COVID-19 Updates & Alerts for Brokers

Questions and Answers

What is the coronavirus?

COVID-19 is a disease that affects breathing. It's caused by a new virus called a coronavirus, which can spread from person to person. People of all ages can get infected. Older adults and people with pre-existing medical conditions may be more likely to become gravely ill if infected. Medical conditions that include:

chronic obstructive pulmonary disease,
cancer,
obesity,
diabetes,
and heart disease.

The number of cases continue to increase throughout the nation and around the world.

Protect yourself and your community

We all have a role to play to help protect our families and community from the spread of COVID-19. You can follow these tips to prevent getting the virus:

Wear a mask. Follow current state and local masking requirements (PDF).
Stay six feet apart from others if they are sick, or if you are unvaccinated or are at a higher risk of getting very sick with COVID-19.
Avoid crowds.
Wash your hands often – at least 20 seconds each time.
If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
Get a flu vaccine.

Check CDC COVID-19 Community Level tool for prevention steps based on your county.

What is the COVID-19 vaccine?

A COVID-19 vaccine helps give you the best chance of keeping yourself and your loved ones safe from getting COVID-19 symptoms. And, the vaccine will help keep you from getting COVID-linked health problems in the future.

Pfizer/BioNTech's and Moderna's COVID-19 vaccines are given in two doses with a few weeks between each shot. The Johnson & Johnson vaccine requires only a single dose.

After your first Pfizer/BioNTech or Moderna shot, you will get a card that reminds you not to forget your second shot. It's important to get both doses of the same Pfizer/BioNTech or Moderna vaccine.

When can I get the vaccine?

Every Californian ages 5 and up are now eligible for vaccination. Visit Vaccinate All 58 for more information.

You can sign up at MyTurn or call (833) 422-4255 (Monday-Friday 8:00 a.m. to 8:00 p.m., Saturday-Sunday 8:00 a.m. to 5:00 p.m.) to get the COVID-19 vaccine.

How can I protect myself and others from COVID-19 until I get vaccinated?

We all have a role to play to help keep our families and neighborhoods safe from the spread of COVID-19. Follow these tips to help prevent yourself and others from getting sick:

Wear a mask. Follow current state and local masking requirements (PDF).
Stay six feet apart from others if they are sick, or if you are unvaccinated or are at a higher risk of getting very sick with COVID-19.
Avoid crowds.
Wash your hands often – at least 20 seconds each time.
If soap and water are not available, using a hand sanitizer with at least 60% alcohol.
Get a flu vaccine.

It is important to urge and help family members, most of all those living in the same household, to get vaccinated.

A vaccinated person may still be able to spread the virus to others. This includes people in the household.

Check CDC COVID-19 Community Level tool for prevention steps based on your county.

Where can I get the vaccine?

Some clinics and pharmacies may take walk-ins for a COVID-19 vaccine. Check these options to find a vaccination site when you are able to get the vaccine:

Contact your doctor or pharmacist.
Reach out to your county public health department.
Visit MyTurn or call (833) 422-4255 (Monday-Friday 8:00 a.m. to 8:00 p.m., Saturday-Sunday 8:00 a.m. to 5:00 p.m.)
Check Vaccines.gov

Is the vaccine safe?

The safety of the COVID-19 vaccine is the main focus! The U.S. Food and Drug Administration (FDA) takes care to review all safety data from clinical trials. They then approve emergency vaccine use only when the expected benefits outweigh potential risks. Scientists tested COVID-19 vaccines across many diverse backgrounds. This helped to ensure the vaccines meet safety standards.

How is COVID-19 vaccine safety tracked?

Health care providers are required to report certain adverse events after vaccination to the Vaccine Adverse Event Reporting System (VAERS). When you receive your vaccine, you will also receive an information sheet. The sheet lets you know how to enroll in a program called v-safe. V-safe allows you to report problems or adverse reactions you have after getting a COVID-19 vaccine. Your report will go to the Centers for Disease Control (CDC). Plus, the FDA and CDC will keep tracking the safety of COVID-19 vaccines. They want to make sure that even very rare side effects are found as early as can be.

Is there a way I can I track my COVID-19 vaccinations on my phone?

V-safe is a smartphone-based tool. It uses texts and web surveys to provide customized health check-ins after you receive a COVID-19 vaccination. Visit v-safe to register! Through v-safe, you can quickly tell the CDC if you have any side effects after getting your COVID-19 vaccine. As a result of how you answered, someone from the CDC may call to check on you and get more information. V-safe will also remind you to get your second COVID-19 vaccine dose if you need one.

Will there be any side effects when I get the vaccine?

You may have soreness, swelling and redness around the point of where the shot was given. You could also develop fatigue, headache, body aches, chills or fever. Some people have nausea, vomiting or diarrhea. These reactions are normal. The side effects occur as your body begins to build immunity to help fight off future COVID-19 exposures. It is important to know that you cannot get COVID-19 from the vaccine. The vaccines in use today and the others that are being made do not contain a live virus.

Will there be any long-term side effects from the COVID-19 vaccines?

COVID-19 vaccines are being tested in large clinical trials to assess their safety. But it does take time, and more people will need to get a vaccine before we learn about any rare or long-term side effects. That is why safety tracking will continue. The CDC has a separate group of experts that reviews all the safety data. And, they provide regular safety updates. If a safety issue is found, quick action will be taken to see if the issue is linked to the COVID-19 vaccine. Also, steps will be taken to plot the best course of action.

How effective is the COVID-19 vaccine?

All three vaccines have been proven to be highly effective in preventing hospital admission and death linked to COVID-19.

How many COVID-19 vaccine doses do I need, and how far apart should I get them?

It's best for you to get:

Two doses of the Pfizer/BioNTech vaccine, 21 days apart, then a booster shot five months later.
Two doses of the Moderna vaccine, 28 days apart, then a booster shot five months later.
Just one dose of the Johnson & Johnson vaccine, then a booster shot two months later.

If two shots are needed at first, get your second shot as close to the suggested interval as you can. If you can't get it at the suggested interval, you can get your second dose up to 6 weeks (42 days) after your first dose. (We only have a small amount of data on how well these vaccines work beyond this window.)

Note: If you get the second dose after 42 days, there is no need to start over.

Children ages 5–11, who get the lower-dose Pfizer vaccine, should also get two shots 21 days apart.

Boosters (or more doses of these vaccines) are available for those 18 and older. Those people, ages 12–17, can get the Pfizer booster. People ages 18 and older can get any booster, however, Moderna and Pfizer are preferred.

The Moderna or Pfizer booster is suggested for those who got the Johnson & Johnson vaccine.

If you are immunocompromised (you have a mild to severely impaired immune system) your first vaccination series may not create enough (or any) defense to fight the disease. If this happens, getting one more dose of the vaccine might help you build more resistance to the disease.

Read Booster shots and additional doses to see if you can get one of the booster vaccines.

Only a single booster dose is suggested now. You should not repeat a vaccine series.

Stay up to date on vaccine and boosters.

When will I be considered fully vaccinated?

People are believed to be fully vaccinated:

Two weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines.
Two weeks after a single-dose vaccine, such as Johnson & Johnson's Janssen vaccine.

Booster doses are not required to be considered fully vaccinated. But, we suggest you get a booster as soon as you are able, in order to get the most protection from COVID-19.

See CDPH's COVID-19 Public Health Recommendations for Fully Vaccinated People for details.

What should I keep doing once fully vaccinated?

You will still need to follow guidance at your workplace and at local businesses.
If you travel, you should still take steps to protect yourself and others. You will still need to wear a mask on planes, buses, trains and other forms of public transportation. This is true when you travel into, within, or out of the United States. You will also need to wear a mask in U.S. transportation hubs such as airports and stations.
You should still watch out for symptoms of COVID-19 – even more if you've been around someone who is sick. If you have COVID-19 symptoms, you should get tested and stay home and away from others.
Talk to your doctor if you have a health condition. Or, if you or are taking medication that weakens your immune system. You may still need to be cautious to help prevent you from getting COVID-19.

