Coronavirus (COVID-19) Information and Updates

Coronavirus (COVID-19) Information and Updates

With an increasing number of people in the United States diagnosed with COVID-19, the illness caused by the novel coronavirus, 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 

All of our service areas have experienced confirmed cases of COVID-19. For the latest information regarding affected areas and number of cases, please visit the websites below:

This is a rapidly evolving situation, and public health officials in each state have set up ways to contact their departments for more information:

  • North Carolina residents can call (800) 662-7000. For COVID-19 questions, call 2-1-1. 

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:

  • Cough
  • Shortness of breath or difficulty breathing

Or at least two of these symptoms:

  • Fever
  • Chills
  • Repeated shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • New loss of taste or smell

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?

If you think you’ve been exposed to the novel coronavirus or to someone with COVID-19, and develop a fever, cough or difficulty breathing, call your healthcare provider for medical advice. Additionally, many hospitals, clinics and other healthcare providers have set up online tools to help evaluate symptoms – check your healthcare provider’s website for these tools, which can help you figure out what actions to take. For more guidance on steps to take if you suspect you are sick, visit this webpage. As always, if you need emergency medical assistance, call 911.

How the Virus Spreads

How does the virus spread?

The first infections were linked to a live animal market in China, but the virus is now spreading from person-to-person. The virus seems to be spreading easily and sustainably among individuals in affected geographic areas in the United States and across the globe. These areas have shown “community spread” of the virus, which means that people in these locations have developed COVID-19, including some who are not sure how or where they became infected. For more information on how the virus spreads, visit the CDC website.  

Who is most at risk?

As the spread of the novel coronavirus and the public health response continue to change daily, so too does the assessment of who is most at risk and when. For this reason, we direct you to the CDC website for the latest information.

Can the virus be spread through food products or other items shipped from foreign countries?

In general, because of the poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packages that are shipped over a period of days or weeks at ambient, refrigerated or frozen temperatures.

Prevention

Is there a vaccine?

The federal government has authorized the use of three vaccines 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 12 and older. We urge all members to strongly consider getting vaccinated when it’s available to them. There’s helpful information about the phased distribution plan available on cdc.gov.

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 will be able to receive the vaccine with no out-of-pocket costs when the vaccine is available to them.

Individuals 12 and older can receive a vaccine through a public mass vaccination site, a local pharmacy or a healthcare provider. Contact your local Public Health agency for more information regarding vaccine availability in your area. Please remember to bring your insurance ID card or the Hally® app (on your mobile device) 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?

No. Vaccines for pneumonia and the flu will not protect you from COVID-19.

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

  • Get a COVID-19 vaccine when it’s available to you.
  • Wear a mask that covers your nose and mouth to help protect yourself and others.
  • Stay six feet apart from others who don’t live with you.
  • Avoid crowds and poorly-ventilated indoor spaces.
  • Wash your hands often with soap and water. Use hand sanitizer if soap and water aren’t available

    For more information about how to protect yourself from respiratory illnesses like COVID-19, visit the CDC website.

    *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?

Masks help stop the spread of the virus. Always visit the CDC website for the most up-to-date information and recommendations about masks.
The CDC’s website recommends the following:

For fully-vaccinated people:

  • Fully-vaccinated people can resume activities without wearing a mask, except where required by federal, state, local, tribal or territorial laws, rules and regulations, including local business and workplace guidance.

For unvaccinated people:

  • Masks are critical to prevent getting and spreading COVID-19.
  • Wear a mask over your nose and mouth in public settings, on mass transportation, at events and gatherings, when traveling and anytime (and anywhere) you’ll be around other people.
  • Unvaccinated individuals age 2 and older should wear masks in public. Masks should not be worn by children under age 2 or by anyone who has trouble breathing.
  • Masks should be worn in addition to staying at least 6 feet apart, especially if indoors around people who don’t live with you.
  • Visit this CDC webpage for much more detailed information.

Should I postpone or cancel my travel plans?

The CDC recommends delaying travel until you’re fully vaccinated, because travel increases your chance of getting and spreading COVID-19. If you’re not fully vaccinated and must travel, follow the CDC’s recommendations for unvaccinated people traveling internationally or domestically.

