(Updated Feb. 2, 2020)

Moda has received questions and concerns about the novel coronavirus (respiratory illness), COVID-19 and would like to keep you informed with the most-up-to-date information as it relates to your health and benefits.

To keep everyone safe, providers may:

• Keep following social distancing rules
• Ask patients to wear masks
• Check all patients’ temperatures

If you need care that was delayed because of COVID-19, call your provider to schedule an appointment. Your provider may also call you to schedule treatment.

If you already have a provider and need to get care from home, call them to learn about their telehealth options.

If you need to find a provider, you can search for one using Find Care in Member Dashboard. If you have questions or need help finding a provider, call us at the Medical Customer Service number on your identification card.

COVID-19 vaccine availability

As the COVID-19 vaccine becomes available, cost-sharing (i.e., copayments, coinsurance and deductibles) will be waived.

Please keep in mind that at first, supply of the COVID-19 vaccine will be limited. The state will determine how the first supplies of vaccine allotted will be prioritized among the population.

The Oregon Health Authority will continue to communicate further vaccine developments/distribution and will consider guidance from the Centers of Disease Control (CDC) to prioritize vaccine administration for additional high-risk groups in subsequent vaccine phases. The FDA-approved COVID-19 vaccines are only available for certain groups at this time. Please visit covidvaccine.oregon.gov to see when you can get vaccinated.

Your benefits

If you have an HSA-eligible high deductible health plan (HDHP)

Under current law, HDHPs are effectively prohibited from covering any medical services not deemed preventive care prior to an enrollee satisfying their deductible, as the taxpayer would be subject to federal income tax penalties.

However, the IRS has posted a notice that extends broad relief, allowing pre-deductible coverage of both testing and treatment of COVID-19, as determined by the health plan. Because the COVID-19 vaccine is considered preventive care, cost-sharing – including the deductible – is waived.

Additional benefits for Oregon medical members on Individual and Family plans or Employer Group* plans

Cost-sharing is waived for COVID-19 vaccines.

Cost-sharing is waived for COVID-19 testing needs, including:

• A telehealth visit to be evaluated for COVID-19 testing
• Provider office visit, urgent care center visit, or emergency room visit to be tested for COVID-19
• COVID-19 lab tests for all testing facilities
• Serological anti-body tests
• Other testing received during a COVID-19 testing visit, when administered to determine the need for COVID-19 testing

This is applicable to in-network and out-of-network providers, facilities and laboratories.

For members covered on an Individual or Family plan or fully-insured Employer Group* only, cost-sharing is also waived for the in-network medical treatment of COVID-19, both inpatient and outpatient, and FDA-approved medications administered inpatient for the treatment of COVID-19, for services received April 1, 2020 – March 31, 2021. Terms of coverage otherwise apply, including eligibility and medical necessity.

*Please note these additional benefits broadly apply to most fully insured plans. Self-funded plans, OEBB and PEBB may or may not offer this same coverage. To find out if you are enrolled in a self-funded plan, refer to the bottom of your ID card for “third-party administrator” language. If you are enrolled in a self-funded plan, OEBB or PEBB, contact your employer to learn about COVID-19 coverage available to you.

If you have a Medicare Supplement Plan

Cost-sharing is waived for the COVID-19 vaccine.

Cost-sharing is waived for COVID-19 testing needs, including:

• A telehealth visit to be evaluated for COVID-19 testing
• Provider office visit, urgent care center visit, or emergency room visit to be tested for COVID-19
• COVID-19 lab tests for all testing facilities
• Serological anti-body tests
• Other testing received during a COVID-19 testing visit, when administered to determine the need for COVID-19 testing

If you have a Medicare Advantage plan

Cost-sharing is waived for the COVID-19 vaccine.

Cost sharing is waived for COVID-19 testing needs, including:

• A telehealth visit to be evaluated for COVID-19 testing
• Provider office visit, urgent care center visit, or emergency room visit to be tested for COVID-19
• COVID-19 lab tests for all testing facilities
• Serological anti-body tests
• Other testing received during a COVID-19 testing visit, when administered to determine the need for COVID-19 testing

This is applicable to in-network and out-of-network providers, facilities and laboratories.

How to protect yourself

Everyday preventive actions that help prevent spreading respiratory viruses are the first step in protecting yourself and those around you.

• Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
• Avoid touching your eyes, nose, and mouth with unwashed hands
• Avoid close contact with people who are sick
• Stay home when you are sick
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash
• Clean and disinfect frequently touched objects and surfaces

These are everyday habits that can help prevent the spread of several viruses. CDC does have specific guidance for travelers.

If you think you are infected

If you are experiencing symptoms of novel coronavirus, such as fever, dry cough or shortness of breath, or believe you have been exposed to COVID-19, we recommend calling your doctor immediately.

In addition to the benefits outlined above, all current Moda benefits apply. They may cover additional care options, such as virtual visits, eDoc (available on Member Dashboard) and calls to our Registered Nurse Advice Line (866-321-7580) if you can’t get in to see your PCP.

Additional resources

If you still have questions about COVID-19 and how it could affect you, the CDC has official responses to frequently asked questions on its website.

It is important to continue to arm yourself with information from credible health care sources on the front lines of studying this virus, such as the CDC and the Oregon Health Authority.