Your frequently asked questions about COVID-19 (coronavirus)
Have a question about COVID-19? We’re here to help.
What COVID-19 vaccines are available?
COVID-19 vaccines continue to be an important step in reducing risk of severe disease, hospitalization, and death, as well as in slowing the spread of the virus. The Centers for Disease Control and Prevention (CDC) recommends everyone ages 5 and older get vaccinated to help protect against COVID-19.
Currently, three vaccines are authorized and recommended in the United States to prevent COVID-19. According to the CDC, Pfizer-BioNTech or Moderna mRNA vaccines are preferred. Johnson & Johnson’s Janssen COVID-19 vaccine is available in some situations.
- Pfizer-BioNTech is authorized for anyone age 5 and older.
- Moderna is recommended for people 18 years and older.
- Johnson & Johnson’s Janssen is available for people 18 years and older.
Will AmeriHealth New Jersey cover the cost of getting a COVID-19 vaccine?
Yes. AmeriHealth New Jersey covers the cost of health professionals administering the vaccine with no cost sharing (co-pays, deductibles, coinsurance) for members regardless of where the vaccine is given or if the health professional administering the vaccine is in the AmeriHealth New Jersey network.
- Cost-sharing for COVID-19 vaccines being administered to high-deductible health plan members by health care providers in and out of the AmeriHealth New Jersey network is being waived before deductible.
- Cost-sharing for COVID-19 vaccines administered by a home health agency is being waived, even if the home health agency is not in the AmeriHealth New Jersey network. The requirement that a member needs to be home-bound to receive the vaccine from a home health agency is being waived for COVID-19.
- Cost-sharing for members who get the COVID-19 vaccine from a health care provider in or out of the AmeriHealth New Jersey network during a preventive office visit is being waived. If a member gets the COVID-19 vaccine from a health care provider but the office visit is not considered preventive, cost-sharing for the office visit will still apply.
Are COVID-19 boosters available?
Yes. Boosters are authorized for anyone 12 years and older.
- Those who received their second dose of the Pfizer-BioNTech or Moderna vaccine more than six months ago, regardless of health status or occupation, are eligible for a booster under federal guidelines.
- Adults who received the Johnson & Johnson vaccine more than two months ago are also eligible.
- Those age 12 and older who completed the primary series of the Pfizer-BioNTech vaccine five months ago are also eligible.
For Children ages 5-11:
- A single Pfizer-BioNTech COVID-19 vaccine booster dose for children is recommended at least 5 months after the primary series is administered.
Some people may be eligible for a second booster, including:
- Adults ages 50 years and older
- People ages 12 years and older who are moderately or severely immunocompromised
- People who got 2 doses (1 primary dose and 1 booster) of Johnson & Johnson’s Janssen vaccine
The CDC shared guidelines for getting a second booster.
Does AmeriHealth New Jersey cover COVID-19 boosters?
Yes. AmeriHealth New Jersey covers the cost of administering booster shots to commercial members with no cost-share.
Can I get a COVID-19 booster that’s a different brand than the one I got the first time?
Yes. Some people may prefer the vaccine type that they originally received, and others may prefer to get a different booster. The Centers for Disease Control and Prevention’s recommendations now allow for this type of mix and match dosing for booster shots for anyone 16 years and older.
For those who received the Johnson & Johnson’s Janssen shot, there is research that supports following up the initial dose with either Pfizer or Moderna could produce a stronger immunity response than a second dose of the Johnson & Johnson’s Janssen vaccine.
Can AmeriHealth New Jersey help me obtain a vaccine and/or booster?
AmeriHealth New Jersey does not control the availability or distribution of any vaccines or boosters. Distribution of the vaccine and boosters is controlled by the federal government, in collaboration with local and state governments and Departments of Health. To find a location near you, visit Vaccines.gov.
Does AmeriHealth New Jersey provide reimbursement to providers for administering the vaccine and/or boosters?
Yes. AmeriHealth New Jersey takes responsibility as a health plan to bear the costs for the administration of COVID-19 vaccines and boosters for its commercial members.
When and where can I get the COVID-19 vaccine?
New Jersey residents, five years and older are currently eligible to be vaccinated. You can check Vaccines.gov to locate potential vaccine distribution sites in your area. AmeriHealth New Jersey has no control over the availability and prioritization of distributing the vaccine.