What does the CDC currently know about COVID Vaccines and what are they continuing to learn?

We know that COVID-19 vaccines are effective at preventing COVID-19 disease, especially severe illness and death.
- We're still learning how effective the vaccines are against variants of the virus that causes COVID-19. Early data show the vaccines may work against some variants but could be less effective against others.
We know that other prevention steps help stop the spread of COVID-19, and that these steps are still important, even as vaccines are being distributed.
- We're still learning how well COVID-19 vaccines keep people from spreading the disease.
- Early data show that the vaccines may help keep people from spreading COVID-19, but we are learning more as more people get vaccinated.
We're still learning how long COVID-19 vaccines can protect people.
As we know more, CDC will continue to update our recommendations for both vaccinated and unvaccinated people.

Until we know more about those questions, everyone — even people who've had their vaccines — should continue taking basic prevention steps when recommended.

Does the COVID-19 vaccine protect against recent variants?

The vaccines are very effective against COVID-19 variants like Delta. We don't yet know how effective they will be against newer variants, like Omicron.

The best thing you can do to limit virus spread and mutation is to:

Get vaccinated
Get your booster, if you're eligible

See variants now present in California.

More info about COVID-19 variants from CDPH:

Will I have a choice between the various COVID-19 vaccines?

Yes. Both My Turn and Vaccines.gov allow you to search for vaccines by maker.

Read CDPH's Choosing the COVID-19 Vaccine That is Right for You (PDF).

When you get your booster shot, you can choose to get a different vaccine brand than you had for your first dose.

I already had COVID-19. Should I still get the vaccine?

Yes. The CDC suggests that people who have already had COVID-19 should get a vaccine. We do not know how long your protection lasts after you recover.

One study showed that people who have not been vaccinated, and have had COVID-19, are more than twice as likely (as vaccinated people) to get COVID-19 again.

How soon can I get the vaccine, after I've had COVID-19?

The CDC recommends:

If you tested positive, had only mild symptoms, and were not treated, you should:
- Wait at least 10 days after the start of COVID-19 symptoms, and
- Meet criteria to stop isolation before getting the COVID-19 vaccine.
Wait 90 days to get the vaccine if:
- You recovered from a COVID-19 infection, and
- Were treated with monoclonal antibodies or convalescent plasma.

Will I test positive for COVID-19 after being vaccinated?

No. A vaccine will not cause you to test positive on viral tests.

If your body develops an immune response, you may test positive on antibody tests. This shows that you may have protection against the virus.

If I have a food or medication allergy, should I worry about an allergic reaction to the vaccine?

Having an allergy to food or medicines does not mean you are at a higher risk of having an allergic reaction to the COVID-19 vaccine. COVID-19 vaccines do not contain eggs, preservatives, or latex. Consult your doctor before getting a vaccine if you have severe allergies.

If you have been told to carry an epinephrine auto-injector for any reason, continue to do so – most of all when you get a vaccine. The CDC suggests that all who get a vaccine should be observed for a period of 15 minutes. This 15-minute period goes up to 30 minutes for those with a background of having allergic reactions.

Who should not get vaccinated?

There are a few groups should not get the vaccine. And, some others should consult with their doctor.

People who should not get the COVID-19 vaccine include:

Those younger than 5 years of age. The current vaccines were not studied or approved for use with children younger than 5 years of age.
People who are isolating from others because they were exposed to COVID-19. Or, people who have symptoms of COVID-19. These people can get a vaccine after they have finished isolating from other people, and their symptoms have gone down.

People who may get the COVID-19 vaccine, after weighing the risks and benefits, and talking with their doctor include:

People with a background of severe allergy to any vaccine or medication given by a shot. They can get any of the vaccines, but must be watched for 30 minutes after getting the shot.
People who are pregnant or breastfeeding may choose to be vaccinated against COVID-19. The American College of Obstetricians and Gynecologists suggests that the COVID-19 vaccine should not be withheld from those who are pregnant or breastfeeding.
People with weakened immune systems. These people might be at increased risk for severe COVID-19. They may get a COVID-19 vaccine. But, they should be aware that data about the safety of COVID-19 vaccines for people who have weakened immune systems is not yet available.

Can those who are pregnant or breastfeeding get the vaccine?

Yes. The CDC strongly suggests that if you're pregnant (or could be pregnant), you get vaccinated. If you get COVID-19 while you are pregnant, you are more likely to get very ill.

The vaccines are safe for you and your baby. They do not contain the live virus, so they cannot cause COVID-19. Vaccinated pregnant people also pass antibodies to their fetus in the womb. Their babies are then born with some protection.

COVID-19 vaccines are also safe for those who breastfeed – as well as their babies. Those who breastfeed and got either the Moderna or Pfizer vaccines, have antibodies in their breast milk. This could help protect their babies.

Talk to your doctor if you have questions about getting a COVID-19 vaccine.

For more information, read:

Can my child get the vaccine?

As of right now, the Pfizer/BioNTech vaccine is suggested for people ages 5 and older. The Moderna and Johnson & Johnson vaccines are suggested for those ages 18 and older.

Why does my child need a COVID-19 Vaccine?

Cases in children are growing. We must get young people vaccinated to prevent more hospitalizations and deaths.

Vaccinations may stop the spread of coronavirus variants. They can also shrink the pool of people at risk for COVID-19. When children 5 and up are vaccinated, families can be safer as we all get back to doing the things we love.

When should my child be vaccinated?

All kids who are 5 years and older should get a COVID-19 vaccine. If your child 5 years and older hasn't gotten their vaccine yet, talk to their doctor about getting it as soon as possible.

What should I expect before, during and after my child's COVID-19 vaccination?

Your child will need 2 shots given 3 weeks (21 days) apart to get the most protection.
Tell the doctor or nurse about any allergies your child may have.
Comfort your child during the appointment.
Your child should lie down in their chair when they get the vaccine and for 15 minutes after the vaccine is given. This helps prevent fainting and injuries if they faint.
After your child gets the vaccine, you will stay for 15 minutes. This is in case they have a severe allergic reaction and need prompt treatment.

Will my child have side effects after they get the Covid-19 vaccine?

Your child may have some side effects. This is a normal sign that their body is building protection. These side effects may affect your child's ability to do daily activities. The side effects should go away in a few days. Some people have no side effects. Side effects from the second shot could be stronger than the ones your child had after their first shot.

Common side effects include:

Pain, redness or swelling on the arm where your child got the shot.
Tired
Headache
Muscle pain
Chills
Fever
Nausea

Contact your child's doctor or healthcare provider:

If the redness or tenderness where the shot was given gets worse after 24 hours.
If the side effects are worrying you or do not seem to be going away after a few days.

Are COVID-19 vaccines safe for my child?

Yes. COVID-19 vaccinations provide safe and great protection against the virus that causes COVID-19. The COVID-19 vaccines have been under the most in-depth safety tracking in U.S. history.

The Pfizer-BioNTech COVID-19 vaccine is now available for everyone ages 5 and older.

Children younger than 5 years of age should not get vaccinated. The current vaccines were not studied or approved for use with children younger than 5 years of age.

When I get the vaccine, can I stop wearing a mask or social distancing?

No. It will take time for your body to build immunity after the vaccine. To prevent yourself from getting sick it's important to:

Social distance
Wear a mask in public
Avoid crowds
Wash hands often – at least 20 seconds each time.

Can I get the COVID-19 vaccine at the same time as another vaccine?

No. The COVID-19 vaccine should be given 14 days before or after other vaccines. At this time there is limited information on the safety of getting other vaccines at the same time as the COVID-19 vaccine.

What if I got the first dose and do not want to get the second dose?

The Pfizer/BioNTech and Moderna clinical trials were not designed to test the effect of a single dose. People involved in the studies all received two doses. It is best to get two doses to achieve the best result.

What if I missed my second dose?

