COVID-19 Information for Members, Employers and Agents - DAKOTACARE - Sioux Falls, SD

COVID-19 Information for Members, Employers and Agents

Questions?

We know this is a confusing time and you have lots of questions. We're here to help you navigate your insurance coverage. For questions, please call the Customer Care Team at 1-800-325-5598, Monday-Friday, 8 a.m. - 5 p.m. CT.

The following member coverage and benefits information are in response to the current COVID-19 pandemic.

COVID-19 Vaccine Information

Many factors are being taken into consideration when determining who will receive the vaccine. Please continue to stay up-to-date on current eligibility and other vaccine information by visiting COVID-19 Vaccine Information page.

For questions on your benefits regarding the COVID-19 vaccine, please call the Customer Care Team at 1-800-325-5598, Monday-Friday, 8 a.m. - 5 p.m. CT.

COVID-19 Treatment Coverage

Effective January 15, the Federal Government announced that Insurance Companies and Group Health Plans are required to cover the cost of at-home COVID-19 Tests. These are tests that are sold at retail stores as an over-the-counter test and do not require a doctors order.

We’re currently trying to make this process as smooth and simple as possible for our members. More details will follow and we will be updating this web page with those details. In the meantime, here CMS FAQs which may help answer some of your questions. If you have any additional questions at this time, please contact Customer Care at 1-888-322-2115, Monday-Friday, 8 a.m. - 5 p.m. CT.

You can also order free at-home tests from the South Dakota Department of Health.

Effective October 1st, 2021, services for the treatment of COVID-19 will be paid as normal plan benefits. This includes outpatient services for post COVID-19 treatment. Examples include Occupational Therapy, Physical Therapy and Durable Medical Equipment.

Due to the pandemic, Federal and State authorities may provide guidance related to extended member rights, such as appeal rights and enrollment rights. Here is an explanation of these updates.

COVID-19 Antibody testing is now available at Avera QuickLabs locations as well as other Avera clinic locations. At Avera, this test is provided at an out-of-pocket cost of $50 and is eligible for Flexible Spending and Health Savings Account (HSA). If ordered by a provider for medically necessary reasons, the test will be covered by insurance at no cost to the member.

At-home COVID-19 Test Reimbursement

Many DAKOTACARE members are now able to purchase over-the-counter (OTC) at-home COVID-19 tests, at little or no cost to you. To help you better understand the benefit, review the frequently asked questions (FAQs) below.

Effective January 15, the Federal Government announced that Insurance Companies and Group Health Plans are required to cover the cost of over-the-counter (OTC) at-home COVID-19 Tests. These are tests that are sold at retail stores and pharmacies as an over-the-counter test and do not require a doctor’s order.

Reimbursement only applies to antigen rapid home tests purchased on or after January 15, 2022. This mandate is in effect until the end of the federal public health emergency.

Please note, in order to be eligible for reimbursement of an over-the-counter (OTC) at-home COVID-19 test, the test can only be used for personal use and cannot be used for required employment testing or for resale purposes. Reimbursement cannot be made if the test has been reimbursed by another source such as a Health Savings Account (HSA), Flexible Spending Account (FSA) or Health Reimbursement Account (HRA) or obtained as a free test.

Where can I go to purchase an OTC at-home COVID-19 test?

Where can I go to purchase an OTC at-home COVID-19 test?

We’re partnering with CVS Caremark, our Pharmacy Benefit Manager (PBM) and its vast nation-wide pharmacy network to provide our members with a preferred network of OTC retailers to obtain approved at-home COVID-19 tests. Members may visit any in-network pharmacy and receive approved at-home COVID-19 tests without paying any upfront costs.

For a list of in-network pharmacies log in to your member portal at CVS Caremark.

Note: All pharmacies participating in the CVS Caremark network will have the option of participating in offering the point-of-sale option to DAKOTACARE members. Pharmacies do have the option to opt-out. Members may call ahead to their local pharmacy to determine participation. If a CVS Caremark in-network pharmacy elects to opt-out, members can still purchase at-home COVID-19 tests and seek reimbursement.

If your pharmacy is unable to directly submit the claim for your OTC at-home COVID-19 test, you can:

  • complete and submit a Pharmacy Claim Submission form. Completed forms and receipt(s) should be mailed to the following address indicated on the form.
  • Or, you can submit a digital form at Caremark.com or via the CVS Caremark mobile app (available for Android and Apple).

Tests that are purchased at a location as described above will be reimbursed. You will not be reimbursed if you purchase a test from an individual, online auction, or resale marketplace.

Who is eligible for reimbursement?

Who is eligible for reimbursement?

If you have private, employer-sponsored or student health commercial insurance, you’re eligible to get reimbursed for OTC at-home COVID-19 kits.

