The Department of Employee Trust Funds continues to work 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.

We will provide updates on group health insurance benefits and coverage related to the COVID-19 as needed.

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

Over-the-Counter Test Coverage

Non-Medicare Member Coverage

Most members can purchase over-the-counter COVID-19 diagnostic test kits at no cost to you. Coverage limits and exclusions apply. See Over-the-Counter COVID-19 Test Coverage Test Information for additional details and resources. 

  • Non-Medicare Member Coverage
  • Medicare Member Coverage
Free federal COVID-19 rapid tests now available via COVIDtests.gov. 
Every household is eligible to order eight (8) free at-⁠home COVID-⁠19 tests. Orders will usually ship in 7-12 days.

Additional Resources

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 6 months and older are eligible for the COVID-19 vaccine. 

For more information, visit the DHS website

Vaccine Availability 

There are several ways you can receive your COVID-19 vaccine. Choose a vaccine provider in your community, locate the specific vaccine you want to receive, or find a vaccination site that’s conveniently close to home. Visit the DHS Find a Vaccine Appointment web page to search for vaccine availability near you.

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 and current CDC quarantine and isolation guidelines.

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.

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.