Coverage during COVID-19
As part of our efforts to help prevent the spread of COVID-19, we’ve made sure you have the following coverage.
*Vaccine availability is subject to change. Appointments are required at most locations.
Be sure to call first; do not go straight to the office, urgent care or ER. Your doctor will assess your symptoms and tell you what to do next.
Find a doctor:
Individual and Family
Medicare Members
Employer-sponsored health plans
Need help choosing a doctor?
Here’s how to reach us:
Individual & Family 855-521-9342 (TTY: 711)
Medicare Advantage 844-253-3028 (TTY: 711)
Employer-sponsored health plans 855-521-9365 (TTY: 711)
DocSquad is providing free, personalized COVID-19 assessments. All COVID-19 screenings are free for Bright HealthCare members.
Coronavirus Disease 2019 (COVID-19) is on everyone’s minds. We at Bright HealthCare want you to know that we are staying current and keeping your health as our top priority. Education, prevention, and proper care are the best lines of defense. We’re responding quickly with important updates to your coverage so you can feel informed and prepared to deal with COVID-19.
As FDA-authorized vaccines for COVID-19 become available, there will be no cost to the member to receive a vaccine. That’s because Bright HealthCare will cover the cost of the administration of the vaccine for our members and the vaccine itself will be available to providers at no cost until further notice. If other services are provided during the office visit where you are vaccinated, you may be responsible for those services.
Availability of the vaccine will vary by community. Each state will have different guidelines that determine who will have access to the vaccination first. In general, emergency responders, healthcare workers and the elderly will be first to receive the vaccine. Please reach out to your local health department, which can be found here, and your provider or pharmacy to determine when you will be eligible to receive the vaccine.
Please work with your provider to receive the correct number of doses for the brand of vaccine available. As additional vaccine brands become available, some will require one dose and others will require two. You should return to the same provider or pharmacy for remaining doses if possible. You will receive a vaccination card from the vaccination site that will tell you when to return for a second dose. We will provide additional or updated information as it becomes available.
As COVID-19 continues to spread, it is vitally important to get a flu shot this year! Getting the two illnesses together greatly increases your chances of developing serious complications. Early information from other countries shows that getting a flu shot may actually make a coronavirus infection less severe. We believe anything you can do to lower your risk of experiencing severe coronavirus and/or influenza symptoms is well worth doing.
Please view our updated COVID-19 Billing Codes in the Payer Spaces/News and Announcements for Bright HealthCare within Availity.com.
View our Updated COVID-19 Policy
All COVID-19 screenings are free for Bright HealthCare members.
As part of our efforts to help prevent the spread of COVID-19, we’ve made sure you have the following coverage.
Changes are in effect until further notice.
If you have symptoms or were exposed to someone known to have the coronavirus, COVID-19 diagnostic testing and associated office visits are covered at no cost to our members, regardless of network. Testing for other purposes, such as return to work or checking one’s own antibody levels will not be covered through your health plan.
Free diagnostic testing is available from departments of health and at many public health sites. You can find them by visiting your state’s department of health website or calling a local COVID-19 hotline. Starting January 15, 2022, Bright HealthCare will cover at-home OTC COVID-19 diagnostic tests for Individual and Family Plan and Small Group members. For more details, see the “COVID-19 Over-the-Counter Test Reimbursement” section below.
All telehealth services (online and virtual care) obtained in connection with doctor-ordered COVID-19 testing and diagnosis are now covered, at no cost to our members.
If you choose to use a telehealth provider other than DocSquad you may be required to pay upfront and submit a claim to be reimbursed by Bright HealthCare.
The reimbursement forms are located here for: Individual and Family and Employer-sponsored health plans.
We hope this information helps you feel more prepared to understand, prevent, and deal with COVID-19.
After all, we’re in this together.
Yes. Not everyone who gets infected by coronavirus develops a strong enough immune response to protect against reinfection. Also, antibody levels drop over time, leading to the potential for reinfection.
No. You should get fully immunized as soon as possible. Consult with your doctor.
Refer them to reputable sources such as their healthcare providers and public health authorities.
The CDC recommends a minimum interval of 14 days between receiving the COVID-19 vaccine and any other immunizations. A shorter period may be used if the benefit outweighs the potential unknown risks of vaccine coadministration, or to avoid barriers or delays to COVID-19 vaccination. Please consult with your provider regarding your particular health situation.