This new coverage reimbursement policy doesn't apply to members who have Medicare, Medicare Supplement, Medicaid or voluntary insurance.

What tests are covered?

What tests are covered?

Tests must be approved, cleared or authorized by the U.S. Food and Drug Administration (FDA). FDA approved at home COVID-19 tests are found here: In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA. OTC at-home COVID-19 tests don’t require an order from your physician to qualify for reimbursement. Tests that are ordered by a provider are not subject to the reimbursement or quantity limit.

Tests must be used to diagnose a potential COVID-19 infection. Tests used for employment, school or recreational purposes are not eligible for reimbursement.

What steps should I take to get an OTC at-home COVID-19 test at no cost?

What steps should I take to get an OTC at-home COVID-19 test at no cost?

The simplest way to receive an OTC at-home COVID-19 test at no cost is to visit a DAKOTACARE in-network pharmacy who is participating in direct coverage of OTC at-home COVID-19 tests.

Bring the test kit and your DAKOTACARE member ID card to the pharmacy counter (not the front register) when purchasing an FDA approved at-home COVID-19 test and your pharmacy will process the test through your pharmacy benefit.

Can I be reimbursed by DAKOTACARE for an at-home COVID-19 test I’ve already purchased?

Can I be reimbursed by DAKOTACARE for an at-home COVID-19 test I’ve already purchased?

Yes. Members who have purchased an FDA approved at-home COVID-19 test on or after January 15, 2022, can submit a form for reimbursement.

All requested information along with an itemized purchase receipt should be submitted with the form in order for reimbursement to be processed.

Are there limitations on the number of tests I can purchase?

Are there limitations on the number of tests I can purchase?

Yes. Each member on the plan is allowed up to 8 FDA-approved at-home COVID-19 tests per individual every 30 days. For example, a family of four covered under the same plan could be reimbursed for up to 32 tests per 30-day period. Each test is counted separately even if multiple tests are sold in a single kit. So, if you buy one kit that includes two tests, we’ll reimburse you for up to four kits.

Are there limits on how much I am reimbursed per test?

Are there limits on how much I am reimbursed per test?

Yes. There is a maximum reimbursement of $12 per test. Many COVID-19 tests are sold as a 2-pack kit ($12 for each test) and would be reimbursed at a maximum of $24 per kit. Reimbursement amount is for the cost of the test only and does not include sales tax or shipping costs. Applicable taxes and shipping are member responsibility.

Can I purchase an OTC at-home COVID-19 test that costs more than $12?

Can I purchase an OTC at-home COVID-19 test that costs more than $12?

Yes. If you get an FDA approved test at an in-store DAKOTACARE in-network pharmacy, you won’t need to pay anything out-of-pocket. At any other location, you may purchase an FDA approved test, but you will only be reimbursed at a maximum of $12 per test.

What if I purchased other items with my OTC at-home COVID-19 tests and those items appear on my receipt?

What if I purchased other items with my OTC at-home COVID-19 tests and those items appear on my receipt?

Only the cost of OTC at-home COVID-19 tests — at a maximum of $12 per test — will be reimbursed.

Can I submit a photo of a receipt?

Can I submit a photo of a receipt?

Yes, but a copy of the receipt must accompany a completed reimbursement form.

Can I submit for reimbursement for an OTC at-home COVID-19 test purchased prior to January 15 without a doctor’s prescription?

Can I submit for reimbursement for an OTC at-home COVID-19 test purchased prior to January 15 without a doctor’s prescription?

No.

Do I need to get a doctor’s prescription for reimbursement for an OTC at-home COVID-19 test purchased after January 15?

Do I need to get a doctor’s prescription for reimbursement for an OTC at-home COVID-19 test purchased after January 15?

No

Do I need to submit my COVID-19 test results in order to receive reimbursement?

Do I need to submit my COVID-19 test results in order to receive reimbursement?

No.

I am on a High Deductible Health Plan (HDHP) and I am contributing to a Health Savings Account (HSA). Can I purchase OTC at-home COVID-19 tests with my HSA and be reimbursed for them?

I am on a High Deductible Health Plan (HDHP) and I am contributing to a Health Savings Account (HSA). Can I purchase OTC at-home COVID-19 tests with my HSA and be reimbursed for them?

No. You cannot be reimbursed for any amount of an at-home COVID-19 test if you purchased the test with HSA funds. You can pay for any unreimbursed amount of the at-home COVID-19 test through your HSA.

How long will I be able to get reimbursed for OTC at-home COVID-19 tests?

How long will I be able to get reimbursed for OTC at-home COVID-19 tests?

At this time, at-home COVID-19 tests are eligible for reimbursement until the end of the Public Health Emergency (PHE).

