How We are Helping with the Coronavirus (COVID-19)
Sentara Health Plans is closely monitoring the spread of the coronavirus (COVID-19). We have enacted our emergency management protocols and our dedicated team continues to monitor and follow COVID-19 closely in Virginia.
Commercial Coverage
The temporary provisions to waive cost sharing for COVID-19 vaccines, testing, and related services ordered by a physician or other provider, and over-the-counter (OTC) tests (eight per member per month) ended on May 11, 2023.
- COVID-19 tests or related services during a physician visit:
- have the applicable cost share depending on where you visit your physician
- have the applicable cost share depending on where you visit your physician
- COVID-19 vaccines:
- in-network: covered as a preventive health service and are still $0 for all plan types
- out-of-network: HMO will not be covered, PPO and POS will be covered at the applicable cost share
- Some self-funded employers have opted to continue to cover COVID-19 OTC at-home test kits under pharmacy Tier 1. This limits members to four tests per month. Please check with your employer to see if your OTC test kits are still covered.
Please refer to your plan benefit documents for cost shares related to the above services.
Medicaid Coverage
- COVID-19 over the counter (OTC) at-home test kits will continue to be covered through September 30, 2024*
- COVID-19 tests or related services during a physician visit
- COVID-19 vaccines
- no copayments for Medicaid and FAMIS members
- pharmacy: 90-day supply for many drugs
- telehealth is permitted for many practice areas and telehealth supplements that provide guidance are attached to the following Medicaid Manuals: ARTS, Mental Health, Psychiatric Services, Physician-Practitioner, Home Health, Early Intervention, and Rehabilitation
*Maximum quantity limitation of two OTC test kits per day or eight kits per 30 days
Medicare Coverage
- COVID-19 vaccines
- COVID-19 at-home tests
- COVID-19 pharmaceutical treatments
- COVID-19 PCR and rapid tests ordered or given by a health professional
Medicare members can order COVID-19 test kits through our partner, NationsBenefits®. OTC COVID-19 test kits are available for ordering online or by calling 1-877-438-7521 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m. Kits will be delivered within 7-10 days. Members should have their Sentara Health Plans member ID number and plan ID handy when ordering.
Health Plans for Individuals
If you or someone you know has recently gone through a life change due to the coronavirus, and need a new health plan, there are options available to help you.