Univera Healthcare Updates on COVID-19 (Coronavirus)
What you pay for COVID-19 related medical and pharmacy care may change once the public health emergency ends on May 11, 2023. The federal emergency required health insurers to provide certain COVID-related services at no cost to you.
After May 11, your cost for COVID-related services will now be based on the details of your current health plan benefits.
Here is more information on what will (or won’t) change once the public health emergency ends:
What’s changing: Most members will continue to receive FDA-authorized COVID-19 vaccines and boosters at no cost once the federal emergency ends.
Almost all health plans already include full coverage for vaccines (including COVID-19 vaccines and boosters) that are recommended by the federal Advisory Committee on Immunization Practices (ACIP) and given by an in-network provider. You may incur a charge, however, if you receive your vaccine from an out-of-network provider.
Certain plans may also ask members to pay some costs for the administration of the vaccine.
What’s changing: You will likely have to pay some costs for FDA-authorized COVID-19 lab tests and related visits after May 11, 2023, depending on the type of test and reason for the visit, as explained in your health plan benefits.
The exceptions:
- Medicaid Managed Care, Essential Plan, Health and Recovery Plans (HARP) and Child Health Plus will continue to cover all COVID-19 lab tests at no cost through Sept. 30, 2024.
What’s changing: Many health plans do not include coverage for over-the-counter (OTC) products. You’ll likely have to pay the full cost for COVID tests that are purchased at a pharmacy or online after May 11. You may still submit bills to Univera Healthcare for reimbursement for OTC tests purchased through May 11, 2023.
The exceptions:
- Medicaid Managed Care, Essential Plan, Health and Recovery Plans (HARP) and Child Health Plus will cover certain brands of over-the-counter tests at no cost until further notice. To search for a list of covered tests, visit the eMedNY site. Select "Description" in the dropdown field and type in "COVID" to return a list of covered tests.
- Medicare does not cover over-the-counter tests.
The alternatives:
- You can still order free over-the-counter tests through COVID.gov/tests while supplies last. Also, you can use your Flexible Spending Accounts or Health Savings Accounts to obtain over-the-counter tests.
What’s changing: You’ll likely receive COVID-19 antiviral medication and treatment at no cost for now. Once the federal government runs out of its supply of treatments, however, what you pay will be based on the terms of your health insurance plan.
The exceptions:
- Medicaid Managed Care, Essential Plan, Health and Recovery Plans (HARP) and Child Health Plus will continue to cover oral antivirals and therapeutics at no cost through Sept. 30, 2024.
Beginning April 1, 2023, all Medicaid members enrolled in Univera MyHealth and Univera MyHealth Plus will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Learn more about the transition of the pharmacy benefit from Univera MyHealth and Univera MyHealth Plus to NYRx, the Medicaid Pharmacy Program. Access general information about NYRx, the Medicaid Pharmacy Program, along with additional information for Members and Providers.
What’s changing: After May 11, 2023, the health plan will resume reviewing requests for early prescription refills.
What’s changing: What you pay for telehealth COVID-19 services after May 11, 2023 will depend on the details of your health plan. Please log in to your member account at UniveraHealthcare.com to view your benefits.
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We know that having any health symptoms can be scary. Because we’re focused on your health and well-being, our team of nurses, social workers, respiratory therapists and mental health coaches are here to support you.
24/7 Nurse Line: You can speak with a nurse by phone anytime – 24 hours a day, seven days a week. Our specially trained registered nurses can answer your questions and provide support.
Ask a Nurse Today! Call 1-800-348-9786 (TTY 1-800-662-1220).
The 24/7 Nurse Call Line is a service provided to our members to support their relationship with their health care providers. The information provided is intended to help educate members, not to replace the advice of a medical professional. If you are experiencing severe symptoms such as sharp pains, fever, loss of bodily function control, vomiting or any other immediate medical concern, dial 911 or contact a physician directly.
If you have Medicaid, Essential Plan or Child Health Plus, you may have to start renewing your coverage once a year, for the first time since early 2020. Renewals will begin in June of 2023, on a rolling monthly basis.
If you’re losing your employer-sponsored health insurance, there are affordable, high-quality options available to you. From free or low-cost New York state sponsored plans to individual and family plans, you can still have the peace of mind that comes with having coverage you know and trust.
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You are not responsible for any charges from a Health Plan participating provider beyond your applicable deductible, copayment, or coinsurance, including any fees charged for PPE. If you have paid PPE charges to a Health Plan participating provider, you should contact the provider and obtain a refund. If you would like to submit a complaint to us about charges for PPE from a participating provider, please contact us toll-free:
- Commercial Group, Medicare, and Qualified Health Plan members, call 1-800-499-1275
- Medicaid and Child Health Plus members, call 1-800-650-4359
- Essential Plan members, call 1-877-626-9298
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