Your frequently asked questions about COVID-19 (coronavirus)
Have a question about COVID-19? We’re here to help.
COVID-19 vaccines are available?
COVID-19 vaccines continue to be an important step in reducing the risk of severe disease, hospitalization, and death, as well as in slowing the spread of the virus. Currently, three vaccines are authorized and recommended in the United States to prevent COVID-19:
- Pfizer-BioNTech, which is FDA-approved for people 16 years and older and is recommended under an emergency use authorization (EUA) for adolescents 12 through 15 years old.
- Moderna, which is recommended under EUA for people 18 years and older.
- Johnson & Johnson’s Janssen, which is recommended under EUA 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 commercial 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?
Pfizer-BioNTech and Moderna boosters received EUA from the FDA for people 65 and older, people at high risk for severe COVID-19, and certain immunocompromised individuals (e.g., solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise). Formal authorization from the FDA is still needed before boosters can be given to the broader population.
Individuals who received Johnson & Johnson’s Janssen COVID-19 vaccine will also likely need a booster. More data is expected on this which we will share when available.
Does AmeriHealth New Jersey cover the cost of getting a COVID-19 booster?
Yes. AmeriHealth New Jersey covers the cost of administering the Pfizer-BioNTech booster based on the recommendation from the FDA. As of September 22, a third Pfizer dose is recommended for people 65 and older, long term care residents, and people with underlying health conditions e.g., solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise).
AmeriHealth New Jersey plans to cover the cost of administering boosters for the broader population once formal authorization from the FDA is received.
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?
AmeriHealth New Jersey does not control the availability or distribution of any vaccines. This includes the COVID-19 vaccine. Vaccine availability varies by state. A list of state and territorial health department websites can be found on the CDC website.
In New Jersey, everyone ages 12 and older is eligible to receive a COVID-19 vaccine. Need help finding a vaccination site? Complete a Vaccine Interest Form and we will reach out to you based on where you live and the opportunities we have in your area.
New Jersey residents can also check New Jersey’s vaccination page for more information on vaccine availability.
When can I get a COVID-19 booster?
The FDA and the CDC’s Advisory Committee on Immunization Practices dictate and advise when the Pfizer-BioNTech and Moderna COVID-19 booster shots will be available to the general population.
As of September 22, the FDA authorized a booster dose of the Pfizer-BioNTech COVID-19 vaccine for people 65 and older and others at high risk of severe COVID-19, including health care providers, residents of long-term care facilities, and those who were first to receive the COVID-19 vaccination.
Does AmeriHealth New Jersey cover testing for COVID-19?
Yes. AmeriHealth New Jersey is waiving cost sharing (deductible, co-pays and coinsurance) for both in- and out-of-network diagnostic testing for fully insured groups and individual members until 90 days after the end of both the state of emergency and the public health emergency related to COVID-19.
AmeriHealth New Jersey also covers COVID-19 antibody testing with no member cost-share in accordance with federal guidelines and with its medical policy for the duration of the COVID-19 pandemic. Please note, antibody testing requires authorization by a licensed or qualified health care professional.
At-home test kits and at-home self-sample collection kits are also being covered by AmeriHealth New Jersey when they are medically appropriate, ordered by a health care professional, and under FDA EUA guidance (the self-collection materials, including kits, also need to have specific FDA EUA approval to be covered).
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.
How can members find a testing location?
If you suspect that you may have COVID-19, you may choose to get tested for the virus. No prescription or order from a health care professional is required for eligible New Jersey residents looking to be tested for COVID-19 during this public health emergency.
You may also choose to contact your primary care doctor to be screened for COVID-19. Members who don’t have a primary doctor can utilize MDLive services by registering at amerihealthnj.com.
AmeriHealth New Jersey is waiving cost sharing (deductible, co-pays and coinsurance) for both in- and out-of-network diagnostic testing for fully insured groups and individual members until 90 days after the end of both the state of emergency and the public health emergency related to COVID-19.
For self-funded health plans, coverage of telemedicine services is provided for COVID-19 services related to testing and diagnosis without member cost-sharing consistent with the federal Families First law.
New Jersey residents can contact the NJ Department of Health for more information at 1-800-962-1253.
Members can find testing locations in NJ on the AmeriHealth New Jersey COVID-19 website.
Does AmeriHealth New Jersey cover the cost of COVID-19 treatment for its members?