If you miss your second dose appointment at 21 days (for Pfizer/BioNTech vaccine) or 28 days (for Moderna vaccine), it is OK. Those dates are the earliest you can get the second dose. It is important to get your second dose as close to those dates to get the full strength of the vaccine.

The second dose of Pfizer/BioNTech and Moderna COVID-19 vaccines may be scheduled up to six weeks (42 days) after the first dose. There is a small amount of data on how well the vaccines work when given after that time.

What is Herd Immunity?

Herd Immunity is a term used to describe when enough people within a large group have protection—either from previous infection or vaccination. The desired result is that the disease spread slows and, in time, stops. Once achieved, everyone within that group is protected, even if some people don't have any protection themselves.

What is a COVID-19 Vaccination Record Card?

A COVID-19 Vaccination Record Card is a small and handy paper card that will be given to you when you receive your first COVID-19 vaccine. This will help you keep track of when you received your first Pfizer/BioNTech, Moderna or Johnson & Johnson dose. And, when you should get your second dose of the Pfizer/BioNTech or Moderna vaccine. It's an easy way to help you keep track of your vaccines and show that you have been vaccinated, if needed.

I lost my COVID-19 Vaccination Record Card. What should I do now?

If the vaccine requires two doses, people should get the same vaccine for both doses in two different visits. Call the health center or provider you received your first dose from to ask about your vaccine information. Be sure to confirm your second appointment and the place to get it.

I am due for my second dose. Can I go to any provider?

The provider should have scheduled a second appointment with you at the same place when you received the first dose. But, you can get your second dose from another provider/place. You'll need to show your COVID-19 Vaccination Record Card so the provider knows what vaccine you have received.

Many counties and pharmacies no longer need appointments for a COVID-19 vaccine. Please check with your local health department or pharmacy to learn about walk-in vaccinations.

Do members have to pay for their vaccine? Or get prior approval?

No. The COVID-19 vaccine will be at no cost to members. Members do not need to get a prior approval for their vaccine. They may be asked to provide their health insurance information for tracking data.

Many counties and pharmacies no longer need appointments for a COVID-19 vaccine. Please check with your local health department or pharmacy to learn about walk-in vaccinations.

Do members need a doctor's script or referral prior to getting their COVID-19 vaccine at a pharmacy?

No, members can get a COVID-19 vaccination without a doctor's script or referral at any pharmacy. Members should follow thier health plan's guidelines for places to get other non-COVID-19 vaccines.
Members can get vaccinated at any place. This includes mass vaccination centers, if/when they are open.
Members can also get their second dose somewhere other than where they got their first dose, if needed. Make sure they bring their vaccination card with them to their second dose appointment.

Many counties and pharmacies no longer need appointments for a COVID-19 vaccine. Members should check with their local health department or pharmacy to learn about walk-in vaccinations.

How much will the COVID-19 vaccine cost?

COVID-19 vaccines cost nothing. The vaccines and their locations are free to the public.

Read more at the Department of Managed Health Care's Know Your Health Care Rights (PDF).

Will a member get an Explanation of Benefits even if they do not have to pay for the COVID-19 vaccine?

Yes. Members will receive an Explanation of Benefits (EOB) if they got the vaccine from a Health Net primary care provider. They will also get an EOB if a non-contracted provider elects to bill or submit office visit information to Health Net. (Note: This excludes Medi-Cal and California Health & Wellness members.)

A member is due for their second dose. They got their first dose from a provider who is not their PCP but don't have their contact information. What do they do now?

The provider should have scheduled a second appointment with the member at the same place when they received the first dose. But, they can get their second dose from another provider/place. They'll need to show their COVID-19 Vaccination Record Card so the provider knows what vaccine they have received.

I am planning to travel outside the United States. How can I get the vaccine?

Check these options to find where to get the vaccine:

Contact your doctor or pharmacist.
Reach out to your county public health department.
Visit MyTurn or call call (833) 422-4255 (Monday-Friday 8:00 a.m. to 8:00 p.m., Saturday-Sunday 8:00 a.m. to 5:00 p.m.)
Check Vaccines.gov.

During the COVID-19 crises, should members get a flu shot?

Yes. An annual flu shot is recommended for most people six months and older to help keep them healthy, unless your doctor identifies a medical reason not to take the flu vaccine.

Are the COVID-19 vaccines developed using fetal cells?

The Pfizer and Moderna vaccines do not use any fetal cell cultures to make their vaccines. Moderna and Pfizer use synthetic matter to form mRNA. These vaccines DO NOT use any fetal cell cultures. The Johnson and Johnson vaccine required the use of a fetal cell culture singled out in 1985 in order to make the vaccine. The final vaccine DOES NOT contain any fetal cells.

How does the COVID-19 vaccine affect my mammogram?

The vaccines that prevent COVID-19 can cause swollen lymph nodes under the arm where the shot was given. Your lymph nodes are part of your body's germ-fighting immune system. The swelling in the lymph nodes is a sign that your body is building up defense against the virus.

Some doctors are concerned that having a mammogram soon after vaccination may cause unneeded worry about swollen lymph nodes. For that reason, some have suggested waiting four to six weeks after your final vaccine dose before having a mammogram. That way, any lymph node swelling caused by the vaccine has time to go away.

For patients who plan to schedule screening mammograms and vaccination appointments, think about booking screening exams before your first dose of a COVID-19 vaccine. If you aren't able to do that, during your visit let your radiologist know when you received the vaccine, and in which arm.

What is Health Net doing to reach at-risk groups to ensure these people keep getting needed health care services?

Health Net is waiving all prior approvals and member cost-sharing for screenings and tests linked to COVID-19. This applies to all Commercial employer group business and Individual and Family Plan members. Plus, Health Net covers all telehealth services that are linked to COVID-19. Members will have all health care services – that can be performed via telehealth – covered through May 31, 2021.

Cost-sharing terms of your health plan will apply for telehealth services received on or after June 1, 2021.
Health Net will waive member cost-share for all treatments linked to COVID-19 through May 31, 2021. Member groups include:
- Medicare
- Medi-Cal
- Commercial fully-insured members
Cost-sharing terms of your benefit plan will apply to treatments linked to COVID-19 received on or after June 1, 2021.

Also, Health Net assembled a COVID-19 taskforce to find, and reach out to members who are at high risk for COVID-19. The purpose of the outreach is to connect with high-risk members. The outreach helps to confirm these high-risk members have access to the support and services they need. The taskforce began making outbound calls to this group in early April, 2020.

Plus, our parent company, Centene Corporation is:

Making it easier to source, order, and ship personal protective equipment (PPE) to our provider partners. This helps them meet the urgent needs of patients. Centene is also in the process of speeding the distribution of about two million pieces of PPE. This includes:
- Safety goggles
- Facemasks
- Hand sanitizers
- Emergency kits
Centene will, keep up these efforts in coming weeks.
Joining with our providers to get help to service areas that have been stricken the most.
Giving data and support that let providers move their resources around. This is based on usage changes caused by COVID-19.
Working to ensure that our community Safety Net providers and groups can survive long-term – beyond the urgent crisis.
Giving help to secure small business loans for:
- Mental health providers
- Community-based mental health groups
- Long-term service support groups
- Other Safety Net providers

The loans help these groups gain access to government-sponsored small business loans, and telehealth technology.

Which transportation services are offered to help members get their COVID-19 vaccines?

Members may be able to get transportation help by contacting United Way-211 to access local transportation resources. This may include the Lyft Vaccine Alliance Program.

What happens if my client's income changes?

Members should report their income changes to Covered California so their eligibility for increased subsidies or new eligibility for subsidies can be determined. This can potentially help reduce their payment responsibility going forward. Off-exchange members are permitted to enroll into a Covered California plan if they become eligible for subsidies.

In some cases, members can qualify for Medi-Cal, which offers low-cost or free health coverage to eligible Californian residents with limited income.

When employees are rehired, will Deductibles and Out-Of-Pocket Max (OOPM) accruals start over?

So long as the employee remains on the same plan with the same member ID, the deductible and OOPM will pick up where it left off when the employee re-enrolls later in the year.

