Vaccinations & Testing
Consumers should not be charged for a COVID-19 vaccine or for the vaccine's administration, regardless of health insurance status.
Learn more in our Consumer Alert by clicking here.
The CDC has also provided information reminding everyone that the COVID-19 vaccine is provided at 100% no cost to recipients.
All organizations and providers participating in the CDC COVID-19 Vaccination Program:
- must administer the COVID-19 vaccine at no out-of-pocket cost to the recipient
- may not deny anyone the vaccine based on the recipient's coverage or network status
- may not charge an office visit or other fee if COVID-19 vaccination is the sole medical service provided
- may not require additional medical services to receive COVID-19 vaccination
- may seek reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the recipient, such as a private insurance company, Medicare, Medicaid, or the HRSA COVID-19 Uninsured Program
- may not seek any reimbursement, including through balance billing, from the vaccine recipient
Individuals aware of any potential violations of these requirements are encouraged to report them to the Office of the Inspector General, US Dept. of Health and Human Services, by calling 1-800-HHS-TIPS or online at tips.hhs.gov.
Health insurance issuers are required to cover free testing and administration of FDA-approved COVID-19 tests. This requirement means you can't be charged cost-sharing like a co-pay. Issuers also can't impose pre-authorization or medical management requirements.
If you are asymptomatic and have no known or suspected recent exposure to COVID-19, issuers must sill cover testing if a licensed or authorized health care provider administers or has referred a patient for COVID-19 testing.
Health Insurance Issuers' Response to the Coronavirus (COVID-19)
The South Carolina Department of Insurance is actively engaged with our health insurance industry to ensure appropriate protections are being implemented in response to the Coronavirus. The Department has compiled the following information from health insurance issuers providing coverage in South Carolina (listed in alphabetical order by issuer).
Please click on the links provided for full details regarding the policies of each issuer. Please note that these are in addition to the requirements regarding testing and vaccination noted above.
- Cost sharing will be waived for medically necessary testing and screening services, including the office visit, for COVID-19 when services are ordered by a licensed health care provider.
- Existing telemedicine services will continue to be made available, as will those being offered by local health systems (see more under the Free Virtual COVID-19 Screenings heading). In addition, ATC will cover telemedicine visits by an in-network provider that is contracted with Teladoc or that has their own HIPAA-compliant telehealth platform and training, including those offered by family and general practitioners.
- Applies to: all fully insured business (including the Health Insurance Marketplace, Healthcare.gov), Medicaid, Medicare Advantage, Medicare-Medicaid Duals (MMP), and Dual Eligible Special Needs (DSNP).
- Co-pays will be waived for COVID-19 vaccines and for diagnostic testing related to COVID-19.
- Aetna will offer 90-day maintenance medication prescriptions for insured and Medicaid members.
- CVS Health is offering several programs to educate members and address any associated anxiety and stress.
- Providers can access additional information regarding payment policies and billing codes by clicking here.
- Aetna has posted FAQs for providers online that can be accessed by clicking here.
- Applies to: all fully insured business and some self-insured plans. The waiver of co-pays for diagnostic testing also applies to Medicare and Medicaid business.
- All cost-sharing associated with COVID-19 diagnostic testing, including the provider visit, will be waived. BlueChoice is also waiving the cost-sharing for the full viral panel that is being given as a part of the screening for COVID-19.
- Applies to: all fully insured business, some self-insured plans, and Medicaid coverage.
- All cost-sharing associated with COVID-19 diagnostic testing, including the provider visit, will be waived. BlueCross is also waiving the cost-sharing for the full viral panel that is being given as a part of the screening for COVID-19.
- Applies to: all fully insured business (including the Health Insurance Marketplace, Healthcare.gov), some self-insured plans, and Medicare Advantage coverage. State employees and retirees covered through PEBA’s State Health Plan, which is administered by BCBSSC, should consult https://www.peba.sc.gov/ for more information on their coverage.
- COVID-19 diagnostic testing is covered at no cost to members. This includes waiving cost-sharing for certain related services, including in-network telehealth or provider office visits, in-network urgent care, and emergency room visits associated with the administration of the screening test. Bright Health is also waiving the cost sharing for the full viral panel that is being given as a part of the screening for COVID-19.
- Members who are concerned about accessing their prescriptions during the COVID-19 outbreak can have their next prescription refilled on an as-needed basis and early-fill edits will be overridden. Members should contact their pharmacist and ask them to request approval for early refills through the company’s pharmacy help line.
- Bright Health will provide maximum flexibility in order to expand access to telehealth services for members. Normal member benefit and cost sharing applies to services unrelated to COVID-19. Providers with questions can click here for more information on how to utilize telehealth services for members.
- Members may contact customer service with questions at these numbers: Individuals and Families: 855-521-9352 or Medicare Advantage: 844-223-8380.
- Applies to: all fully insured business (including the Health Insurance Marketplace, Healthcare.gov).
- Cigna covers the cost of approved vaccines without any cost-share. The vaccines is currently purchased by the federal government and provided free to individuals. Cigna covers the cost of administering the vaccine without any out-of-pocket costs when done by any in-network or out-of-network provider.