Can I get an at-home COVID-19 test directly from DAKOTACARE?

Can I get an at-home COVID-19 test directly from DAKOTACARE?

No. DAKOTACARE is not directly distributing at-home COVID-19 tests to our members.

Telehealth Coverage

DAKOTACARE will waive the member cost for all applicable telehealth services through December 31, 2020. This policy is subject to change and review as federal guidance evolves. Members receiving applicable telehealth services from participating providers during this period will have their normal cost-share waived regardless if the telehealth visit is directly related to COVID-19 or not.

Avera providers are utilizing virtual visits for the safety of our members/patients during this pandemic.

Flex Spending Accounts and Health Savings Account Benefits

Changes to your current election(s) may be possible depending on your individual situation during the COVID-19 pandemic. Please contact the DAS FLEX Team at 605-322-4542 if you have any questions or would like to discuss your options.

Over-the-counter medications and menstrual products are now permanently included as eligible expenses. Please reference the IRS list of eligible expenses for more information

Prescription Drugs Coverage in Response to COVID-19

We want to continue to ensure our members have access to their needed prescription drugs while social distancing is encouraged.

  • Contact your local pharmacy when you have one week of prescription drug supply remaining to request your next refill.
  • Most plans offer the ability to fill a 90-day supply for most medications. Consider obtaining a 90-day supply to ensure continued access to needed prescription drugs.
  • Please contact your local retail pharmacy to ask about home delivery options.

Please call your pharmacy for additional details.

Questions?

We know this is a confusing time and you have lots of questions. We’re here to help you navigate your insurance coverage. For questions, please call the Customer Care Team at 1-800-325-5598, Monday – Friday, 8 a.m. – 5 p.m. CT.


Employer Group Information

We understand the stress and worry that COVID-19 is bringing to your workplace. As your partner, we wanted to share some business resources we have developed to help you keep your staff and their families safe. Some portions of this business toolkit have been translated into various languages. Please reach out to your Client Relationship Executive to see what translated pieces are available to you.

Please know we are working with our employer groups challenged by economic disruptions. Employers have options when it comes to employee eligibility for coverage, leave of absence, and premium payment requirements and have placed additional FAQs within the agent quote portal.

Questions?

For more information contact your agent, call us at 1-800-325-5598, or email info@dakotacare.com.


Personal Health Services Frequently Asked Questions

My surgery at Avera has been cancelled/postponed/moved. My doctor said I can have it at “X” facility. Can I move it there?

Avera is following the recommendations set by the Centers for Disease Control. The recommendations are to postpone non-emergent elective procedures in order to limit patient risk of complications from COVID-19 after surgery and preserve the necessary personal protective equipment that will be needed to protect the public. Avera is following those recommendations.

Why are other hospitals still doing surgeries?

At DAKOTACARE, we are following guidance made by the local, state, and federal health officials in regards to the current public health emergency. Please know all decisions like this are not made lightly and are done with the safety of our members in mind.

I want to cancel my surgery because I am scared of being the hospital right now. What can I do?

We recommend you talk to your provider to determine if it is safe for you to wait based on your individual situation.

Can my doctor still preauthorize my surgery?

Absolutely. Our team is prepared to continue to process requests for services that require preauthorization according to our normal policies and procedures.

Questions?

We know this is a confusing time and you have lots of questions. For questions regarding your chronic conditions, prescription drugs and health questions, please call the Personal Health Services Team at 1-888-605-1331, Monday – Friday, 8 a.m. – 5 p.m. CT.

COVID-19 Resources and Health Care Information

Learn more about Avera facility closures, what to do if you’re sick and tips for home isolation.

Learn More


Agent Information

During this time, we believe we must all do our part to limit the spread of COVID-19. We are working to keep our employees safe by following the guidelines for social distancing and working remotely from home when possible. We are maintaining essential functions at our office that cannot be done remotely. We also encourage you to work from home and limit contact with clients as much as possible.

Questions?

If you have questions, contact a member of our sales team at info@dakotacare.com.


AveraNow Virtual Care and Triage Resources

Please call your physician or the COVID-19 hotline toll-free at 1-877-AT-AVERA if you are experiencing COVID symptoms.

We recommend logging in to AveraNow virtual video visits if you need to see a provider for simple issues like sinus infections or pink eye that are non-COVID-19 related. To encourage use of virtual visits, we are waiving co-pays for all member plans through June 14.

  • You can log in on your smartphone, tablet or laptop.
  • Members with a coupon code should still use it. Your coupon code is on your member ID card or in your member portal.
  • Members without a coupon code will not be charged a co-pay through the claims process.

Questions?

If agents have any questions, please email info@DAKOTACARE.com.