Will employers be able to continue benefits if the entire workforce is laid off?

Standard Policy COBRA and state continuation protocols apply if one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.

Can health benefits be extended through the end of the month if a significant portion, or all, of an employer's workforce is laid off?

If premiums have been remitted for the month the employee is laid off, coverage will continue through the end of that same month.

If employees enroll in a short-term plan, how quickly will their coverage be effective?

Health Net does not offer short term coverage.

Can an employer reduce their current minimum hours threshold down to 20 hours off-anniversary?

Through the end of the public health emergency, Health Net is temporarily relaxing its requirement that employees be actively working to be eligible for coverage and will allow employers to cover their reduced-hour employees, as long as employers pay the monthly premium. Employers must offer this coverage on a uniform, non-discriminatory basis.

Will eligibility be closely monitored? If a client's workforce goes to less than 30 hours a week or below the hourly requirement, will flexibility be allowed?

If an employee took a sabbatical or temporary leave of absence, can they keep their benefits intact for a few months without being paid a salary?

What is required in order to re-enroll/reinstate the member without the waiting period?

Health Net will waive the normal waiting period for rehired employees. Employees rehired through the end of the public health emergency will not be subject to a waiting period. Rehired employees must submit a new enrollment form. Please write "COVID-19 SEP" on the enrollment form.

What benefit enhancements has Health Net made for COVID-19 services, for California Small Group Fully-Insured Members?

COVID-19 Testing and Screening

Health Net covers screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Pharmacy

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8:00 a.m. to 6:00 p.m. Pacific time (PT) for questions or assistance.

Mental Health Resources

Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.

Telehealth

To limit your risk of COVID-19 infection, Health Net urges the use of telehealth – doctor visits through video and/or phone calls – to receive health care services.

Your cost share is waived for all telehealth services through May 31, 2021.
Cost-sharing terms of your health plan will apply for telehealth services received on or after June 1, 2021.

Please note that member cost-share for COVID-19 testing and screening telehealth services will keep being waived.

Is Health Net waiving cost-share requirements for treatments linked to COVID-19?

Yes, through May 31, 2021, Health Net will waive member cost share for COVID-19 related treatments for all:
- Medicare
- Medi-Cal
- Commercial fully-insured members
Cost-sharing terms of your health plan will apply for all COVID-19 related treatment received on or after June 1, 2021.

Is Health Net waiving prior authorizations for COVID-19 related treatments?

Effective immediately, Health Net and its delegated entities will waive prior authorizations for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members. Inpatient admission notification is still required as soon as possible to Health Net and the member's assigned delegated participating physician group (PPG) or IPA, if available.

CARES Act - H.R. 748

Sweeping legislation to respond to the COVID-19 pandemic was cleared by Congress and signed into law by President Trump on March 27, 2020. The Coronavirus Aid, Relief, and Economic Security Act ("the CARES Act" or "the Act") authorizes more than $2 trillion to battle COVID-19 and its economic effects, including immediate cash relief for individual citizens, loan programs for small business, support for hospitals and other medical providers, and various types of economic relief for impacted businesses and industries.

Will there be any delays on processing claims?

Health Net intends to provide the same level of service and claim processing support as it does during normal circumstances.

How will Health Net comply with the Extension of Certain Timeframes for Employee Benefit Plans, Participants and Beneficiaries Affected by the COVID–19 Outbreak?

On May 4, 2020, the Department of Labor (DOL) and the IRS jointly published the "Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak." The final rule extends time frames affecting participants' rights to health care coverage, portability and continuation of group health plan coverage under COBRA, as well as extending the time for plan participants to file benefit claims or appeal denied claims until the end of the outbreak period, and applies only to groups subject to federal COBRA (groups with 20 or more employees) and to ERISA.

There have not been any changes to the election and premium payment under Cal-COBRA.

Health Net will comply with the DOL and IRS guidelines related to COBRA extension during the COVID-19 outbreak period. We will be working through the operational implications of administering COBRA extension eligibility and claims adjudication, and will update you when we finalize our exception process. Please note that employees and dependents who lose coverage under the employer plan have affordable alternatives to COBRA, including Health Net's Individual and Family Plans with subsidies through Covered California which could reduce their costs.

Will Health Net be able to offer coverage options to employees that have been laid off and lose their work-based insurance? Will employers be able to offer continuation coverage to their employees at their own expense?

Standard Policy COBRA and state continuation protocols apply provided that one or more employees are terminated as a result of COVID-19. Health Net will offer assistance in alternative enrollment options, including Individual & Family Plans (IFP) and Medi-Cal.

Covered California is offering a Special Enrollment Period (SEP) through May 15, 2021, due to the COVID national emergency. This SEP qualifying event is available if you enroll through Covered California as well as enrollment on our off exchange plans.

If your clients are interested in IFP coverage, please instruct them to call Health Net Direct Sales at 1-877-878-7983. Our representatives will assist your clients to determine their eligibility for subsidies, as well as provide information for IFP plans through Covered California, off-exchange IFP plans, and Medi-Cal.

For employee health and safety, the Center for Disease Control and Prevention (CDC) recommends focusing on preventing exposure to the COVID-19 virus in the workplace. There are specific measures that have proven beneficial in preventing infection. These measures include conducting daily health checks, practicing hand hygiene, social distancing (at least 6 feet from others), wearing cloth face covering, installing barrier shields such as plexiglass when feasible, and improving the building ventilation system.¹ Daily health checks including temperature checks and symptom questionnaires are especially essential in workplace settings where it is difficult to maintain consistent social distancing.

Employees who screen positive for, or report symptoms related to COVID-19 infection, should be excluded from work and referred to a healthcare provider for evaluation and potential testing.²These employees should stay home and should not return to work until the criteria to discontinue home isolation are met, under the guidance of a healthcare provider.¹

For asymptomatic employees who have a recent known or suspected exposure to COVID-19, testing is recommended if they had close contact with the infected person. Close contact entails being within 6 feet of the infected person, for a total of 15 minutes or more, without personal protective equipment. It is important to quickly identify and quarantine such employees. Early testing after exposure at a single point in time may miss many infections so testing that is repeated at different points in time, also known as serial testing, may be more useful. For detecting current COVID-19 infection, viral tests are recommended. Antibody testing is not recommended.²

In certain workplaces where physical distancing is difficult, workers are in close contact with co-workers or the public, and community transmission is high, viral testing of asymptomatic workers without known or suspected exposure to COVID-19 may be considered. In these circumstances, the CDC recommends that employers contact their local health department for guidance.²

Please refer to these CDC website links for more details. This information is current as of May 2020 and October 21, 2020.

¹ Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Interim Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 (COVID-19), May 2020.

² Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 Testing Strategy: Considerations for Non-Healthcare Workplaces. Updated October 21, 2020.

Updated 6/21/22

Where can members receive COVID-19 testing/screenings/treatments under their plan coverage?

Members can receive COVID-19 testing at no cost from an in-network or out-of-network provider. Members can get treatment for covered services based on their plan benefits. Members should refer to their Policy or Plan Contract and Evidence of Coverage for provider network and cost-share information.

What are the symptoms?

Some people can have COVID-19 and be contagious without showing symptoms. People with COVID-19 symptoms have mild to severe breathing problems. Other symptoms include:

What else causes similar symptoms?

Influenza (the flu) is another illness that affects breathing. It's caused by flu viruses (Type A and Type B). The flu is highly active in the United States during the winter months. Everyone six months of age and older should get a flu vaccine.

I may have symptoms. What do I do?

If you have been exposed or begin showing symptoms of COVID-19 or the flu, contact your health care provider or health department right away.

How do members get an at-home COVID-19 test for free?

If they have pharmacy coverage as part of their Health Net plan, they can get an over the counter (OTC), FDA-approved, EUA at-home COVID-19 test at no cost if they visit one of Health Net's in-network retail pharmacies. View approved in-network pharmacy test kit list (PDF).