The CDC now recommends that children 5 to 11 years old be vaccinated against COVID-19 with the Pfizer-BioNTech pediatric vaccine. Immunizing children helps protect them against COVID-19 and reduces transmission of the virus in the community. Vaccinating children reduces disruptions to their in-person learning and other activities. Trials of other vaccines in young children are underway, and future vaccinations may include them.
COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant. Pregnant women who get COVID-19 are at greater risk for:
There is no evidence that COVID-19 vaccines cause fertility problems in women or men. Getting vaccinated may help pregnant women protect their babies from COVID-19 by sharing antibodies that travel through the placenta.
If you are pregnant, you might want to have a conversation with your provider about COVID-19 vaccination. While such a conversation might be helpful, it is not required before vaccination.
No. Most commercial antibody tests are looking for antibodies against a different protein than the one in the vaccines. This will lead to false-negative results. The CDC also doesn’t recommend antibody (or diagnostic) testing before vaccination.
Yes! Starting January 15, 2022, Bright HealthCare will cover at-home OTC COVID-19 diagnostic tests for Individual and Family Plan and Small Group members. Members can purchase at-home OTC COVID-19 diagnostic tests online or at a pharmacy or store. Diagnostic COVID-19 tests must be authorized by the U.S. Food and Drug Administration (FDA).
Yes, but we will reimburse you! After you purchase your test, submit a reimbursement claim form along with the proof of purchase to the Bright HealthCare mailing address listed on the form. You may also visit the Member Hub and send a secure message with the reimbursement form and proof of purchase attached. You can find the reimbursement claim form and instructions here.
If you have a health FSA or HSA: Please note that the cost of OTC COVID-19 tests cannot be reimbursed by Bright HealthCare if you use your FSA or an HSA to purchase the test, pursuant to federal law. If you are going to submit your test purchase for plan reimbursement, do not use your health FSA or HSA debit card to purchase the OTC COVID-19 tests.
Supply is currently limited nationwide. Please visit your pharmacy or your favorite retailers online or in person to find out if they have tests available.
Bright HealthCare will reimburse you for the actual cost of the test when you submit a reimbursement claim form and provide proof of purchase of a diagnostic COVID-19 test that has been authorized by the U.S. Food and Drug Administration (FDA).
If you have a health FSA or HSA: Please note that the cost of OTC COVID-19 tests cannot be reimbursed by Bright HealthCare if you use your FSA or an HSA to purchase the test, pursuant to federal law. If you are going to submit your test purchase for plan reimbursement, do not use your health FSA or HSA debit card to purchase the OTC COVID-19 tests.
Only diagnostic COVID-19 tests that are authorized by the U.S. Food and Drug Administration (FDA) will be covered by your health plan. Approved tests include the following:
The CDC recommends testing when you have symptoms that may be due to COVID-19, or at least five days after exposure to a known COVID-19 case to get the best results. You should follow package instructions (like testing on two separate occasions if the package includes two tests) to obtain a more definitive result.
If you are experiencing a health emergency, please call your doctor or go to a hospital immediately.
Only tests purchased on or after January 15, 2022, are covered by your Bright HealthCare plan (in accordance with federal law).
To be reimbursed for a test you paid for up-front, please submit a reimbursement claim form:
Bright HealthCare will mail you your reimbursement for the cost of the test.
Bright HealthCare pledges to reimburse members promptly for test purchases. Once we receive your form by mail, your reimbursement will be mailed to you. Bright HealthCare will pay, deny, or settle the claim within the turnaround times established by applicable state law.
No. Bright HealthCare is not required to cover work-mandated tests. Please speak with your employer if you have concerns about the cost of testing for employment purposes.
Yes. The U.S. Postal Service is coordinating the federal government’s program to distribute free tests. Visit the USPS COVID-19 test kit page here.
Paxlovid (Pfizer) is approved for patients who:
Molnupiravir (Merck) is approved for patients who:
Older adults and people with certain underlying medical conditions are more likely to get severely ill from COVID-19. People from certain ethnic minority groups and people with disabilities are also at increased risk. See the CDC’s list of underlying medical conditions here.
