COVID-19: What You Need to Know

COVID-19 Services You Receive from In-Network Providers Are Covered at No Cost

Community Care Health is required by law to provide coverage for COVID-19 services from both in-network and out-of-network providers. This includes tests, immunizations, and treatments. However, starting May 1, 2024, you will have to share in the cost of those services if you receive them from out-of-network providers. Your cost-share will be 50% of their reasonable and customary value. This is known as “R&C.” You will also have to pay for the difference, if any, between the R&C amount and the provider’s billed charges. This could be a lot of money and these amounts will not apply to your out-of-pocket maximum. All of these services are available from in-network providers at no cost to you; so there is no need to get them from out-of-network providers. Important: If there are no in-network providers who are readily available to provide these services, or if you need the services on an urgent basis and cannot reach an in-network provider, Community Care Health will cover the services at no cost to you. Call Customer Service if you need help in finding a provider or have questions about your coverage. They can be reached at 559-724-4995, or toll free at (844) 516-0181, Monday-Friday, from 8:00 a.m. to 5:00 p.m.

Reimbursement for Over-the-Counter COVID-19 Tests

Community Care Health members who have purchased COVID-19 Tests are eligible for cost reimbursement. Please review complete and return the Member Claim Form to be reimbursed.

COVID-19 Test Reimbursement Form

Member FAQs

A1. Yes. Community Care Health will cover FDA approved COVID-19 vaccines. There will be NO cost to Community Care Health members if the vaccine is received from in-network providers.

A2. Yes. Community Care Health will cover FDA approved vaccines in accordance with the requirements established by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This includes any vaccines administered over more than one injection.

A3. Yes, in addition to vaccines, Community Care Health will cover COVID-19 tests and treatments. These services are covered at no charge and no cost-sharing (i.e., co-pays, co-insurance, deductibles or out-of-pocket costs) if you receive these services from an in-network provider.

A4. Community Care Health is required by law to provide coverage for COVID-19 services from out-of-network providers. However, starting May 1, 2024, you will have to share in the cost of those services. Your cost-share will be 50% of their reasonable and customary value. This is known as “R&C.” You will also have to pay for the difference, if any, between the R&C amount and the provider’s billed charges.

A5. If there are no in-network providers who are readily available to provide the services, or if you need the services on an urgent basis and cannot reach an in-network provider, Community Care Health will cover the services at no cost to you if you receive them from an out-of-network provider. Please call Customer Service at 559-724-4995 if you need help in finding a provider or have other questions about your coverage.

A6. Yes, all Community Care Health members have access to Teladoc (1-800-Teladoc).

A7. Yes. Community Care Health will cover medically necessary treatment of COVID-19 from both an in-network or out-of-network provider. However, you may be responsible for a share of the cost of the services from out-of-network providers. See A4 above for more information on the cost share differences.