Get the test from the pharmacy itself. Do not get a test and pay for it at the store's normal register. If they pay for the test at the normal register, then they will need to submit a medical claim form to get reimbursed.

Visit our website to find an in-network pharmacy for their plan type.

Are there tests not covered through pharmacy?

COVID test kits that are not covered include:

Kits that have to be sent to a lab (collection kits)
Kits that are not indicated as "OTC"
COVID kits obtained outside of the United States

A member has a Health Net group medical plan, but the prescription coverage is through another company. How do they get an at-home COVID test for free?

They can check with their pharmacy to see if they can bill the vendor through their pharmacy system. The member can then get an OTC at-home COVID-19 test at no cost. They can also purchase an OTC FDA-approved, EUA at-home COVID-19 test and be reimbursed by Health Net for the cost of the test. Please complete and submit a Health Net medical claim form.

A member bought an at-home COVID-19 test on their own, will they be reimbursed?

Yes. If they bought an OTC FDA-approved, EUA at-home COVID-19 test at any place outside of our in-network pharmacies (e.g., Amazon, grocery store, drug store, etc.), they will be reimbursed for the cost of the test kits (up to $12 per test) as follows:

Purchase an at-home test that is on the FDA-approved EUA list. View the FDA-approved EUA at-home test list. Tests available without a prescription will include "OTC" (for over-the-counter at-home tests) in the Attributes column.
Complete and submit a separate claim form for each member:
Claim form – English (PDF)
Claim form – En Español (Spanish) (PDF)

They must include a copy of their receipt. On the receipt, write or circle (if the information is on the receipt):
- The name of the OTC COVID Test Kit.
- The UPC code found on the box.
Complete Section 1 and Section 2 of the claim form.
For Section 3, include this information in the fields as follows:
1. The store where they bought the test kit (Amazon, grocery store name, drug store name, etc.)
2. The address of the store if applicable.
3. Write "COVID-19 Home Test" and the number of tests.
4. The date they purchased the kit(s).
5. The amount being asked for reimbursement.
Sign and return the claim form (don't forget the receipt).
Mail to:
Health Net, LLC
Commercial Claims
PO Box 9040
Farmington, MO 63640-9040

The member will be reimbursed based on federal guidance set on January 10, 2022, which states:

The cost of the at-home test – up to $12 per test
Maximum of 8 tests per covered member in a 30-day period
A single testing kit box that includes two tests would count as two (e.g. $12 x 2 = $24)

If they purchased a physician ordered, FDA/EUA approved test before January 15, 2022, Health Net will reimburse the member when the claim form is turned in based on what they paid.

If the member bought an FDA-approved EUA at-home COVID-19 test on Amazon, how do they show their proof of purchase?

Please print an image of the digital receipt and submit it along with the claim form. If they can't provide a digital receipt, please put the order or invoice number for the purchase on the claim form. This is for proof of purchase and tracking. See above FAQ on how to be reimbursed.

Will Health Net limit the number of tests that a member can get for free?

Yes. Health Net will cover 8 OTC FDA-approved, EUA at-home COVID-19 tests purchased over-the-counter per covered member in a 30-day period. This follows the federal guidance released on January 10, 2022.

Will members be charged for any out-of-pocket costs for COVID-19 testing and screening?

No. We will cover medically-required COVID-19 testing and medical screenings at no charge to members. We will do this when these services are ordered and/or referred by a licensed health care provider. If relevant, member's plan will waive the costs for required COVID-19 diagnostic testing along with the doctor visit. This includes:

copayment
coinsurance
deductible cost-sharing

If a member needs treatment for COVID-19, is that covered by their plan?

Yes, Health Net will waive member cost-share for all treatments linked to COVID-19 through May 31, 2021. Member groups include:
- Medicare
- Medi-Cal
- Commercial fully-insured members
Cost-sharing terms of your benefit plan will apply to treatments linked to COVID-19 received on or after June 1, 2021.

We are committed to making sure members have access to COVID-19 treatment services, per federal and state law.

Is prior approval needed for COVID-19 testing, screenings and/or treatment under the member's plan coverage?

No. We will not require prior approval, prior notice and/or step therapy rules for:

Medically-required COVID-19 diagnostic testing.
Medical screenings.
Treatment when ordered and/or referred by a licensed health care provider.

Will Health Net cover COVID-19 serological tests?

During this emergency period, Health Net's benefit plans cover medically necessary serologic (antibody) testing, using AMA approved CPT codes and CDC guidance for appropriate use of FDA approved antibody tests.

Will Health Net cover testing if a member is not showing any COVID-19 symptoms?

Per federal and DMHC guidance, COVID-19 diagnostic testing is covered for members with or without symptoms. This is true even if there is no known or presumed exposure to COVID-19 when the purpose of the testing is for personal diagnosis or treatment of COVID-19. And, when a licensed or approved health care provider either gives the test or has referred you to get a test.

How often can the member get a COVID test?

There is no limit to the number of times you may get tested for COVID-19. This aligns with federal and DMHC guidance.

Will Health Net cover the COVID-19 testing required by my employer?

Yes, keeping in line with California law, Health Net provides coverage of COVID-19 testing for employment purposes.

Does Health Net have a list of approved testing locations?

No, Health Net does not maintain a list of approved testing locations. Employees should seek an in-network doctor's order for a COVID test, who will direct the member to the most convenient testing location. In some cases, their physician will be able to provide the service at their facility.

If a member paid out of pocket for COVID-19 testing, what is the process for members to be reimbursed?

Members who paid out-of-pocket for COVID-19 test should submit a claim form to Health Net. Members may find a claim form on www.healthnet.com or by calling the Customer Contact Center at the telephone number listed on their ID card.

Will carriers pay wellness companies providing test for employees on the companies' site?

No, Health Net will not pay wellness companies for testing services at the employer's workplace. We will, however, cover voluntary COVID testing for "essential workers", in compliance with the DMHC all plan letter. For non-essential workers, Health Net will cover medically necessary COVID testing, in accordance with the CDC guidelines. All diagnostic testing should be directed and provided by an in-network provider.

Who should members contact to be screened and tested for COVID-19 and where can members be tested?

For guidance on COVID-19 testing and screening, call your physician or other authorized health care provider. Health Net members can also access telehealth services through Babylon.

If your physician or other health care provider determines that you meet COVID-19 testing criteria, your physician will direct you on where to obtain the test.

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law and Health Net's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Will COVID tests that are received outside of the US be reimbursed as a covered benefit?

We will cover medically-required COVID-19 testing and medical screenings at no charge to members. We will do this when these services are ordered and/or referred by a licensed health care provider.

If relevant, your plan will waive the costs for required COVID-19 testing along with the doctor visit. This includes:

Copayment
Coinsurance
Deductible cost-sharing

When can I get a COVID-19 vaccine booster?

Booster shots are now available for those who got Pfizer, Moderna, or Johnson & Johnson vaccines.

People who are able to get a booster dose are as follows:

Pfizer: 12 and older
At least 5 months after getting the main COVID-19 vaccination series
Moderna: 18 and older
At least 5 months after getting the main COVID-19 vaccination series
Johnson & Johnson: 18 and older
At least 2 months after getting the main COVID-19 vaccination

To book your booster shot, visit My Turn.

California has ample supply to ensure all Californians who are able to get the vaccine will have access to the vaccine.

If I need a booster shot, does that mean that the vaccines aren't working?

No. COVID-19 vaccines are working well. They are helping to prevent severe illness, hospital stays and death. But, public health experts are starting to see reduced protection. This is true mainly among certain groups of people and against mild and moderate disease.

Do I have to pay for the booster shot?

No. COVID-19 vaccines are free to the public.

What's the difference between an additional vaccine dose and a booster dose?

Additional vaccine dose

The added dose appears to help protect some immunocompromised people. Because of this, the CDC suggests that immunocompromised patients think about getting a third dose of an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna). And, that they do it at least 28 days after they complete the first two-dose mRNA COVID-19 vaccine series.