- Cigna customers continue to have $0 cost-sharing for all FDA-approved diagnostic COVID-19 testing and testing-related screening office visit or virtual visit, as required by the CARES Act.
- Prescription drugs are available with free home delivery of up to a 90 day supply of maintenance medications through Express Scripts Pharmacy.
- Cigna has developed a self-screening tool for COVID-19 that is available online by clicking here.
- Cigna is also providing free resources for all customers, clients and communities to support them during these times of high stress and anxiety. The company has opened a 24-hour toll-free help line (1-866-912-1687) to connect people directly with qualified clinicians who can provide support and guidance.
- Applies to: all fully insured business, some self-insured plans and Medicare Advantage coverage.
- All COVID-19 testing will be provided at no cost to members when ordered by a physician, regardless of network status of the testing provider (including emergency room visits, office visits or any urgent care visits when the purpose of the visit is to be tested for COVID-19). All prior authorization requirements are also being waived for diagnostic testing for COVID-19 that adheres to CDC testing guidelines.
- Members may receive a 100-day supply of prescription drugs through their pharmacy benefit. Additionally, Clover Health has temporarily relaxed refill restrictions in order to permit early refills of maintenance prescriptions.
- Telemedicine and telehealth visits are permitted with no copay or cost sharing for members. Providers can review the company’s guidelines at cloverhealth.com/ease-of-access or reach out to our Provider Services team at 1-877-853-8019, Monday through Friday, 8:00 am - 5:30 pm EST.
- Members may utilize the company’s telemedicine services by calling Teladoc at 1-800-835-2362.
- Applies to: all Medicare Advantage coverage.
- Humana is waiving all member out-of-pocket costs associated with COVID-19 diagnostic testing for tests administered by in- and out-of-network providers.
- For the 2021 plan year, Humana Medicare Advantage plan members will have not have copays, deductibles, or coinsurance for covered services for treatment of confirmed cases of COVID-19, regardless of where the treatment takes place. Medicaid plans will continue to follow state requirements for COVID-19 treatment and cost-share waivers.
- Effective January 1, 2021, employer group members' standard benefits and cost-sharing will apply for COVID-19 treatment.
- Humana will cover FDA-approved medications as they become available.
- All FDA-authorized COVID-19 vaccines will be covered at no additional cost during the public health emergency. Coverage applies no matter where you get the vaccine, including in- and out-of-network providers.
- Including hospital admissions. This waiver applies to all medical costs related to the treatment of COVID-19 as well as FDA-approved medications or vaccines, when available, whether delivered in-network or out-of-network.
- An online self assessment tool is available by clicking here.
- Applies to: all fully insured business, Medicare Advantage, Medicare Supplement plans, and Medicaid.
- Molina Healthcare is waiving all member costs for testing and related services as required by the CARES Act. This includes in-network office and telemedicine visits, urgent care visits, and emergency department visits.
- Prescription refill limitations will be relaxed until further notice. Refill timing allows refills up to 5 days early. Molina will allow up to 90-day prescriptions if this is covered by the member's plan. Additionally, the company's pharmacy benefits manager, CVS, is offering free delivery of prescriptions.
- Molina Healthcare is expanding access to telehealth services for its members.
- Applies to: all fully insured business (including the Health Insurance Marketplace, Healthcare.gov), Medicaid, Medicare-Medicaid Dual Eligibles (MMP), and Dual Eligible Special Needs Program (DSNP).
- Select Health will cover COVID-19 testing. COVID-19 testing will not require prior authorization or copay. Members will have no copayments for office visits.
- Members may refill their prescription medicines (non-opioid/non-controlled substance) earlier than usual to help ensure a sufficient supply. Medicaid members may also receive a temporary, 72-hour supply of medicines that normally require a prior authorization. Use of out-of-network pharmacies will be authorized upon member request when access to in-network pharmacies is difficult, unsafe, or not practical.
- Use of certified out-of-network and/or out-of-state providers will be allowed for medically necessary services.
- Members may also receive health care services by phone or through video interaction with their health care provider.
- Members and providers needing information can click here: First Choice, First Choice VIP Care Plus
- Applies to: Medicaid (First Choice) and Medicare-Medicaid Plan (First Choice VIP Care Plus), unless otherwise noted.
- UnitedHealthcare announced a premium credit program ranging from 5% to 20% for members covered through fully insured health insurance plans and new and renewal price stability for AARP Medicare Supplement policies.
- UnitedHealthcare covers medically-appropriate COVID-19 testing at no cost share when ordered by a physician or appropriately licensed health care professional for purposes of diagnosis or treatment. Learn more about their policies by clicking here and here.
- UHC has established a navigation support program for members under home isolation that will guide them through the process and help coordinate access to medications, supplies, food, appropriate care, and any needed support programs. Members should call the customer care number on the back of their ID card and indicate their provider has prescribed self-isolation to access the program.