Yes. AmeriHealth New Jersey is waiving member cost-sharing (co-pays, co-insurance or deductible) for in-network, inpatient, acute care associated with a COVID-19 diagnosis for commercial groups and individual members until December 31, 2021.
AmeriHealth New Jersey is also waiving cost sharing for Emergency Department visits associated with admissions for in-network, in-patient, acute care treatment of COVID-19 whether medical or behavioral health for commercial groups and individual members until December 31, 2021.
Cost sharing applies to:
- Post-acute care (e.g., skilled nursing, rehabilitation, and long-term acute care facilities)
- Outpatient treatment
- Prescription drugs
- Ambulance transportation to a post-acute setting
- Out-of-network care
Please note: For High Deductible Health Plans, in-network cost sharing waivers for inpatient COVID-19 treatment detailed above will remain in effect through December 31, 2021, unless prohibited by law. If our members would like information about specific symptoms they are experiencing or have questions about their personal health, we recommend that they contact their doctor. For reliable information about the coronavirus disease (COVID-19), we suggest visiting the CDC website at cdc.gov/coronavirus.
Does AmeriHealth New Jersey cover telemedicine services for COVID-19?*
AmeriHealth New Jersey has expanded coverage of telemedicine services. The change is one of many efforts to encourage social distancing and increase access to care.
Expanded telemedicine coverage is in effect for fully insured groups and individual members until 90 days after the end of both the state of emergency and the public health emergency.
Cost sharing is waived on:
- All MDLIVE telemedicine visits
- All telemedicine with in-network PCPs**
- Telemedicine appointments with in-network specialists; nutritionist; urgent care; physical and occupational therapists (video-only); and speech therapists (audio or video)**
- In-network behavioral health telemedicine visits**
Members should ask their primary care doctor or specialist to see if they can conduct a visit by phone or video chat. Members can also access MDLIVE through our member website at amerihealthnj.com.
For self-funded health plans, it is federally mandated that telemedicine visits related to COVID-19 testing and diagnosis are covered without member cost-sharing.
How is AmeriHealth New Jersey communicating with its employees about COVID-19? How is AmeriHealth New Jersey working to keep its workforce 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 associates and have taken several steps to safeguard their health.
In March 2020, AmeriHealth New Jersey closed its office in Cranbury. All employees have been required to work remotely since that time to help reduce the risk of illness through person-to-person contact.
Our company's leadership is developing a reentry strategy based on guiding principles that focus on the health and safety of our employees. 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 working with, and communicating with, providers related to COVID-19?
AmeriHealth New Jersey is fortunate to have strong relationships with the providers, hospitals and health systems that provide care for our members. Our executives are staying in close contact with leaders within the provider community to monitor this rapidly changing situation and make the most appropriate decisions to help maintain the health and wellness of people in the communities we serve.
AmeriHealth New Jersey launched a COVID-19 Provider Hub website to inform doctors, hospitals, health systems, and other health care professionals on everything AmeriHealth New Jersey is doing to support front line workers during the pandemic.
AmeriHealth New Jersey has also been communicating the latest news and information about COVID-19 to providers through our existing communication channels.
If members or employers want more information about COVID-19, where should they go?
If members or employers would like information about specific symptoms they are experiencing or have questions about their personal health, we recommend that they contact their doctor.
For reliable information about the coronavirus disease (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.
Additional resources include:
- How to prepare: Managing anxiety and stress (provided by the CDC)
- Mental Health COVID-19 resources (provided by Magellan Health)
- Living with threats of violence (provided by Magellan Health)
- What to do if you are sick with COVID-19 or caring for someone with COVID-19 (provided by the CDC)
¹The waiver of cost sharing (deductible, co-pays and coinsurance) for both in- and out-of-network testing and diagnosis of COVID-19 will continue until 90 days after the end of both the state of emergency and public health emergency declared by the State of New Jersey in response to COVID-19.
*References to telemedicine include telehealth.
**Out-of-network services are not covered unless included in the applicable benefit design or permitted by AmeriHealth New Jersey due to network adequacy or access limitations. Please note the exception below regarding out-of-network testing and diagnosis related to COVID-19.
Please note: Out-of-network testing and diagnosis of COVID-19 is covered without cost sharing (deductible, co-pays and coinsurance) when performed during in-person or telemedicine visits, or at any site, until 90 days after the end of both the public health emergency and the state of emergency declared by the State of New Jersey in response to COVID-19.