This includes people who have:

Been getting active cancer treatments for tumors or cancers of the blood.
Received an organ transplant and are taking medicine to suppress the immune system.
Received a stem cell transplant within the last two years. Or, are taking medicine to suppress the immune system.
An advanced or untreated HIV infection.
Active treatment with drugs that may suppress your immune response.

If you believe you qualify, talk to your doctor to ensure you are able to get a third dose.

More information on a third COVID-19 vaccine dose

Booster dosage/booster shot

A booster dosage is another dose of a vaccine given to someone who got the vaccine, but whose protection later decreased with time.

CDC COVID-19 vaccine booster shot information

Does getting a third vaccine dose get rid of the need for further safeguards?

No. Not everyone who is immunocompromised has a normal immune system response – even with an extra dosage of mRNA vaccine. Because we are still learning about this, it is very important to take extra care to protect yourself. When you are with friends, family and out in public, you should still follow the current safeguards, such as wearing a mask indoors.

Can I mix and match COVID-19 vaccines from different makers?

Yes, after you complete your first vaccination series. In the United States, that means:

Two shots of the Pfizer vaccine 21 days apart, or
Two shots of the Moderna vaccine 28 days apart, or
One shot of the Johnson & Johnson vaccine.

After this first series, you may choose another vaccine maker for your booster dose. Some people may prefer the vaccine brand they got for their first series, while others may want to try a different booster. The CDC recommendations now allow for this type of mix-and-match dosing for your booster shots.

We strongly advise a Pfizer or Moderna booster for those who got the Johnson & Johnson first vaccine.

Will there be a change in our contacts? Or contact phone numbers (cell phones)?

There will be no change in our contacts. Health Net has made all necessary arrangements for its employees to assure uninterrupted service.

How is Health Net addressing potential technical issues?

We have thorough Business Continuity Plans in place for our IT systems, Call Centers and other operations. Health Net and Centene offices remain open, with essential personnel in place. We have implemented appropriate technology, and work from home capabilities for the majority of our employees under HIPAA/PHI/PII compliance guidelines. There are no changes to business hours.

Will there be a change in Health Net's escalation process?

Our escalation process remains sound and there are no changes planned for our escalation process.

What are some of the details about the 2020 law California enacted about COVID-19 in the workplace and Workers' Compensation coverage?

CA Senate Bill 1159 (CA SB 1159) became effective on September 17, 2020. The law creates a rebuttable presumption that workers who contracted COVID-19 did so at work, unless the employer can prove otherwise. Previously, employees had to show that that their illness or injury was caused at the workplace. The presumption that COVID-19 was contracted at the place of employment applies retroactively to July 6, 2020, and through January 1, 2023.

This means that employees' COVID-19 treatment could be covered under workers' compensation coverage.

Below is a high-level summary of the law. CA SB 1159 is complicated, and this summary is for informational purposes only, and is not legal advice. We suggest employers contact their workers' compensation carriers and legal counsel for more information about the law and reporting requirements.

Impacted Employers

First Responders and Health Care Workers: CA SB 1159 presumes COVID-19 cases contracted by certain first responders and front line health care workers from July 6, 2020 through January 1, 2023 occurred on the job.

These workers include but are not limited to firefighters, peace officers, employees of health facilities who provide direct patient care or custodial services, nurses, EMTs, and employees who provide direct patient care for home health agencies, and other employees of designated health facilities.
Other California employers with 5 or more employees: CA SB 1159 presumes the employee contracted COVID-19 at work under any of the following "outbreak" conditions:
- If the employer has between 5 and 100 employees, four employees who test positive for COVID-19 within 14 calendar days
- If the employer has 101 or more employees, 4 percent of the number of employees test positive for COVID-19 within 14 calendar days
- The place of employment is ordered closed by certain public authorities due to a risk of infection with COVID-19
CA SB 1159 defines employees' place of employment as the building, store, facility, or agricultural field where an employee performs work at the employer's direction and explicitly excludes work performed in the employee's home or residence, unless the employee provides home health care services to another individual at the employee's home or residence.

New Employer Reporting Requirements

Employers who become aware that an employee has tested positive for COVID-19 must report the following information to their workers' compensation claims administrator within three business days.

An employee has tested positive. But the employer shall not provide any personally identifiable information regarding the employee who tested positive for COVID-19 unless the employee asserts the infection is work related or has filed a worker's comp claim form.
The date that the employee tests positive (the date the specimen was collected for testing).
The specific address or addresses of the employee's place of employment during the 14-day period preceding the positive test.
The highest number of employees who reported to work in the 45-day period preceding the last day the employee worked at the place of employment.

Failure to do so may result in a civil penalty of up to $10,000.00 imposed by the California Labor Commissioner.

What Health Net Is Doing

Health Net will continue its standard process of coordinating with your workers' compensation carrier.

For up-to-date information refer to the following:

How can employers access previous Health Net invoices to get information for a Paycheck Protection Program (PPP) loan?

Employers and brokers with delegated access are able to obtain this information through the self-service option on the employer portal (available for active groups) or by calling their Account Manager.

What if a Health Net member requires proof of insurance to re-enter the country?

Members may download proof of coverage or their ID card from our website. We encourage all members to register on our website and update their current contact information, including email and cell phone number.

If an employer is indefinitely closing their offices due to COVID-19 guidelines, how does this affect open enrollment?

Health Net will suspend all face-to-face open enrollment meetings until further notice, and will offer online/virtual open enrollment meetings.

What is the payment grace period for Individual and Family Plans?

Members who receive Advanced Premium Tax Credits (ATPC), also referred to as subsidies, have a 90-day grace period. Members who do not receive APTC have a 30-day grace period.

How is Health Net handling late or partial premium payments from employer groups? Will there be extensions?

There will be no change to our 30-day grace period policy for employer groups. Health Net requires full payment of premium for employees covered.

If an employer lays off the bulk of their workforce, and are experiencing cash flow issues, can they remit payment for the "true" amount of their bill for the upcoming benefit month, to allow for 1-2 billing cycles to be trued up?

Yes, employers may choose to adjust their premium remittance for current terminations as long as they:

do not terminate employees retroactive to the current invoice remittance, and
clearly identify on their remittance, the employees who will remain active on their payroll, so we can appropriately and timely process any terminations.
Remit the "true" amount which is Current Due total less terminated employees

Employers should submit their remittance with appropriate updates to the "Current Membership" and "Membership Changes" sections of their Group bill. Members on the current invoice have coverage until the end of the invoice month.

How will Voluntary premiums be impacted?

Current requirements continue to apply to voluntary premium/products.

What is Health Net doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans Health Net has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Health Net regularly reviews and updates its emergency business continuity protocols.

As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations.

How is mental health covered as a result of COVID-19? What about mental health that is not linked to COVID-19? If done through telemedicine, is it at a $0 copay?

Through May 31, 2021, Health Net will waive member cost-share for all telehealth services.
Cost-sharing terms of your health plan will apply for telehealth services received on or after June 1, 2021.

Please note that member cost-share for COVID-19 testing and screening will keep being waived. Behavioral health services given in person will be covered, as per your plan benefits. Applicable cost-sharing will be applied.

If you are enrolled in a PPO plan, and use an out-of-network provider, that provider may bill you amounts in addition to your applicable cost-share. The bill will be for the difference between the provider's charge and what the plan pays. This is known as balance billing.

Are there strategies for coping with the COVID-19 outbreak?

Worry and stress can rise about the spread of COVID-19. Concern for friends and family who live in places where COVID-19 cases are growing is natural. So is concern about the continued spread of the disease. Try these tips to help you cope:

Take care of your body. Take deep breaths, stretch or meditate.
Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.
Share the facts about COVID-19 and the real risk to others. People who have returned from places of ongoing spread for more than 14 days, and do not have symptoms of COVID-19, have a much lower chance of putting others at risk. Wearing masks, washing hands and social distancing help to keep the risk very low.
For more information, see the CDC's suggestions for mental health and coping during COVID-19.

