Moving toward a healthier community

COVID-19 vaccines that have received Emergency Use Authorization (EUA) or been approved by the FDA External Link, will be covered at no cost share through the Cares Act.

Once a vaccine is authorized or approved by the FDA and receives an Advisory Committee on Immunization Practices (ACIP) recommendation on its vaccination index, it will be covered as a preventive service through the Affordable Care Act (ACA) Preventive services benefit.

The COVID-19 vaccines currently available were proven to be highly effective across diverse races and genders. So, across the U.S., every family and neighborhood can expect the same effectiveness and protection.

COVID-19 vaccines have gone through the same rigorous safety assessment as all vaccines before being authorized for use in the U.S. by the FDA. When it comes to safety, you can be assured there have been no shortcuts. The unprecedented speed of the COVID-19 vaccines was due to multiple factors, including past research into these types of vaccines. COVID-19 is caused by the SARS-CoV-2 virus. Research was already underway to prevent past coronavirus diseases such as SARS and MERS and that experience helped jumpstart work on our current vaccines. When the current pandemic hit, scientists were able to build on their past research to develop the COVID-19 vaccines in use today.

Health experts recommend the COVID-19 vaccine even for people who have had a COVID-19 infection. Although infection likely provides some immunity to reinfection, we don't know yet how long natural immunity lasts. So, it's important to still get vaccinated even if you've had COVID-19 to reduce the risk of reinfection—to protect yourself and others around you. Your health care provider can help you determine the best time to get vaccinated after a COVID-19 infection.

All adults are eligible to get the COVID-19 booster dose at least six months after the second vaccine dose (if a two-dose series) or after the initial vaccine dose (if a single dose vaccine).

Wellmark recommends you talk to your primary care physician about when you should receive your booster shot. To learn more about the COVID-19 booster shots we encourage you to review the CDC's frequently asked questions External Link.

Yes, we will continue to waive cost shares for most testing and related services through the end of the public health emergency as declared by the federal government. For the test to be waived, it must be ordered by a health care provider after the provider individually assesses the member and decides a test is medically appropriate based on the member's circumstances. This can include at-home tests that are ordered by a provider after a clinical assessment is completed. Your health plan does not cover return to work/return to school/return to other activity testing, and it does not cover tests that are not ordered by a health care provider or except for over-the-counter COVID 19 tests.

Wellmark will cover OTC COVID-19 tests through the end of the public health emergency as declared by the federal government, subject to certain limitations:

To be covered/reimbursed, the OTC COVID-19 test must be purchased on or after January 15, 2022. Wellmark will not be reimbursing OTC COVID-19 tests purchased before that date.

• The OTC COVID-19 test must be approved by or have an emergency use authorization from the FDA. Visit the FDA's website External Link to make sure the test you are planning to purchase qualifies for coverage. Enter "OTC" in the search box to see the list of 13 tests that qualify.
• The OTC COVID-19 test must be one for which you collect your own specimen and read the test at home. OTC COVID-19 tests that require you to drop off or mail your specimen to a laboratory are not covered under the OTC COVID-19 test coverage.
• Members will only be reimbursed for up to eight OTC COVID-19 tests per member (including dependents on the same health plan) every 30 days. As an example, if a family has five members on the same health plan, the family is eligible to be reimbursed for up to 40 OTC COVID-19 tests every 30 days.
• OTC COVID-19 tests must be purchased from the pharmacy counter of an in-network pharmacy to receive direct coverage. If purchased from any retailer at a regular check-out, you will need to pay retail price and submit a claim to CVS Caremark for reimbursement.
• OTC COVID-19 tests covered by your health plan are for the personal use of the member requesting reimbursement from the health plan and their dependents on the same health plan. These tests should only be used by that member and their dependents.

The federal government has made four free at-home COVID-19 tests available to each American household. Visit this site External Link to submit an order. Also, Wellmark has partnered with CVS Caremark to provide members with a streamlined purchase experience where members will not have to pay anything up front for the OTC COVID-19 test in most situations. You must purchase the test from the pharmacy counter of an in-network pharmacy to be covered with no out-of-pocket costs. If you purchase the test from a regular check-out, you will need to pay retail price and submit a claim to CVS Caremark for reimbursement.

• OTC COVID-19 tests only qualify for coverage and reimbursement if the test is both self-administered and self-read at home – no laboratory or health care provider involved.
• Visit the FDA's website External Link to make sure the test you are planning to purchase qualifies for coverage. Enter "OTC" in the search box near the middle of the page to see the list of tests that qualify.
• With demand for OTC COVID-19 tests often being greater than available supply, there are quite a few OTC COVID-19 tests being sold that have not been approved or authorized by the FDA, fake tests being sold that look like authorized FDA tests but are counterfeit, and scams where you pay for an OTC COVID-19 test but never receive it. Online purchases of OTC COVID-19 tests are particularly vulnerable to potential fraud, so it's important that you make sure you are buying OTC COVID-19 tests from valid and trustworthy pharmacies and sellers. The FTC has compiled some tips on identifying unauthorized/fake tests External Link and scams when purchasing OTC COVID-19 tests online. Pharmacies and large national retailers are your best bet to purchase a qualifying OTC COVID-19 tests.

