Your frequently asked questions about COVID-19 (coronavirus)
Have a question about COVID-19? We’re here to help.
Will AmeriHealth New Jersey cover the COVID-19 vaccine?
COVID-19 vaccines are an important step in slowing the spread of the virus. . However, it will take time for the U.S. to reach COVID-19 herd immunity. During that time, we urge members to continue following the advice of health professionals to minimize the chances of catching or spreading the disease. We also encourage members to continue to wear a mask, practice social distancing, and wash their hands regularly.
The U.S. Food & Drug Administration (FDA) has granted Emergency Use Authorizations for three COVID-19 vaccines. The vaccines can reduce the risk of getting the virus by up to 90 percent. Millions have already received their shots, but in order to finally beat COVID-19, 80 percent of Americans must be vaccinated.
The Federal government is currently covering the cost of the COVID 19 vaccine itself. 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.
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 now 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.
Will AmeriHealth New Jersey cover testing for COVID-19?
AmeriHealth New Jersey is committed to ensuring that our members have access to the care they need, at the right time, and in the right setting. We are working to make sure that our members can receive appropriate testing and treatment for COVID-19 if needed.
At the start of the pandemic, we quickly announced we would cover testing¹ at any site for active COVID-19 (RT-PCR) at no cost to our members. We are waiving cost sharing (deductible, co-pays and coinsurance) for both in- and out-of-network 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 will cover COVID-19 antibody testing with no member cost-share in accordance with federal guidelines and company 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 Emergency Use Authorization (EUA) guidance (the self-collection materials, including kits, also need to have specific FDA EUA approval in order to be covered).
For services not related to COVID-19, we will continue to apply the appropriate member cost-sharing. This includes members enrolled in our commercial fully insured plans, employer-sponsored plans and the individual and family plans available through the Affordable Care Act.
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, your first step should be to contact your primary doctor. Your primary doctor will screen you for testing based on CDC guidelines. If you meet the testing criteria, your doctor will discuss your testing options with you.
Members who don’t have a primary doctor can utilize MDLive services without cost-sharing. An MDLive physician can perform the screening and determine your next steps. You can register for MDLive at amerihealthnj.com.
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.
What about treatment?
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 through June 30, 2021.
Cost sharing will be applied 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
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.
How are prior authorizations being handled?
For COVID-19 diagnoses, AmeriHealth New Jersey will continue to temporarily suspend prior authorization requirements for acute inpatient admissions from the Emergency Department at in-network facilities through June 30, 2021.
For non-COVID-19 diagnoses, we will continue to require and apply prior authorization for acute inpatient admissions from the emergency department at in-network facilities and out of network facilities.
As of April 1, 2021, AmeriHealth New Jersey resumed the prior authorization requirement for COVID-19 and non-COVID-19 diagnoses for:
- Transfers from acute in-network, in-patient facilities to in-network post-acute facilities, including long term acute care, rehabilitation, and skilled nursing facilities.
- Transfers from acute in-network, inpatient facilities to another acute in-network, in-patient facility including ambulance transport.
This applies to all fully insured and self-funded groups and individuals*.
*As of March 31, 2020, prior authorization has been waived for telemedicine/telehealth services for all diagnosis in New Jersey.
Should members be using telemedicine?²
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.
The 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 related to COVID-19. This includes:
- Waiving cost-sharing on any in-network telemedicine services which may be appropriately delivered via video or telephone through telemedicine (including but not limited to primary care, specialty, ancillary services, behavioral health3)
- Waiving prior authorizations on any telemedicine services while the COVID-19 emergency order is in place. Providers must notify AmeriHealth New Jersey that the member is receiving services.
This expansion of telemedicine complies with legislation passed in New Jersey in response to the pandemic.
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, coverage of telemedicine services is provided for COVID-19 services related to testing without member cost-sharing consistent with the federal Families First law.
Will AmeriHealth New Jersey waive prescription drug refill limits?
At this time, we are not waiving prescription drug refill limits. However, we are carefully monitoring COVID-19 developments and will adjust policies as appropriate. We recommend that members call the Pharmacy Services number on their ID cards as needed if they require additional medication refills.
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. We have 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 our 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.
²References 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 and public health emergency and the state of emergency declared by the State of New Jersey in response to COVID-19.