The Department of Employee Trust Funds is working with state health officials and health plans participating in the State of Wisconsin Group Health Insurance Program to ensure you receive the care you and/or your covered dependents need during the COVID-19 pandemic.

We will provide updates on group health insurance benefits and coverage related to the COVID-19 pandemic as the situation continues to develop.

Below you will find answers to commonly asked questions about your health benefits in relation to COVID-19.

Vaccine

Vaccine Coverage

COVID-19 vaccines are covered by the medical benefit for all members and by the pharmacy benefit for non-Medicare members. There is no cost for the COVID-19 vaccine. However, vaccinators can charge an administration fee for giving the shot.

  • Medicare members - The COVID-19 vaccine will only be covered under medical insurance, Part B, of your Medicare benefit. You will need to go to a medical provider that accepts Part B coverage to receive a COVID-19 vaccine. Bring your Medicare ID card to the appointment. Medicare's pharmacy benefit, Part D, will not cover the COVID-19 vaccine.

Non-Medicare members can receive the COVID-19 vaccine at any Navitus network pharmacy.  To find an in-network pharmacy near you anywhere in the United States, go to www.etf.benefits.navitus.com, click on your plan type, and the Pharmacy Search option will appear in the right-hand menu. 

If you receive your COVID-19 vaccine at a pharmacy outside of the Navitus network, you may be responsible for administrative fees. To view a list of participating national and regional pharmacy chains and groups, visit the Navitus website

Vaccine Eligibility 

The Wisconsin Department of Health Services has announced that all individuals age 16 and older are eligible for the COVID-19 vaccine. 

For more information, visit the DHS website

Vaccine Availability 

There is a limited supply of the COVID-19 vaccine available. Please work directly with your medical provider or pharmacy to ensure enough doses are available for you to be fully vaccinated. 

The COVID-19 vaccine is typically given in two shots, one at a time, at least three weeks apart. 

While you wait for your turn to receive the COVID-19 vaccine, continue to wash your hands, wear a mask, and practice social distancing. You should continue these practices even after you are fully vaccinated. 

Vaccine Resources 

For more information about the COVID-19 vaccine, visit:

Testing

COVID-19 testing is now widely available throughout Wisconsin at health providers and community testing sites. 

If you and/or a covered dependent are showing symptoms of COVID-19, you should contact your health care provider by phone and/or use telehealth to discuss your symptoms. According to the Centers for Disease Control and Prevention, symptoms typically appear 2-14 days after exposure and include fever, cough, and shortness of breath.

Your health plan will cover testing received from an in-network provider. Some plans may cover out-of-network testing. Contact your plan for details. 

Members with an It's Your Choice (IYC) High Deductible Health Plan can also receive testing at no cost, following guidance provided by the IRS.

There are two types of tests available, both of which will be covered by your health plan:

  • Diagnostic testing - Diagnostic testing will show if you have an active COVID-19 infection. You should seek this test if you are showing symptoms of COVID-19, such as a cough or fever. These tests are available at community testing sites.
  • Antibody testing - Antibody testing will show if you have had COVID-19 in the past, even if you are no longer sick. These tests may not be available at community testing sites. For many diseases, having antibodies will prevent you from becoming infected a second time. It is not yet known if COVID-19 antibodies will prevent a second infection. You should continue to take necessary precautions, such as frequent hand washing. 

Treatment

If you and/or a covered dependent are diagnosed with COVID-19, follow your provider’s instructions following diagnosis. Most people isolate at home during their illness and limit contact with others. The current treatment protocol for COVID-19 is the same as the flu, including rest and fluids.

If you and/or a covered dependent require hospitalization because of COVID-19, treatment will be covered the same as it would for any other hospitalization.

Medications

The public health emergency declaration has the following impacts on the pharmacy benefit:

  • Removes the “refill too soon” (RTS) edits. Members will now be able to get medication refills sooner than they normally would.
    • As of April 1, 2020, the RTS edits do not apply to Schedule II controlled substances, such as opioids. 
    • Other claims processing edits will still apply. These include quantity limits, as well as prior authorization and step-therapy requirements.
  • Allows for the maximum extended day supply (90 days) of a medication at the time of refill.

Members are encouraged to have at least a 30-day supply of prescription medications and frequently used health supplies, like allergy medications.

  • Talk with your provider or pharmacist about getting a 90-day supply of your medications at your refill.
  • You may also consider utilizing ServeYou Rx, the mail-order pharmacy available through Navitus, the State of Wisconsin Group Health Insurance Program pharmacy benefit manager, to have a 90-day supply delivered to your home. 90-day prescriptions filled through ServeYou are only subject to two copays instead of the usual three.