Yes. Both Paxlovid and molnupiravir are available by prescription only.
There will be no cost to you. The federal government will pay for the country’s supply, and Bright HealthCare will pay pharmacies for dispensing the medication to you.
It must be prescribed by your provider. Supply is very limited (as of December 2021). Medication supplies were allocated to states and jurisdictions, who will then select their partnered pharmacies. Check your state COVID-19 website for local pharmacy listings and availability.
The United States ordered millions of additional treatment courses of Paxlovid and molnupiravir to make them more available in 2022.
Yes. According to the CDC, oral treatment for COVID-19 at any time before or after COVID-19 vaccination is unlikely to impair antibody response. However, data is limited on the effectiveness of COVID-19 treatment in vaccinated individuals, because fully vaccinated individuals were not included in clinical trials.
Your provider will advise you about the use of oral medications if you have all of the following:
You are considered fully vaccinated:
Or
If you received Pfizer-BioNTech or Moderna
You should get a booster if you are:
When to get a booster:
Which booster should you get?
If you received Johnson & Johnson’s Janssen
You should get a booster if you are:
When to get a booster:
Which booster should you get?
You may choose which COVID-19 vaccine you receive as a booster shot. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.
Yes because vaccination significantly reduces the chances severe disease that results in hospitalization and death.
You may not be as well-protected as healthy individuals who are fully vaccinated. People may have lower immunity if they are older, on dialysis, or on certain medications for cancer, autoimmune conditions or other issues. You may need to continue to follow the recommended precautions for unvaccinated people to get the most protection. Talk to your doctor to get advice about your circumstances.
For additional information, visit this CDC webpage: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html
No. You should follow the precautions for unvaccinated people.
For additional information, visit this CDC webpage: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
Follow local public health guidance. CDC has recommended that vaccinated individuals wear masks indoors in areas where transmission of the virus is substantial or high. With the rapid spread of Delta, it’s recommended to proactively use masks indoors and in crowded outdoor settings to minimize the chances of increasing transmission to a significant degree.
No. You don’t need to get tested before or after travel, or to self-quarantine after US travel.
Pay close attention to the situation at your international destination before traveling outside the United States. For more details on international travel, click here: travel
Fully vaccinated people should get tested 5–7 days after being exposed to COVID-19, even if they don’t have symptoms. They should wear a mask indoors in public for 14 days following exposure or until they receive a negative test result. They do not need to quarantine after contact with someone who has COVID-19 unless they have symptoms or a positive test result.
When you travel, you will still be required to wear a mask on planes, buses, trains, and other forms of public transportation.
Watch out for symptoms of COVID-19, especially if you’ve been around someone who is sick. If you have, you should get tested and self-quarantine.
First, make sure you are getting your facts from a trusted source. The CDC and your local health authorities are the best places to go for the most accurate, up-to-date information. State governments may have travel restrictions in place, so please be aware of these and how it may affect your travel plans. For up-to-date information and travel guidance, the CDC has state and local health department information here. Here are some resources we think you’ll find valuable:
Call 411 or check online to find out if your state or city department of health has an information hotline number.
Visit your local hospital’s website.
Always call your doctor before going to the doctor’s office. Call an urgent care or hospital if you can’t reach your doctor.
Because immunity decreases over time and not everyone gets the same level of immunity to start with.
Mask use recommendations apply to settings outside of the household. Follow local public health guidance. You may choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.
Below summarizes advice from the CDC regarding when you should isolate yourself:
*A diagnostic test finds the virus itself in someone who is carrying it—especially if that person has COVID-19 symptoms. Antibody tests are not diagnostic.
IMPORTANT: See additional advice below.
If you need to isolate:
Local health authorities usually follow the same guidance and may occasionally have different requirements. Talk to your doctor or a local health authority.
Always let your doctor know about your circumstances, especially if you are in a high-risk group.
If you were exposed and develop symptoms suspicious of COVID-19 consult with your doctor. If you have even mild symptoms, call ahead before going to the doctor’s office, urgent care or the emergency room. This way you know before arriving where to go and what to do when you get there.
IMPORTANT: If you have a severe immune system condition, talk to your doctor. You may need to stay home longer than the period suggested below. A negative diagnostic test may be used to determine the end of isolation for people with severe immune conditions. This would be done in consultation with an infectious disease specialist. Note: A negative diagnostic test is actually two negative results of tests done at least 24 hours apart.
