What You Need to Know About COVID-19
Horizon NJ Health continues to monitor the latest updates related to COVID-19 provided by these credible resources:
- World Health Organization (WHO)
- Centers for Disease Control and Prevention (CDC)
- National Institutes of Health
- New Jersey Department of Health
WHAT IS COVID-19?
COVID-19 is a respiratory disease caused by a specific strain of coronavirus (SARS-CoV-2). Coronaviruses are a large family of viruses often causing mild to moderate upper-respiratory tract illnesses, similar to the common cold or flu.
WHAT ARE THE SYMPTOMS?
Respiratory symptoms, such as a cough, difficulty breathing and fever. People who are elderly and/or have underlying health conditions are more at risk for severe complications. Symptoms of coronavirus may appear two to 14 days after exposure.
HOW DOES IT SPREAD?
The virus is thought to spread from person-to-person through droplets produced when someone with the virus coughs or sneezes. This can happen when people are in close contact with one another (within six feet), usually for a prolonged period of time.
We encourage our members to follow the advice of all respected public health experts to get vaccinated and boosted. Vaccination is the most effective action we can take to protect ourselves, our families and our communities. As a reminder, the COVID-19 vaccines are available at no cost to you.
We realize you may have questions or concerns about the vaccine, and we are here to make sure you have the information you need to take care of your health.
If you think you were exposed to COVID-19, or begin to experience symptoms, call your Primary Care Provider (PCP). If you don’t know your doctor’s phone number, you can find it on your member ID card or look it up using our online Doctor & Hospital Finder. It is important to call your PCP’s office or other health care facility before you go there. When you call, you can inform them of your concerns, and they will give you further directions. If you are experiencing an emergency, go to the nearest emergency room or call 911.
Below are answers to some questions you may have:
Questions about coverage
Q. I heard the government is setting up a website so people can order free at-home COVID-19 tests online. Is that true?
Yes. The Federal government has launched a national website where each household can order a one-time shipment of four (4) free over-the-counter (OTC) at-home COVID-19 tests. Orders are shipped directly from covidtests.gov.
The state of New Jersey also offers New Jersey residents the option to order a free saliva-based PCR test, shipped directly to their homes.
Yes. As a Horizon NJ Health member, you are eligible for up to eight OTC, at-home tests (per member) every month.
Members can get an OTC, at-home test at one of our participating pharmacies. Go to the pharmacy counter and show them your Horizon NJ Health member ID card. You are eligible for up to eight tests per member, every month. However, due to supply and demand, pharmacies and online retailers may limit the number of tests you can buy at one time.
To find a participating pharmacy, search our Doctor & Hospital Finder. Select Pharmacies from the drop-down menu, choose Horizon NJ Health as your plan, and then click Find.
As of January 20, 2022, the following tests are covered:
- BinaxNOW COVID-19 Antigen Self- Test
- CareStart COVID-19 Antigen Home Test
- InteliSwab COVID-19 Rapid Test
- QuickVue At-Home COVID-19 Test
- Flowflex COVID-19 AG Test
- Flowflex COVID-19 Antigen Test
We cover vaccines and boosters recommended by CDC's Advisory Committee on Immunization Practices (ACIP) and the U.S. Preventive Health Services Task Force (USPSTF). That means you will not pay any money out of your pocket to get the vaccine.
During the COVID-19 public health emergency, COVID-19 vaccines will be covered 100% through in- and out-of-network doctors, hospitals, pharmacies and other health care professionals, as well as through vaccine administration sites.
Horizon NJ Health covers FDA-authorized antibody testing performed by a lab that has appropriate Clinical Laboratory Improvement Amendments (CLIA) certification when testing is performed consistent with the Centers for Disease Control and Prevention’s (CDC’s) Interim Guidelines for COVID-19 Antibody Testing.
The test must be for a diagnostic purpose consistent with CDC guidelines and ordered by your licensed doctor or other health care professional. These CDC guidelines specifically note Serologic testing should not be used to determine immune status in individuals until the presence, durability, and duration of immunity is established. Currently, the clinical use of serologic or antibody testing for COVID-19 is to support a diagnosis of COVID-19 in patients who are seeking care late in their course of illness or in patients who are seeking care for late complications, such as multisystem inflammatory syndrome in children.
Antibody tests should not be used as a sole basis for diagnosis. When antibody testing is covered, members will have no cost sharing during the COVID-19 public health emergency.
At this time, there is no specific antiviral treatment for coronavirus. Members should call their PCP to ask about care to help relieve symptoms, like for any other viral respiratory infections. Horizon NJ Health will continue to cover health care costs to treat infectious diseases.
Talk to your doctor about what is right for you. You can also visit the CDC's website for up-to-date information on COVID-19 vaccines and boosters.
Horizon NJ Health will waive early medication refill limits on 30-day prescribed maintenance medications and allow for 90 days' supply of maintenance medications.
Q. Will Horizon NJ Health cover medical supplies such as masks, gloves or disinfectants for members?
These supplies are not currently covered.
Q. Will Horizon NJ Health waive prior authorization requirements for testing and treatment of COVID-19?
Horizon NJ Health will waive prior authorization for:
- Diagnostic tests and covered services that are medically necessary and consistent with CDC guidance; and
- Lab or diagnostic testing required during an ER evaluation or inpatient hospital stay.
Q. If my coverage with Horizon NJ Health requires a copay, will it be waived for costs related to COVID-19 testing or treatment?
We are waiving the copay for a visit to an in-network PCP or urgent care center or an in-network or out-of-network emergency room for:
- Evaluation of symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough and shortness of breath).
- COVID-19 testing for members who know they have been exposed to an individual diagnosed with COVID-19.
Also, we are waiving copays at in-network and out-of-network labs for charges associated with the delivery of services connected to CDC-approved lab studies or tests for COVID-19 for members who:
- Know they have been exposed to an individual diagnosed with COVID-19 or;
- Have symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough and shortness of breath).
Q. Does Horizon NJ Health have any resources that can connect me to a health care professional by phone?
Members can call our 24/7 Nurse Line to get reliable health information. The nurses are experienced professionals who can provide doctor-approved information to help you make informed health care decisions. To access the 24/7 Nurse Line by phone, please call 1-800-711-5952 (TTY 711).
We will work closely with our members to make sure needs are met. If your Adult Medical Day Care Program is closed and you need assistance with services you normally receive when you are attending that program, please contact us at 1-844-444-4410 (TTY 711).
Members should not see any disruption in services. In the event that you are not receiving services according to your care plan, please call 1-844-444-4410 (TTY 711) to speak to your MLTSS Care Manager.
Yes. You will still receive your approved DME equipment. If you are experiencing any issues, we can connect you to your Care Manager for assistance in receiving your needed supplies. To access the 24/7 Nurse Line by phone, please call 1-800-711-5952 (TTY 711).