If you have pharmacy benefits through Wellmark:

To avoid having to submit a claim for reimbursement, purchase from the pharmacy counter at an in-network pharmacy. Otherwise, Wellmark members must submit claims for OTC COVID-19 tests through CVS Caremark External Link.

• If starting from myWellmark®:
• Log in
• Once you are in myWellmark, click "Find a Pharmacy"
• If you already have an account with CVS Caremark, clicking on "Find a Pharmacy" will take you straight to your CVS Caremark portal
• If you do not have an account with CVS Caremark, clicking on "Find a Pharmacy" will take you straight to the CVS Caremark website where you will need to create a CVS Caremark account
• Once on the CVS Caremark website:
• Log into your CVS Caremark account
• Once you are in the CVS Caremark portal, go to Plan and Benefits and click "Submit Prescription Claim"
• Click "Submit at-home COVID-19 test reimbursement claim". The form will walk you through the claim submission process step-by-step.
• After you complete the form, you can upload a picture of your receipt electronically. Note: Do not write on the receipt or cross items off the receipt.
• Submit the form to process the claim.

If you purchase an OTC COVID-19 test at an out-of-network pharmacy or a non-network retailer, your reimbursement may be limited to $12 per test (or $24 for a box of two tests).

If you don’t have pharmacy benefits through Wellmark:

Many plans whose pharmacy benefits claims are processed by someone other than CVS Caremark (through Wellmark) have decided to cover OTC COVID-19 tests through the pharmacy benefit instead of the medical benefit. If your plan does not have pharmacy benefits with Wellmark through CVS Caremark, you should contact your employee benefits department for information on how and when you can submit claims for reimbursement of these tests.

No. COVID-19 testing performed so that a member can travel, including, but not limited to, flying internationally or boarding a cruise, is not a covered health plan benefit.

Wellmark recommends checking with your primary care provider first. Most medical clinics and offices have procedures in place to get you tested safely, quickly, and with reliable results. Your primary care provider can also advise you on how to quarantine if needed or help effectively monitor symptoms given prior knowledge of your health conditions and medical background.

There are several alternate means of testing that are reliable and safe.

In Iowa, visit TestIowa.com External Link. At this website you can find the closest location to pick up an at-home PCR test, as well as read instructions on how to accurately take the test and return for analysis. The website also allows you to order COVID-19 at-home tests to be delivered via mail, so you can keep handy for future use. All tests are free.

In South Dakota, visit COVID.SD.gov/testing External Link. This website contains information on drive-up locations and hours at which you can have a COVID-19 test conducted. It also has instructions on how to order and take an at-home saliva PCR test kit and return it for analysis. Both testing methods — at-home and drive thru — are free.

The federal government has made four free at-home COVID-19 tests available to each American household. Visit this site External Link to submit an order.

Rapid antigen tests are now available over-the-counter at pharmacies and various other retailers, and will be covered by your health plan subject to certain limitations.

In response to many physician and dentist offices in the markets eliminating or severely restricting in-person visits, Wellmark expanded telehealth benefits on a temporary basis to ensure all our members had access to important health care services. The $0 cost-share for telehealth services expired on Aug. 31, 2020.

Even though the pandemic still exists, members have choices between telehealth and in-person visits. Beginning Sept. 1, 2020 standard benefits applied for telehealth services.

Consistent with the federal requirements, antibody testing is covered when ordered by a health care provider after the provider individually assesses the member and decides a test is medically appropriate based on the member's circumstances.

All of Wellmark's fully insured and Medicare supplement plans include a telehealth benefit. If your self-funded group plan does not offer telehealth benefits, effective Sept. 1, 2020, you may be responsible for the full amount charged by the telehealth provider which is generally no more than an in-office visit.

Please note: If telehealth is not a covered benefit on your plan, the cost share will not apply towards an out-of-pocket maximum. Employees are always encouraged to further discuss their health insurance options/needs with their employer.

Doctor On Demand has contracted with Medicare and will now be covered by your Medicare supplement policy according to your benefits.

Get tactics for protecting yourself at home, at school and in the workplace.

• Clean hands often and limit handshaking
• Disinfect surfaces you touch frequently
• Wear a mask when you are around people who don't live in your household
• Hold meetings virtually and rearrange travel when possible
• Know when to stay home
  

See the CDC's recommendations.

Download the guide External Site

Wellmark uses the guidance from the World Health Organization (WHO) External Site, the Centers for Disease Control and Prevention (CDC) External Site, Iowa Department of Public Health (IDPH) External Site, and South Dakota Health Department External Site as our official sources of information. For the latest U.S. impacts of COVID-19, please see the data reported by the CDC.