Questions about Coverage

If you have not signed up for informational emails related to COVID-19, this email is likely to be a spear phishing email that could download malicious software (malware) onto your computer without your knowledge. If that happens, cybercriminals can take control of your computer, log your keystrokes or access your personal information and financial data.

A COVID-19-themed phishing email may look like it’s from the CDC. However, there are a couple of things that should tip you off:

• Scammers purposefully create a sense of urgency, curiosity or fear to fool you into taking immediate action such as clicking on a link; this is especially true for COVID-19-themed attacks.
• Be suspicious of emails that do not use your name and contain grammatical and spelling errors.

When you’re in a rush or eager for information, it’s easy to click a link you shouldn’t. Taking a few extra seconds to stop and think is always a good idea.

Call Braven Health’s Special Investigations Unit (SIU) hotline at 1-800-624-2048 (TTY 711), and explain what happened.

Tests for COVID-19 are not offered by phone or door-to-door. Phone calls asking for your member ID number or other information for free testing/services are likely to be scams.

Current guidance about COVID-19 testing is available on the CDC website.

Testing asymptomatic individuals is not medically indicated and against the current advice of the CDC and World Health Organization.

The CDC recommends voluntary home quarantine for those who have traveled or who have been exposed to individuals with the virus.

Testing is covered if you become symptomatic, have a known or suspected exposure to COVID-19, or your health care provider recommends testing.

Yes. To help you get the care you need, Braven Health is waiving out-of-pocket costs for covered services when provided through telehealth for at least 90 days after the end of the public health emergency and State of Emergency as declared by Governor Murphy. Braven Health is:

• Relaxing its telehealth rules so members can get covered services by phone, video (including common video platforms such as FaceTime and Skype) and chat from in-network and out-of-network health care professionals.
• Waiving member out-of-pocket costs for members enrolled in a fully insured plan for covered services provided by an in-network health care professional for a telehealth visit provided by primary care doctors, specialists, therapists, mental health and substance use treatment professionals, or urgent care doctors.
  • Members enrolled in self-insured plans can get care for covered services through a telehealth visit, but will pay based on their plan’s provisions.
  • Members with out-of-network benefits who get care from an out-of-network health care professional will be responsible for costs according to their benefits.
  • Members with no out-of-network benefits should continue to obtain covered telehealth services from in-network health care professionals.

We encourage you to call your in-network doctor to find out if they offer telehealth (by phone, video or chat) as an option for you to get care. If they do, you may be able to avoid a visit to their office.

COVID-19 viral testing with an FDA-authorized test is covered when performed for diagnostic purposes in health care settings, including pharmacies and drive-up testing sites.

Home test kits for members showing symptoms of COVID-19, and for members who are asymptomatic but have a known exposure to COVID-19, are also covered. However, shipping and handling, and any administration fees charged by the lab, are not covered.

You may receive coverage for one COVID-19 and related test without the order of a physician or other health professional, but any additional COVID-19 tests must be ordered by a health care professional.

Braven Health will waive PA requirements for:

• A visit to a primary care physician, urgent care center or ER for evaluation of upper respiratory symptoms, fever, shortness of breath or other symptoms that may represent COVID-19.
• Diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19.
• Lab studies or diagnostic testing for COVID-19 required during an ER evaluation or inpatient hospital stay.

Your out-of-pocket costs for testing will be waived. The waiver of out-of-pocket costs for COVID-19 testing is in place now and will be for at least 90 days after the end of the public health emergency and State of Emergency, as declared by Governor Murphy.

Additionally, through March 31, 2021, unless extended, most members will not pay any cost share (copay, coinsurance, deductibles) for covered services related to inpatient or outpatient treatment when the primary diagnosis is COVID-19.

COVID-19 Update: Antibody Testing

The COVID-19 public health emergency has resulted in changes to the delivery and coverage of health care, including new protocols, new tests and new treatments.

On June 23, 2020, new guidance was issued by the federal government that impacts how antibody (serological) tests are covered under the Families First Coronavirus Response Act (the FFCRA) as amended by the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act).

This federal guidance, supported by guidelines from the Centers for Disease Control and Prevention (CDC) and guidance from the Food and Drug Administration (FDA), clarifies how diagnostic testing for COVID-19 should be covered by health plans. We want you to know Braven Health will cover antibody testing under your health plan.

Claims for antibody testing rendered by in- and out-of-network providers will be covered without member cost sharing until at least 90 days after the end of the public health emergency and State of Emergency declared by Governor Murphy in Executive Order 103 of 2020.

Watch this video from the FDA about antibody testing.

At this time, the best way to avoid COVID-19 is to follow the CDC guidelines, including:

• Get the vaccine as soon as you are able and if it is appropriate for you.
• Wear a mask in all public places.
• Follow social distancing guidelines and avoid close contact with those who are sick.
• Get the flu shot. While the flu vaccine can’t prevent COVID-19, many of the symptoms are the same, and preventing the flu can help ease the burden on doctors and hospitals.
• Follow government travel recommendations.

All vaccines distributed in the United States must follow strict Food and Drug Administration (FDA) guidelines for safety.

Learn more about how the FDA and CDC are ensuring the safety of COVID-19 vaccines.

Talk to your doctor about what is right for you.

Regardless of which COVID-19 vaccine you get, it’s important to note that the two vaccines available through EUA require two doses of the vaccine administered several weeks apart.

The CDC and every state have established specific plans to distribute vaccines, which will initially be in limited supply, and to identify the priority populations for vaccination. Please follow the guidance issued by public health authorities on when and how to be vaccinated.

Yes, all vaccines recommended by the Centers for Disease Control and Prevention (CDC) are 100% covered. The Centers for Medicare & Medicaid Services (CMS) covers both the vaccine and administration costs for Medicare members through 2021. That means you will not pay any money out of your pocket to get the vaccine.

During the COVID-19 public health emergency, the COVID-19 vaccines will be covered 100% through in- and out-of-network doctors, hospitals, pharmacies and other approved vaccination sites, including New Jersey’s six state-coordinated mega sites.

To make an appointment to get the vaccine at one of the vaccine administration mega sites, you can register for a vaccine on the NJ Vaccine Scheduling System (NJVSS). The NJVSS lets you find a vaccination site, pre-register and schedule an appointment. You will be notified when the vaccine is available for you.

As the vaccine becomes more widely available, you will be able to get vaccinated by in- and out-of-network doctors, hospitals, pharmacies and other approved vaccination sites, including New Jersey’s six state-coordinated mega sites.

Vaccines will be administered according to the New Jersey Department of Health’s designated priority groups. Registration for appointments is required at this time.

If you live outside of New Jersey or are temporarily living outside of New Jersey, please visit the Centers for Disease Control and Prevention (CDC) website to learn about your state’s vaccine administration plan.

Vaccines are being administered in a phased rollout according to the priority groups established by the New Jersey Department of Health. For information on New Jersey's vaccine administration phases, please visit the New Jersey COVID-19 Information Hub.