on OTC COVID-19 diagnostic test purchases for employment purposes.

Where can I learn more about testing and the Family First Coronavirus Response Act?

As a reminder, free testing remains available for community members. Resources to help community members find available free testing can be found through your state or local public health agency. 

NOTE: Before traveling to a site for testing, check availability as sites may close during inclement weather conditions.

Additional information about the Families First Coronavirus Response Act (FFCRA) can be found here.

FAQs from the Centers for Medicare & Medicaid Services (CMS) can be found here.


I have a High Deductible Health Plan with a Health Savings Account. Will my plan cover testing for COVID-19 even if I haven’t yet met my deductible? Will I lose my tax incentives if I get tested before meeting my deductible?

All fully-insured and self-funded High Deductible Health Plans will cover medically necessary diagnostic laboratory testing as described in the previous question/answer, even if you haven’t yet met your deductible. Usually, your plan cannot cover medical services that are not classified as preventive care until you meet your deductible. However, the Internal Revenue Service (IRS) has allowed us to cover services related to COVID-19 without jeopardizing the tax benefits associated with your Health Savings Account (HSA), even if deductibles have not been met. Call the number on the back of your member ID card. 

When a COVID-19 vaccine becomes available, will my health plan cover it?

FirstCarolinaCare Insurance Company wants to assure members that they have and will continue to have access to any COVID-19 vaccines authorized for use by the United States Food and Drug Administration (FDA) as they become eligible.

In accordance with the recent federal rule, most FirstCarolinaCare Insurance Company members and members of self-funded group health plans administered by FirstCarolinaCare Insurance Company are able to receive the vaccine at no out-of-pocket costs when the vaccine is available. Cost sharing may apply for members covered under short-term, limited-duration or grandfathered plans.

The Centers for Disease Control and Prevention (CDC) has approved and recommended that everyone ages 6 months and older get vaccinated against COVID-19. Currently, the CDC has approved both Pfizer and Moderna vaccines for children as young as 6-months. We also encourage parents to speak to their physician for added consultation. Additional resources about the vaccines and other FAQ’s can be found at the CDC's website Vaccines for COVID-19 | CDC. Please be prepared to show your insurance ID card when you go in to receive the vaccine. As of this time, the federal government is covering the cost of the vaccine. It’s a $0* cost to you.

*Providers may charge a fee for the administration of the vaccine, and the cost of this administration fee will be covered without applying copays, coinsurance or deductibles for most FirstCarolinaCare Insurance Company plans and self-insured plans administered by FirstCarolinaCare Insurance Company. Cost sharing may apply for members covered under short-term, limited-duration plans or certain grandfathered group health plans. If you have questions about your specific coverage, please call the number on the back of your member ID card.

Will my health plan provide benefits for treatment of COVID-19?

Your health plan will continue to provide benefits for medically necessary healthcare costs to treat infectious diseases, including COVID-19, based upon the terms of your specific health plan. Call the number on the back of your member ID card if you have any questions.

What if I get the virus and require emergency services – will my health plan provide benefits for these?

Many individuals who have contracted COVID-19 have not required any emergency services. However, in circumstances where emergency services are required, most health plans will provide benefits for these services at in-network levels regardless of which provider performs the services. Call the number on the back of your member ID card if you have any questions.

Will my health plan provide benefits for expenses incurred for medical supplies such as facemasks, gloves and disinfectants?

Most of these supplies are not covered by health plans. Call the number on the back of your member ID card if you have specific questions.

Will my health plan allow early medication refills of prescription medications? I might want extra medication on hand if there is an outbreak of the virus in my community.

Yes, fully-insured plans and some self-funded group health plans do – with exceptions. You must have an active prescription available for refill. Please notify your prescriber if you do not have an active prescription on file with your pharmacy. Inform the pharmacy that you wish to have your medication filled to ensure you have 30 days’ worth of medication on hand in case of COVID-19. Exclusions include requests for most opioids and specialty medications, and instances where the member already has 30 or more days of medicine remaining. We recommend filling maintenance medications for 90-day supplies if possible. Call the number on the back of your member ID card if you have any questions.

Does my health plan cover any type of telehealth and/or virtual doctor visits?

Most FirstCarolinaCare Insurance Company fully-insured plans and FirstCarolinaCare Insurance Company-administered plans provide benefits for telehealth and/or virtual doctor visits. For FirstCarolinaCare Insurance Company plans, we’re temporarily broadening our telehealth codes to cover additional services, including behavioral therapy, in response to the COVID-19 pandemic. With regard to the plans we administer, some of these self-funded employer plans have temporarily expanded telehealth codes in a similar manner. Call the number on the back of your ID card to validate if your plan has temporarily expanded telehealth benefits. Telehealth services are a great way to avoid unnecessary travel to a doctor's office and are in line with the practice of social distancing. Call the number on the back of your member ID card if you have specific questions about the types of telehealth services that are eligible, or questions about cost sharing or in-network restrictions that may apply.

Your plan may specifically offer Virtual Visits with a doctor through
 FirstHealth On the GO. Member cost sharing may apply. Certain self-funded employer group plans may offer alternative platforms for virtual doctor visits and telephone help lines.

As always, please visit a hospital emergency department for all serious conditions and call 911 for all emergencies.

Can my health insurance carrier – or my self-funded employer/plan sponsor – cancel my insurance policy or health plan, or refuse to renew it, if I am diagnosed with COVID-19 in connection to a preexisting respiratory illness?

No. Most insurance policies and self-funded group health plans cannot impose any pre-existing condition exclusions, including in connection with COVID-19. 

To all of our valued members, if you have any questions or concerns about your coverage or your premium payments, please do not hesitate to call the number on the back of your member ID card.

How Can I Help?

Are there specific ways to help my community during the COVID-19 situation?

Yes. There are many ways you can help address the COVID-19 situation, including staying home to prevent the virus’ spread, making donations to various health organizations and keeping yourself informed of the latest recommendations coming from public health officials. If you’re healthy, you can also donate blood.