Is coping assistance offered to members impacted by COVID-19?

For more information, including travel alerts, please visit:

Will members be able to refill their prescriptions before the refill date?

Yes, members will be able to refill their prescriptions prior to the refill date.

What is Health Net doing to address possible drug shortages related to coronavirus?

First, we are closely monitoring the spread of the coronavirus to prepare for any impact. We are also actively monitoring for news of any drug shortages. Second, if needed, we may send prescriptions from another one of our pharmacy locations. This will help ensure our members have continued access to medications. Finally, we always encourage members to refill maintenance medications in a timely manner.

Are medications safe? Could they be contaminated or at risk? Are medications from China?

The US Food and Drug Administration (FDA) monitors drug safety. It sends alerts in case of any safety or contamination issues. We check all prescriptions for safety and quality, and will let our members know of any safety concerns. Members should continue to take their prescription medications as advised by their doctor.

Is there a drug to prevent Coronavirus?

Not at this time, but our pharmacists are monitoring the new drug pipeline for any medication or vaccine that may become available.

Where can I get credible information?

You can visit these websites that provide the most current information available:

If a state of emergency is issued, will Refill Too Soon on member prescriptions be lifted?

We will work with our members on a case by case basis to ensure they have access to their medications.

How much medication should members have on hand during this crisis?

Members should have at least a one-month supply of the prescription medications they need to manage their medical conditions.

If members don't have a one-month supply can they get more medication before its refill date?

Yes, Health Net has relaxed the refill limits so members can have more of their medications. Members should contact their pharmacy to get an added supply. Also, members should be sure to request a refill several days in advance of when their current supply runs out. This will allow extra time for the pharmacy to prepare it.

Can members get more than one prescription refilled early?

Yes. As a matter of fact it's best for members to arrange for all their prescriptions to either be picked up or delivered all at the same time. If they have more than one prescription, they should try to have them refilled on the same date. Health Net has been working with pharmacies to allow them to fill most prescriptions sooner than normal. This helps when trying to get prescriptions filled that have different refill dates.

What is a good way to limit being exposed to other people at the pharmacy?

Use the pharmacy drive-thru. Many pharmacies now have drive-thru windows. If your pharmacy has one, it may be a good option to use. A drive-thru limits coming in contact with other people picking up their medications.

Members can also wait in the car for their prescription. If their pharmacy doesn't have a drive-thru and they need to wait for a prescription to be ready, they might want to sit in their car rather than the pharmacy waiting area. By waiting in their car, members reduce the time they are exposed to other people. Some pharmacies will bring medications to the car. Note: Because of COVID-19 many pharmacies are changing the hours they are open. Members should contact their pharmacy to confirm business hours.

My client doesn't want to go out unless they really need to – is there a way to avoid going to the pharmacy?

Yes, the member should ask the pharmacy if they will deliver medications. During this pandemic, many pharmacies have offered to have medication delivered for free or at a low cost. CVS and Walgreens will deliver for free. Members should make sure to talk to their pharmacist to confirm their prescriptions qualify for delivery and if there is a delivery charge.

Are there other options besides going to the pharmacy?

Yes, members can use their mail-order option. Mail order will fill 30-day medication supplies. Or, members may be able to receive a larger amount – up to a 90-day supply for maintenance medications.

How can my client change my prescription from a 30-day supply to a 90-day supply?

If you have a maintenance prescription, ask your pharmacist if you are able to get a 90-day supply. Mail order is also an option for filling a 90-day supply.

My client has never used a mail-order pharmacy. Is this the right time to start? If so, how does it work?

Yes! Using a mail-order pharmacy or getting prescription delivered helps with social distancing. It lowers the risk of being exposed to COVID-19 and can reduce chances of getting sick. Benefits of mail-order pharmacies include:

Simple, fast, and free delivery: Many mail-order pharmacies offer free shipping and can deliver prescriptions usually within five business days.
Time and money saved: Some benefits offer discounts on medications if members get them through a mail-order pharmacy. Members can also save on time and transportation costs since they don't have to make a trip to a pharmacy.

How it works:

Option 1: Members should ask their doctor to send an electronic prescription (eRx) to CVS Caremark Mail Service Pharmacy. It should be for a prescription of up to a 90-day supply of your maintenance medication.
Option 2: Members can sign up or sign in at Caremark.com. Select Prescriptions from the navigation bar. From the drop-down menu, select Request a New Prescription. Search for the drug name and strength. Add it to the cart by choosing Request a New Prescription, and complete the order.
Option 3: If a member cannot contact their doctor or they are not able to sign up at Caremark.com, CVS Caremark Mail Service Pharmacy can contact their doctor. To start this process, complete the Start Mail Service request form.
Option 4: Members can call Caremark mail order at the toll-free number 1-888-624-1139 (TTY 711), 24 hours a day, 7 days a week.

Members can also contact Health Net Customer Service toll-free at 1-800-522-0088 for help. Please allow 14 days for shipment to arrive from mail order.

What if my client's medication comes from a specialty pharmacy?

Specialty pharmacies ship medications straight to a member's home or office. Members can have their specialty prescription drug shipped most likely within a few days. Members should contact the specialty pharmacy for their refills.

What about medications that need prior approval?

Health Net has extended prior approvals scheduled to end in the next couple of months. This helps to ensure that you will get your medications without delay of getting a new approval. Many doctors are sending requests online from their homes. Health Net has waived the need for a signature to make it easier for doctors.

How do members obtain an emergency supply of a prescription?

On March 19, 2020, the state of California launched a new coronavirus awareness website. According to this website:

California is expanding the coronavirus testing capacity daily.
Currently, testing is being prioritized for people who have the coronavirus symptoms AND have one of these risk factors:
- Have had contact with a person who has tested positive for COVID-19, OR
- Are health care providers or work with vulnerable populations (such as a long term care facility), OR
- Traveled to an affected country in the past 14 days, OR
- Are over age 60, have a compromised immune system or have serious chronic medical conditions

How else can members get health care services?

Babylon is a useful way for Health Net of California, Inc. and Health Net Life Insurance (Health Net) members to get telehealth services. This service is for non-emergency medical and behavioral health issues. Members will receive access to in-network health care providers. Babylon medical appointments are available 24/7 and behavioral health appointments are available 7:00 a.m. to 7:00 p.m. (Pacific time). This means members can speak to a doctor or therapist when they need to. Get more information about Babylon and other health plan services.

What is Babylon?

Babylon is a mobile telehealth/telemedicine app that combines the power of Artificial Intelligence (AI) with human medical expertise. Users can meet with a licensed physician via telephone and/or video for any non-life threatening medical or behavioral health issue.

Babylon healthcare providers are available for medical appointments 24/7 and behavioral health appointments are available 7:00 a.m. to 7:00 p.m. (Pacific time). The clinical support team is available 7 days a week, 5:00 a.m. to 7:00 p.m. Pacific time. That means if your clinical support need arises after 7:00 p.m. Pacific time, you can leave a message for a return call on the next day. Or you can schedule a virtual visit within the app.

Please note that Behavioral health appointments are scheduled, not offered on-demand.

How do I use Babylon?*

All members will need to visit the Babylon website or Health Net telehealth web page to select and download the Babylon mobile application. At that time, members will be required to register.

*Babylon is not available on all group plans.

Can a member use Babylon for any health issues that may not be related to COVID-19?

Yes, Babylon is available for general medical and behavioral health issues when a member cannot see their primary care medical provider at their medical home. It can be used for issues not related to COVID-19.

Are behavioral health services available thru Babylon, and if so what happens if there is a crisis situation during a call?

Yes, behavioral health services are available thru Babylon. The Babylon clinical team follows standard crisis protocols.

Can Babylon provide members with a doctor's note, i.e. missed work due to illness?

Yes, Babylon can provide members with this type of documentation.

How often is COVID-19 guidance updated within the Babylon app?

The app is updated on a regular basis to provide the most current information from the Centers for Disease Control and Prevention (CDC).

