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COVID-19 Benefits

Active Members

Effective July 1, 2023, the PEBTF provides coverage related to COVID-19, as follows:

Active Members What you pay:
COVID-19 vaccines

$0

Covered in full at a network provider under your medical plan or at a network pharmacy under your prescription drug plan

If not available at a network medical provider, full cost shall be covered without any cost sharing
Diagnostic testing, in-network inpatient hospital care, ER or urgent care for COVID-19

Appropriate copay, deductible or coinsurance

You are subject to any plan costs related to COVID-19 same as any other covered medical care

Examples include:

  • You will pay a copay for PCP, specialist, ER or urgent care visit
  • PPO members: Your inpatient hospital care and diagnostic testing, such as X-rays, are subject to the annual deductible
  • PPO members: Deductible and coinsurance apply if you receive care at an out-of-network provider
Teladoc and telemedicine visits with your Medical doctor

You will pay the appropriate copay under your medical plan
Teladoc and telemedicine visits with your Behavioral Health doctor

$0 copay under the Optum Mental Health & Substance Use benefit
COVID-19 test (processed at a pharmacy, doctor’s office or other location)

Copay applies

PPO: $0 if at a Quest Diagnostics or LabCorp; subject to your deductible elsewhere
Over the counter COVID-19 test kits

Covered 4 per member per month under your prescription drug plan; maximum reimbursement of $12 per test kit if claim form is submitted to CVS Caremark

To purchase an at-home COVID test: Present your CVS Caremark Prescription Drug ID card at the pharmacy counter.

Reimbursement for at-home tests if you did not use your Prescription Drug ID card: If you did not purchase the test at the pharmacy counter or purchased a test at a non-participating CVS pharmacy, you will need to submit a claim for reimbursement online at Caremark.com/covid19-otc. You must have a Caremark.com account to request reimbursement, but if you do not, select Register Now on the right side of the page to create one. Follow the instructions to submit for reimbursement. You will need a copy of your receipt.
Bronze Plan members: Services are subject to your annual deductible except for COVID vaccines and Behavior Health telemedicine, which continues to be covered at no cost.