New Jersey residents can also check New Jersey’s vaccination page for more information on vaccine availability.
Does AmeriHealth New Jersey cover COVID-19 testing?
Yes. AmeriHealth New Jersey covers the cost for medically appropriate diagnostic and antibody testing that is ordered by a physician or authorized by a health care professional at no cost to the member. This coverage is in accordance with federal mandates through the end of the federal state of emergency. AmeriHealth New Jersey does not cover tests that are needed for return to work, a condition of employment, return to school, or travel.
Members should report any concerns about claim payment to our customer service staff at the number on their member card. If you have any questions about whether you should be tested, please contact a health care professional.
Does AmeriHealth New Jersey cover over-the-counter COVID-19 tests?
Yes. On January 15, 2022, AmeriHealth New Jersey began covering up to eight FDA-approved over the counter COVID-19 tests per calendar month as directed by the Biden administration.
Which tests are covered? Coverage includes at-home COVID-19 test kits authorized by the Food and Drug Administration (FDA). The most common tests are BinaxNOW™, Flowflex™, InteliSwab™, On/Go™ and QuickVue®.
Is there a limit to how many tests will be covered? Covered members can get up to 8 individual tests per month. For example, a family of 4 would be eligible for 32 tests a month.
Where can I get a test kit at no cost? You can get an FDA-authorized COVID-19 test kits at Walmart, Sam’s Club, Rite Aid, and Walgreens for no out-of-pocket cost. Simply go to the pharmacy counter, present your member ID card, and ask to have the test submitted to OptumRx.
What about other stores or online retailers? You can also purchase an FDA-authorized over the counter COVID-19 test kit at other stores or online retailers. Keep your purchase receipt(s) to submit for reimbursement. You can be reimbursed for up to 8 tests per covered member, per month without a prescription. You will be reimbursed up to $12 per test by submitting a claim. Please note: Some pharmacies and other stores are experiencing supply shortages for these tests.
How do I submit a claim? If you paid out-of-pocket for a test you purchased on or after January 15, 2022, submit a claim online. A separate claim must be submitted for each covered member. If you prefer, you can also print a mail-in form.
When can I submit my claim? You can submit your claim now for covered tests purchased on or after January 15, 2022. Please submit your claim within one year of your purchase date. Reimbursement will be available through the end of the emergency health period.
How can members find a testing location?
If you suspect that you may have COVID-19, your first step should be to contact your primary care doctor. Your primary care doctor will screen you for testing based on CDC guidelines. If you meet the testing criteria, your doctor will discuss testing options with you.
If you don’t have a primary care doctor but have telemedicine benefits, you may be able to contact an MDLIVE physician without cost-sharing.² MDLIVE physicians can perform COVID-19 screening and help you determine next steps. You can register for MDLIVE at amerihealthnj.com.
You can also search for a testing location by zip code. Or, contact your state health department for information on testing. New Jersey residents can contact the NJ Department of Health for more information at 1-800-962-1253 or 1-800-222-1222.
Does AmeriHealth New Jersey cover the cost of COVID-19 treatment for its members?
Yes, for commercial members, AmeriHealth New Jersey covers in-network, inpatient treatment of COVID-19. Standard cost-sharing will apply.
Are telemedicine services for COVID-19 covered?
Yes. AmeriHealth New Jersey covers telemedicine for COVID-19 related services.
Telemedicine services with in-network primary care doctors, specialists, and behavioral health providers are covered through the federal state of emergency for COVID-19 related services. Services must be for testing or to diagnose COVID-19.¹ Normal member cost-sharing applies to telemedicine services that are not related to COVID-19. Some members can also access MDLIVE for telemedicine visits.2 Cost-sharing for those visits vary based on members’ benefits. If you have questions about your access to MDLIVE telemedicine services, please check your member benefits at ibx.com. Members can also access MDLIVE through our member website.
(Note: Self-funded groups will have the option of asking for a benefit exception to continue waiving cost-share).
Does AmeriHealth New Jersey cover telemedicine services for members that don’t have a COVID-19 diagnosis?
Yes. AmeriHealth New Jersey has a permanent telemedicine policy for fully insured and self-funded commercial members. The policy covers many of the expanded telemedicine services made available during COVID-19 and includes substantially more telemedicine services than the policy that was in place before the pandemic. For example, prior to the pandemic, AmeriHealth New Jersey only offered coverage for primary care telemedicine visits whereas the updated policy covers telemedicine for many specialty services, including:
- Evaluation and management services for primary care and many specialty services (e.g., office/outpatient visits for most preventive medicine services, cardiology, pulmonary, etc.)