If the Babylon provider determines the member needs to be referred for an in-person testing location, how is the referral tracked?

At this time, Babylon is available as a telehealth provider only. Babylon offers general medical and behavioral health appointments. Referrals to specialty care will be coordinated by the member's assigned PCP. Babylon will provide clinical documentation to the member's PCP following the Babylon visit. All referrals to in-person testing locations are tracked in the medical record and included in the encounter summary for members to access within in the Babylon app.

What is the member share of cost for telehealth services through Babylon?

Health Net waived member cost-shares for all telehealth services through May 31, 2021.
Cost-sharing terms of the member's health plan will apply for telehealth services received on or after June 1, 2021.
Babylon appointments are available at no cost to most Health Net members but some members may have a co-pay. Please refer to the member's health coverage document for more information.

Please note that member cost-share for COVID-19 testing and screening will keep being waived.

Can the developmentally delayed population access these apps with support of a relative, conservator or staff from the local regional center?

Yes, a relative, conservator, or staff member can assist members who have special needs.

Can I request the same Babylon healthcare provider each time?

If you wish to make an appointment with the same healthcare provider that you used before, please contact their support team at (800) 475-6168. A support agent will book your appointment for you.

If you book through the Babylon App, the healthcare provider available will depend on the date and time requested. Any healthcare provider you book a consultation with will have access to notes related to your care from your previous Babylon appointments, if you have had any.

How will the Babylon appointment start?

You'll get an incoming video call from the healthcare provider within a few minutes of your scheduled appointment time. You don't need to have the Babylon App open to receive the call.

If you haven't received a call after a few minutes, read what to do if your appointment is late. We recommend turning on notifications so that you receive appointment reminders. To turn on notifications, follow these steps in your phone's general settings:

Go to Notifications > Babylon
Make sure notifications are turned on

You will receive a push notification reminding you about your appointment five minutes before it starts.

How do I prepare for my telehealth appointment?

Go somewhere quiet where you feel comfortable discussing your health. This could be at home or work, just as long as you won't be disturbed.
Try to avoid:
- Being in a public place.
- Being on a bus or train.
- Doing other things during the call.
- A lot of background noise. The healthcare provider might ask you to move if there's a lot of background noise, so you may want to keep headphones handy.
- Unsafe or inappropriate circumstances. The healthcare provider will end the call if they think it's unsafe or inappropriate to continue, like if you take the call while driving or you're not fully dressed.
Make note of the main points you want to discuss and any relevant details, like:
- How long you've experienced these symptoms.
- What makes you feel better or worse.
- Any medication you take, whether for your current symptoms or another health condition.
- Don't worry about taking notes. Your healthcare provider will write up a summary that you can view after the appointment.

What new communications have you issued regarding telehealth?

In addition to posting information on our Member portal, we released Member email campaigns for telehealth in April and September 2020, and are planning additional communications in the coming months.

In terms of Provider communications, we are posting to the provider alerts pages. We have also distributed provider recruitment letters for our telehealth services via fax and mail (standard process). Our Provider Relations team is emailing the Provider FAQs to providers as they are updated.

Are interpreter services available for a member on a telehealth call?

Babylon offers members to select a Language Preference via the mobile app. After downloading the app, the member is asked to choose a preferred language.

Will Health Net be making changes due to the new IRS guidance on Section 125 plans, FSAs and HSAs?

To align with recent IRS guidance on Section 125 plans, FSAs and HSAs (Notice 2020-29 and Notice 2020-33), Health Net will allow members to elect mid-year plan changes and allow FSA and HSA updates at the request of the employer group. Please contact your Account Manager for more details if you wish to make a change to your Section 125 plan. Please note that Health Net is not allowing another Special Enrollment period.

Will Health Net allow mid-year plan downgrades (employer and employee) due to financial hardship? If yes, what documentation is required?

Groups have a one-time opportunity to downgrade their existing plans without penalty.

The plan downgrade must be within the plan family (for example, HMO to HMO, or PPO to PPO)
HMO plan downgrades that include a change in provider network require Underwriting approval (for example, Full-network HMO to WholeCare HMO)
Plan upgrades are not available
The group's renewal date will not change

Will Health Net allow mid-year employer contribution changes? If yes, what documentation is required?

Health Net will allow contribution changes as long as the minimum contribution requirements are met.

Will Health Net waive the reinstatement fee for groups that experience COVID-19 financial issues?

Health Net will be waiving all reinstatement fees through the end of the public health emergency.

Is Health Net considering any other options for employees who are not able to provide wet signatures (pen ink signature on paper) on their applications?

In addition to wet signatures, Health Net accepts member enrollment forms with electronic signatures, provided that the forms are submitted to Health Net via the group administrator, contracted broker or third party administrator (TPA). The group, broker or TPA is responsible for ensuring that the information provided to Health Net is accurate and the form was e-signed by the individual applying for coverage.

Will Health Net extend renewal deadlines?

No, renewal deadlines will not be extended. Health Net continues to comply with the 60-day renewal notification requirement for Small group employers, and 120-day renewal requirements for Large group employers.

Will Health Net be flexible on new business submission requirements (proof of business, payroll, etc.)?

Yes, we will provide an extension for new group business through the end of the public health emergency.

Will Health Net provide a partial premium refund for PPO plans as requested by the Insurance Commissioner on October 7, 2020?

No, Health Net will not issue a partial premium refund for PPO plans. The Affordable Care Act’s medical loss ratio (MLR) provision require plans to provide a credit or rebate if the plan does not spend a certain percentage of premiums on medical care and activities to improve the quality of care. IFP and SBG plans must spend at least 80% of premiums on care; the threshold for large group plans is 85%. Health Net will provide a premium credit or refund next September if the plan does not meet the 2020 MLR threshold.

Health Net encourages members to seek care, and has waived member deductible, copays and coinsurance for telehealth visits and COVID-19 testing and treatment.

Will an employer group's rates/premium be subject to change if enrollment drops by more than 10% as a result of COVID-19?

Both small group and large group rates will not adjust off-renewal cycle.

If an employer reduces staff to below 100 for either part of or for the entire plan year, how will this affect their renewal?

Health Net will continue to apply Standard Policy rules to determine the coverage applicable to each group. Health Net will continue to comply with Federal and State guidelines on group size and applicable determination.

Regarding marketing for groups that renew between 5/1 and 8/1, will Health Net accept a census that was pre-layoff/reduction of hours?

Health Net will use current policies and will require and use best information available at time of quote.

Did you know you can get help paying your broadband internet costs?

The federal Emergency Broadband Benefit (EBB) is a program that can help pay for your broadband internet costs. It offers a short-term discount that will end later this year.

This discount for your monthly internet bills can help you stay linked to jobs, health care, online classrooms and more. Check this list of participating providers.

All Medi-Cal members qualify to receive the discount (one per household)

The benefits include:

Up to $50 per month to help cover internet costs.
A one-time discount of up to $100 for a laptop, tablet or desktop computer. Check this list of internet providers that offer connected devices in California.

Others who may qualify to get the discount

You can also qualify to get the discount if one person in your home meets any one of the following:

Have a loss of income from a job lost or furlough any time since February 29, 2020 and a total household income is less than $99,000 (single) or $198,000 (joint) a year.
Receive food help through the Supplemental Nutrition Assistance Program (SNAP), which used to be known as food stamps.
Receive Supplemental Security Income (SSI) payments.
Receive Medicaid.
Receive Veterans Pension and Survivors Benefit.

To check the full list to see if you qualify, go to Get Emergency Broadband.

Apply soon while the funds are still available

The program will last until funding runs out. Or, it will last up to six months after the end of the COVID-19 pandemic. (It depends which comes sooner.) If you qualify to get a discount, you should apply online now through Get Emergency Broadband. You can also print out an application form and apply by mail. Send it to:

Emergency Broadband Support Center
P.O. Box 7081
London, Kentucky 40742

Questions?

Read more information about the EBB program. Find out what you need to do to apply at Get Emergency Broadband.