Information about coronavirus
We will cover over-the-counter COVID-19 tests for all members. We will cover the cost of up to eight over-the-counter FDA-emergency use authorized tests per member per month without prior authorization through June 30, 2023. Effective July 1, 2023, two tests per member per month will be authorized without prior authorization. Coverage for the test kits will remain in place until September 30, 2024.
How to get reimbursed for test kits
You cannot get reimbursed for tests that you paid for out-of-pocket. The only way that you can access covered tests at no cost to you is by getting one of the approved tests (see above) at any network pharmacy. You will need to go to the pharmacy counter, show your Fallon Health ID card and ask to have the product submitted to OptumRx.
Where to get test kits
You can get one of the FDA-authorized COVID-19 test kits below at any network pharmacy at no cost to you. Just go to the pharmacy counter, show your member ID card, and ask to have the product submitted to OptumRx.
- QuickVue At-home
Vaccines for COVID-19
- For the most up-to-date information about how to get your vaccine in Massachusetts, visit https://www.mass.gov/covid-19-vaccine.
- For answers to your common questions about COVID-19 vaccines, visit https://www.mass.gov/info-details/covid-19-vaccine-frequently-asked-questions
It’s important to know that vaccines go through more testing than any other pharmaceuticals. Before any vaccine is made available, it must go through rigorous development and testing. For more information regarding vaccine safety, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html.
Coverage for COVID-19 vaccines
Fallon 365 Care members will have not have to pay if they choose to be vaccinated. Fallon 365 Care also covers the flu shot vaccination in full and we recommend that all members receive the flu shot.
What to do if you have symptoms
- Check your symptoms with Buoy, a free online tool available to all Massachusetts residents.
You can use Buoy to check your symptoms, figure out if you should be tested for coronavirus, and learn about care options available to you.
- If you have any of the symptoms below, you should contact your primary care provider.
- Fever or chills
- Shortness of breath or difficulty breathing
- Muscle or body aches
- Sore throat
- New loss of taste or smell
- Congestion or runny nose
- Nausea or vomiting
- Multisystem inflammatory syndrome (in children only).
If you or a loved one begin to exhibit any of the following signs, seek emergency medical care immediately: trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, and/or pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone.
- Get vaccinated as soon as you can
- Wear a mask in public settings, and make sure your mask covers your nose and mouth and fits snugly against your face.
- Maintain good social distance (about 6 feet) from other people. You should avoid crowds and poorly ventilated spaces.
- Test to prevent the spread to others
- Wash your hands often with soap and water. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- If you are wearing a mask, you can cough or sneeze into your mask and then put on a new, clean mask as soon as possible and wash your hands. If you are not wearing a mask, cover coughs and sneezes with a tissue or your elbow.
- Monitor your health daily, stay home when you feel sick and avoid contact with others who are ill.
- Routinely clean and disinfect frequently touched surfaces.
- You can access telehealth services from all network providers who are offering these services. To schedule a telehealth visit, you can contact your provider at the same phone number you would use to request an in-office visit.
- You can use Teladoc to get access to doctors and nurses by phone or online.
- You can use Care Connect (our 24/7 nurse call line) to receive medical services or advice at no cost to you. Call 1-877-219-0873 (TDD/TTY: 1-800-848-0160).
- You can also access physical therapy/occupational therapy/speech therapy (PT/OT/ST) services through both telephonic telehealth visits and video telehealth visits. This will be effective until further notice.
Maintaining emotional health and well-being
Taking care of your emotional health and well-being during this time is important. Decreasing stress can help bolster your immune system and can help keep you and others around you healthy.
- During this time of social distancing, consider creative ways to fight isolation and loneliness which can worsen some mental health symptoms.
- There's a lot of information being shared about COVID-19. Not all of it is accurate and the bombardment of news and updates can add to an already stressful situation. To stay informed, but not overwhelmed, bookmark the websites in the "For more information" section below.
- If you need mental health support
- Contact your behavioral health provider to see if they can schedule a telehealth visit. Telehealth is a virtual therapy session. Many providers are now offering this option.
- Fallon Health's behavioral health partner, Carelon Behavioral Health, has information and resources to help you. Visit their website to learn more.
- Contact SAMHSA's Disaster Distress Helpline. The Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters. Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.
- Contact the Massachusetts Emergency Services Program/Mobile Crisis Intervention (ESP/MCI) - 1-877-382-1609.
- You can find additional information and resources at https://www.mass.gov/info-details/maintaining-emotional-health-well-being-during-the-covid-19-outbreak.
Food assistance during the COVID-19 emergency
If you need food assistance, you are not alone. As a result of COVID-19, one in three people in Massachusetts faces food insecurity, many for the first time. Several programs can help you and your family get the food you need to stay healthy. Find out more.
Help with rent or mortgage payments
Are you struggling with rent or mortgage payments because of COVID-19? There are eviction protections and financial programs available to help.
- Visit www.mass.gov/CovidHousingHelp to learn more about state financial aid programs for eligible households.
- Call 2-1-1 to connect with housing resources.
- Talk to your landlord or bank to create a plan.
Be aware of scams
Unfortunately, during this time, there is a greater risk of people trying to run scams. Here are a few tips that you should keep in mind:
- Do not respond to unsolicited texts, emails or calls requesting your personal information in exchange for a vaccine/booster, home testing kit, or PPE.
- Ignore offers for a COVID-19 cure or treatment. Remember, if there is a medical breakthrough, you won’t hear about it for the first time through an email, online ad or unsolicited sales pitch.
- If you receive a message about being eligible for a vaccine/booster, look carefully. Ask yourself who is sending the message? Is it your PCP? Your pharmacy? The local Department of Public Health? If the message is from one of these entities that you know, call them back at the number you have for them to make sure the message was from them. But your best bet to make sure that you sign up only for a valid vaccine clinic is to visit https://www.mass.gov/covid-19-vaccine to find vaccination locations near you and to sign up for a vaccine
- Research any charities or crowdfunding sites soliciting donations in connection with COVID-19 before giving. An organization may not be legitimate even if it uses words like “CDC” or “government” in its name.
- Be cautious of purchasing personal protective equipment (PPE) from unknown third-party vendors. Verify that the company is legitimate before ordering their products or sending money.
- Never click on a link or open an email attachment from an unknown or unverified source. Links and attachments may be embedded with a virus that will infect your computer or mobile device. To better protect yourself against malware, make sure your anti-virus software is operating and up-to-date.
For more information
For the latest information on coronavirus:
- Visit the CDC’s website
- Visit the Commonwealth of Massachusetts’ website.
- Visit Buoy, a free online tool available to all Massachusetts residents
- Call our dedicated COVID-19 hotline at 1-877-835-8440.
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