- Optum’s Emotional-Support Help Line is available to support anyone who may be experiencing anxiety or stress following the recent developments around COVID-19. The free service can be reached 24/7 at (866) 342-6892.
- Applies to: all fully insured business, some self-insured plans, Medicaid, and Medicare.
Please note: “All fully insured business” means major medical health insurance coverage issued in the commercial health insurance market. It includes health insurance sold to individuals, families and sole proprietors through the Marketplace (Healthcare.gov) or purchased through a health insurance agent/ broker as well as health insurance sold to employers that is not self-funded or self-insured by the employer.
Free Virtual COVID-19 Screenings through South Carolina Health Systems
Several health systems in South Carolina have announced that they will offer free virtual screenings through their telemedicine services. Below are links to their websites. Additional information is available through DHEC by clicking here.
- Beaufort Memorial Hospital
A patient can use a smart phone, tablet or computer to set up a BMH Care Anywhere account, select the “COVID-19 Visits” option, then see a board-certified provider and start a visit. The provider will review intake information, then connect with the patient to discuss symptoms and treatment options.
Patients will need a credit or debit card to begin their visit and will see an authorization hold of $59 placed on their account. At the end of the visit, the provider will waive the fee for patients with respiratory symptoms and the authorization hold will be immediately lifted. The length of time to clear the charge from billing statements varies by bank and/or credit card company.
- McLeod Health
- If you are experiencing fever, sore throat, cough, or shortness of breath, you can have a virtual screen with a trained medical professional. To access the Free Screening, you must type in the code: COVID19.
- The McLeod Outpatient Pharmacy is offering curbside delivery to protect its 4,500 patients and staff who use the pharmacy.
- If you are concerned about coronavirus (COVID-19) or experiencing respiratory or flulike symptoms such as fever and/or cough, MUSC recommends you speak to an online virtual care provider. Virtual COVID-19 screenings are free. Just use the code COVID19 when you log in.
- Prisma Health
- People who are experiencing coughing, fever or shortness of breath can go online and schedule a free online visit. Virtual visits are still subject to cost sharing. To schedule an appointment, patients have to make an account and enter the promo code COVID19.
- Roper St. Francis
- Patients who have fever, coughing and shortness of breath can speak with a provider between 8 a.m. to 8 p.m. Use the promo code COVID19. Virtual visits outside of this time frame will be charged the standard flat rate of $59.
Prescription Delivery Services
- CVS Pharmacy is waiving charges for home delivery of prescription medications.
Health Insurance Options after Job Loss
COBRA (20 or more employees)
If you had insurance coverage through your employer and your employer has 20 or more employees and is still in business with an active group policy, you are entitled to continuation coverage by the federal Consolidated Omnibus Budget Reconciliation Act (COBRA).
Under COBRA you have the option to continue your health care coverage for up to 18 months. You are required to pay the full premium yourself, even if your employer paid part of your premium while you were employed. Your employer may charge an additional, limited administrative fee. Consumers should reach out to their employer’s Human Resources Department for enrollment information.
State Continuation (less than 20 employees)
If your employer had less than 20 employees and is still in business with an active group policy, our state has a mandatory continuation of coverage privilege. The law provides that an employee or member who has been insured under the group policy for at least six months and who loses coverage for any reason (other than non-payment of premium) may continue coverage for the portion of the policy month remaining plus six months. View our state continuation brochure for more information.
This type of coverage is also known as temporary health insurance or short-term medical. It typically lasts several months, but cannot last for longer than 11 months in South Carolina (although it may be able to be renewed). It is primarily designed to fill gaps in major medical health insurance coverage, such as when you are in between jobs or switching coverage. Coverage may be more affordable than major medical insurance, but it does not provide the same protections as major medical coverage and can be subject to pre-existing condition exclusions, among other limitations.
Business Interruption Insurance Coverage & COVID-19
Businesses generally purchase insurance to protect themselves from potential losses. Business interruption or business income insurance coverage are examples of those types of insurance coverage and are usually offered as a supplement to a business owner's property insurance policy to recover financial losses that may result from an interruption or cessation of the business’ operations.
Extra Expense and Civil Authority coverage(s) are additional coverages that may be purchased as a part of business owner’s business interruption or business income coverage.
Extra Expense Coverage
Extra expense coverage is complementary to business interruption insurance coverage. It is designed to compensate the business owner for those necessary extra expenses to operate while the business is being repaired to enable the insured to minimize suspension or interruption of the business’ operations.
Civil Authority Coverage
This coverage is also additional coverage under a business owner policy. It covers situations where the business has not been damaged but has been ordered to shut down by civil authorities.
With the outbreak of the Coronavirus, some business owners may be wondering whether their insurance policies cover losses resulting from a business shut down or other losses related to the Coronavirus. Under the business income policy, there likely is no coverage as losses occurring as a result of a virus or bacteria are typically excluded.
Business owners with questions about their coverage should contact their agent/broker or insurer directly and consider whether it is in their own best interest to file a claim. Please note that the South Carolina Department of Insurance does not have the authority to require insurers to extend coverage under the policy where specifically excluded or to sell this type of coverage to consumers.