- Speech therapy
- Medical nutrition therapy services
- Transitional care management
- Hospice care
- Lactation counseling
- Specific behavioral health
- Medical genetics and genetic counseling
Please note that there are some services better performed face-to-face that we covered through telemedicine at the height of the pandemic to keep everyone safe and healthy that are no longer covered through telemedicine under the permanent policy.
Does AmeriHealth New Jersey cover telemedicine services from non-participating providers for members with out-of-network coverage?
Given AmeriHealth New Jersey’s broad network, it is unlikely that a member would need to seek care from an out-of-network provider. Telemedicine visits from out-of-network providers are covered for commercial members with out-of-network coverage and are subject to the out-of-network cost-sharing under the member’s benefit plan. This applies to specialists, including behavioral health providers.
How is AmeriHealth New Jersey communicating with its employees about COVID-19 and keeping them safe?
AmeriHealth New Jersey remains steadfast in the aim to reduce the impact of COVID-19 on our workforce, our members, our customers, and our business. We communicate regularly with our employees and have taken many steps to safeguard their health. We remain committed to maintaining high-performing operations to ensure the stability of our business and service to our members and customers.
How is AmeriHealth New Jersey addressing the needs of the health care community on the frontlines of fighting COVID-19?
AmeriHealth New Jersey is fortunate to have strong relationships with the health care community that provides care for its members.
We launched a range of clinical and business initiatives since the start of the pandemic to address the key needs of the health care community on the frontlines of fighting the virus. These initiatives were put in place to help ensure that providers had the support they needed to continue delivering high-quality care to their patients.
Our COVID-19 Provider Hub, which outlines many of these initiatives, is accessible to doctors, hospitals, health systems, and other health care professionals. We have also been communicating the latest news and information about COVID-19 to providers through our existing communication channels.
If someone wants more information about COVID-19, where should they go?
If you are looking for more information about specific symptoms you are experiencing or have questions about your personal health, we recommend you contact your doctor. For reliable information about COVID-19, we suggest visiting the Centers for Disease Control and Prevention (CDC) website at cdc.gov/coronavirus. The State of New Jersey has also established a website with information about COVID-19.
How can members protect themselves against fraud?
Unfortunately, fraud exists everywhere. AmeriHealth New Jersey, like many other organizations, have received some reports of potential frauds and scams related to COVID-19.
Members should be aware of individuals attempting to profit from this emergency and should remain diligent in protecting personal and health insurance information. Some of the reports we have received include:
- Individuals and businesses selling fake tests, treatments, and cures for COVID-19 online
- Phishing emails from entities posing as trusted organizations like the World Health Organization or the Centers for Disease Control and Prevention
- Online sellers falsely claiming to have in-demand products like cleaning, household, and health and medical supplies
- Unsolicited calls, e-mails or home visits from individuals offering free services or supplies in exchange for member numbers
Members can help to avoid fraud by following these tips:
- Reviewing medical claims submitted at AmeriHealth New Jersey for accuracy
- Protecting their insurance card
- Protecting their identity and not providing their Social Security Number
- Declining to provide insurance information to anyone that is not directly providing care to a member
- Being cautious of unsolicited telemarketers and recruiters
If members suspect that something potentially fraudulent has occurred with respect to their AmeriHealth New Jersey health insurance, they should contact us. All reports can be submitted anonymously. Here are three options for submitting a report:
- Submit through the Online Fraud & Abuse Tip Referral Form
- Call our confidential Fraud Hotline at 1-866-282-2707 (TTY: 888-789-0429). 24 hours a day, 7 days a week
- Mail a description of your complaint, enclose copies of any supporting documentation, and mail it to:
AmeriHealth New Jersey
Corporate & Financial Investigations Department
1901 Market Street, 42nd Floor
Philadelphia, PA 19103
¹The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that member cost-sharing (co-pays, deductibles, and coinsurance) is waived both in and out-of-network for the testing and diagnosis of COVID-19 through the federal state of emergency. The waiver of member cost sharing for both in and out of network will continue through the federal state of emergency.
²If a member has coverage through an employer, benefits and coverages may vary. MDLIVE is an independent company.