Some people should not travel. People who are sick with symptoms of COVID-19, have recently tested positive for the virus that causes COVID-19 or have been exposed to a person with COVID-19 pose a very high risk to others during travel. See more here: https://www.cdc.gov/coronavirus/2019-ncov/travelers/when-to-delay-travel.html.

Should I avoid visiting my doctor or the hospital, or delay seeking other healthcare services, so as not to catch the virus?

If you have a serious or life-threatening condition, please continue to visit the hospital emergency department, and call 911 in all emergencies. In these cases, you should not stay home. Hospitals and healthcare providers are taking extra measures to ensure the safety of all their patients, so that vital and emergency procedures can continue.

If your condition isn’t serious or life-threatening, don’t delay, and call your healthcare provider to get his or her recommendation for what action is best in your situation. You may do the same for previously scheduled appointments for healthcare services that are not critical or timely. Your provider will help you determine your best course of action, whether that involves visiting a facility in person, receiving a service remotely (i.e. virtually) via telehealth or virtual visits, postponing a service or another option.

For more information on telehealth services and virtual visits, please see the question below, “Does my insurance cover any types of telehealth and/or virtual doctor visits?”

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.

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 medically necessary 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).*

If you get tested for other non-clinical purposes (excluding employment), our health plans will cover the testing and testing-related visits, but cost-sharing will apply.* An example of this type of testing would be pre-operative COVID-19 testing before a medical procedure, when there’s no other clinical indication.

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 below titled “will my health plan cover over-the-counter COVID-19 diagnostic tests for home use?” for more information. 

These actions, 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?

President Biden recently announced that individuals who purchase over-the-counter (OTC) COVID-19 diagnostic tests beginning on January 15, 2022 and continuing through the remainder of the public health emergency would be 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 does not apply to Medicare Advantage, Medicare Supplement and Short-Term, Limited-Duration plan members. For members on Medicare Advantage, Medicare Supplement, or Short-Term, Limited-Duration plans, the U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members.. HHS also has established more than 10,000 free, community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation. The Biden-Harris Administration is purchasing 500 million at-home, over-the-counter tests to be distributed for free to Americans who want them, with the initial delivery starting in January 2022. There will be a website where all Americans can request at-home tests for home delivery – for free. More information on this federal program is expected soon.

*Consult with your plan administrator for more details about this coverage.

Are there other resources available to get at-home COVID-19 tests?

Yes. The Biden-Harris Administration will be providing free, at-home tests to community health centers and Medicare-certified health clinics to distribute at no cost to patients and community members. Additionally, the federal government has committed to making tests available for shipping directly to your home at no cost to anyone in the U.S. by visiting covidtests.gov. We encourage you to explore these no-cost resources.

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.

What should I look for when purchasing an OTC COVID-19 diagnostic test?

We encourage you to only purchase tests that are authorized by the US Food and Drug Administration (FDA). 

According to the FDA, the at-home rapid COVID-19 test may not be as reliable in detecting the new highly contagious omicron variant. While they do detect the omicron strain, they may have reduced sensitivity. It’s also good to remember that these tests are more sensitive in people with symptoms and are most sensitive during the first week of symptoms.

The FDA also states that at-home rapid antigen tests currently available in the US are only developed and studied using nasal swabs. Swabbing your throat along with your nose could actually contaminate your sample. COVID-19 tests should be purchased from reliable sources and used as authorized, including following their instructions for use regarding obtaining the sample for testing.

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 ensure members that they’ll have access to any COVID-19 vaccines authorized for use by the United States Food and Drug Administration (FDA) as they become available.

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 will be 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 vaccine isn’t yet available to everybody. Hospitals, pharmacies, and other providers in our communities are currently working with local government officials on a phased distribution schedule, and frontline healthcare workers and those residing in nursing homes are getting the first doses in most places. As the vaccine becomes available to more people, we and your providers will keep you informed. Please remember to bring your insurance ID card or the Hally® app (on your mobile device) 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 provide benefits for a hospital quarantine stay if I am diagnosed with 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. Custodial care is not a covered expense.

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 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.

Please note that other providers in our network may also accept home-sewn masks. Please check their websites for more information.