Navitus is monitoring for current and any future nationwide drug shortages and pharmacy supply chain issues due to COVID-19. They will work with members and pharmacies to make sure needed medications are available for members.

Telehealth

Most health plans offer telehealth services to diagnose and treat common illnesses or conditions. Telehealth is ideal if you have a common illness and wish to limit your interaction with others during the COVID-19 pandemic.

Not only is telehealth fast and affordable, it’s available to most members without any out of pocket costs. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) allows for telehealth services to be covered under a High Deductible Health Plan (HDHP) before the deductible is met for plan years 2020 and 2021. For more information, see Telehealth Options.

Many health plans also offer a 24-hour Nurseline. A Nurseline may be useful to determine what type of care is most appropriate for your symptoms. For more information, see Health Plan Contact Information

Well Wisconsin Health Screenings

Additional Health Screening Options

The Group Insurance Board recently approved changing the health screening to a health check and added options for participants to fulfill the Well Wisconsin program activities to earn the $150 incentive. In addition to completing the health assessment questionnaire and well-being activity, participants may choose one of the following by the October 8, 2021 deadline:

  • Biometric screening: Click “Get Started” on the biometric screening card on the webmdhealth.com/wellwisconsin homepage to get started. There are three options:
    • Home test kit (NEW): Request a kit by September 24, 2021.
    • Onsite screening event: Register for an appointment to attend an employer-hosted event. See additional considerations in the Biometric Health Screenings section below. 
    • Health Care Provider Form: The fillable form can be completed using the most recent data found in the individual’s electronic medical record. There is no date limitation for this option so long as the individual can certify they are up to date on their physician’s care recommendations.
  • Dental cleaning (NEW): Receive credit for completing a routine dental cleaning visit between January 1 – October 8, 2021.
  • One coaching call (NEW): Complete one call with a WebMD health coach by calling 1-800-821-6591 to make an appointment, or schedule a meeting on webmdhealth.com/wellwisconsin.

Biometric Health Screenings

Onsite biometric health screenings have resumed at some limited employer locations with enhanced safety precautions including:

  • Participants are encouraged to wear masks to their appointment
  • Screening providers will wear masks and gloves from the time of arrival through the event
  • The screening room will be limited to 10 people at a time
  • Screening providers will cleanse and sanitize supplies before and during the event, including high touch items between participants
  • Screening providers will have temperature checks prior to the event. If the screening provider has a temperature above 100.4°F, they will not work the event
  • All tables must be 8 to 10 feet apart in the screening room
  • Spaces will be marked on the floor to ensure participants social distance while they wait

You may log into the WebMD wellness portal to confirm if you have an upcoming appointment by going to the biometrics screening card in the center of your homepage and clicking in the on-site health screening section. If your employer cancels the event, you will be notified via email from WebMD.

Pre-Tax Savings Accounts

HSA and Health Care FSA Eligible Expense Changes

Eligible expenses for Health Savings Accounts (HSA) and Health Care Flexible Spending Accounts (FSA) were permanently changed to allow for Personal Protective Equipment (PPE) for the primary purposes of preventing the spread of COVID-19 to be reimbursed pre-tax. This change is retroactive to January 1, 2021. Eligible PPE includes:

  • Face masks
  • Hand sanitizer 
  • Disposable gloves
  • Sanitizing wipes 

Optum Financial/ConnectYourCare has updated their resources, including the searchable list of eligible expenses, and debit card settings to reflect these changes. Major retailers are still working to implement changes to their sales systems. 

  • If you purchase PPE in the near future, you may need to submit a reimbursement request.  
  • Retroactive reimbursement requests must be submitted manually via the member portal or mobile app. 

Vendor Update - Optum Financial

ConnectYourCare is now part of Optum Financial. Optum Financial will replace the ConnectYourCare name and brand throughout the member experience. 

  • Customer service offerings will remain the same. 
  • Payment cards will not be reissued - use the same card until it expires. 
  • Use the same online account and mobile app to manage your account. 

Resources

You can learn more about COVID-19 from the Centers for Disease Control and PreventionWorld Health Organization, or Wisconsin Department of Health Services. You may also receive information about COVID-19 from your health plan.

ETF will provide updates on group health insurance benefits and coverage related to the COVID-19 pandemic as the situation continues to develop.

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