The virus is thought to be spread mainly from person to person through close contact (about 6 feet or less) for about 15 minutes in a 24-hour period. The most likely way to get sick is to come into contact with the respiratory droplets from an infected person that they produce when they talk, sneeze, or cough. COVID-19 is also present in their stools.
However, it’s possible to get infected through handshakes or contact with infected surfaces or objects. Most common surfaces include counters, tabletops, doorknobs, toilets, phones, keyboards, keys, light switches, etc.
COVID-19 can feel a lot like a cold or the flu. In fact, the Coronavirus is a class of viruses best known for causing the common cold. The main symptoms are:
Less-common symptoms include loss of sense of smell, sore throat, runny nose, abdominal complaints, and headache. Other less-frequent symptoms may also occur.
As with other infectious conditions, these prevention basics are your best defense:
The virus spreads mainly from person to person through close contact (about 6 feet or less) for about 15 minutes in a 24-hour period. The virus can travel more than six feet, especially in winter’s drier indoor air. It can also hang in indoor air for many hours, especially if no fresh air is circulated. Open windows to circulate the air whenever possible. The most likely way to get sick is to come into contact with the respiratory droplets from an infected person that they produce when they talk, sneeze, or cough. COVID-19 is also present in their stools.
However, it’s possible to get infected through handshakes or contact with infected surfaces or objects. Most common surfaces include counters, tabletops, doorknobs, toilets, phones, keyboards, keys, light switches, etc.
It is highly recommended to use cloth face coverings -- whether you have symptoms or not -- to help prevent the spread of infection. In many communities, facemasks are required to be worn in public. The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders. Face coverings do not replace the need for social distancing. Homemade masks should be thick enough to prevent blowing out a candle or seeing light through it. For example, fleece gaiters are too thin to prevent viral particles from passing through them.
We will do our best to keep you up to date as more information becomes available.
Scientists will continue to look for any rare side effects in the months after immunization. You can help, too, by downloading the V-safe app to tell the CDC if you have side effects after COVID-19 vaccination. Find information about the app here.
If you have a specific health condition and are concerned about the safety of the vaccination, be sure to consult with your provider.
Yes. The majority of molecular tests detect the UK variant. The FDA is monitoring new SARS-CoV-2 variants to ensure that authorized tests continue to provide accurate results. Please consult with your provider.
Find Bright HealthCare’s latest news here.
If you’re concerned about your symptoms, call your doctor before going into the office. They are trained to ask the right questions and give you the best advice about any needed precautions or instructions. Be sure to mention:
If you can’t reach your doctor, call an urgent care or hospital before visiting. If you’re directed to the emergency room, call them for any special instructions before you leave.
If you go to your doctor for any reason, even if you do not believe you’re at risk for COVID-19, call your doctor before going into the office. They may need to make special arrangements to protect other patients.
Ask your doctor or hospital if they offer virtual or online visits (telehealth) for flu symptom or COVID-19 evaluation and treatment, or click here to be connected with DocSquad.
There are diagnostic tests available for patients with symptoms who may have COVID-19 and for individuals who were exposed to someone known to have the coronavirus. A healthcare professional will determine if you should be tested. Your doctor is your best resource, but urgent care centers, hospitals, and emergency rooms have access to the test, too. Drive-through testing is available in many communities. Try to stick with in-network providers. Out-of-network services may come with a bill from the provider.
Antibody testing is not diagnostic, and decisions about isolation and quarantine should not be based on the results. As a caution, we want you to be aware that antibody testing has been used by some to generate revenue for themselves without regard to the test’s limited value.
Testing for purposes such as returning to work or checking antibody levels won’t be covered through your health plan. Free diagnostic testing is available through other community resources and can be found by visiting your state’s department of health website or calling a local COVID-19 hotline.
The flu shot is extra-important this season because people are more likely to get very sick or even die if they are infected with the flu and COVID-19 at the same time. The cost of your vaccination is included in your plan. Even if it is past the holiday season, if you haven’t had your shot yet, we urge you to do it soon. Because of the high demand this year, supplies may run low.
We’re always happy to help answer coverage questions, help you find a doctor, and more. Contact us here.