Information about
coronavirus (COVID-19) 

Fallon Health covers over-the-counter COVID-19 tests for all Fallon members whose plan includes a pharmacy benefit. We will cover the cost of up to eight over-the-counter FDA emergency use authorized tests per member per month for our NaviCare and ACO plans through June 30, 2023. Effective July 1, 2023, two individual tests per member per month will be covered without prior authorization. For our Fallon Medicare Plus plans (Medicare Advantage plan members), we will cover up to four over-the-counter FDA-emergency use authorized antigen tests per member per month without prior authorization through December 2023. For Community Care members, we will cover 8 tests per member per month through December 31, 2023. Beginning January 1, 2024, we will cover 2 tests per member per month. In addition to over-the-counter tests, Fallon covers diagnostic tests known as polymerase chain reaction (PCR) and antigen tests. These tests identify whether a person has active COVID-19 infection, and is covered at no cost-sharing for you as long as your health care provider identifies that you are symptomatic with COVID-19 related symptoms. Learn more about coverage for at-home COVID-19 tests.  ▶

You can also access tests directly from the federal government by visiting covidtests.gov. Every home in the U.S. can order 4 free at-⁠home COVID-⁠19 tests. The tests will be completely free—there are no shipping costs, and you don’t need to enter a credit card number.

Getting the vaccine

At this time, children ages 6 months and older are eligible to get the COVID-19 vaccine. The recommendations can vary based on your age and the product you get. Discuss options with your healthcare provider or vaccine administrator or learn more at the CDC website.

• You should visit https://www.vaccines.gov/ to find vaccination locations near you
• For answers to common questions about the vaccine, visit https://www.mass.gov/info-details/covid-19-vaccine-frequently-asked-questions

Vaccine safety

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 members will have no cost sharing if they choose to be vaccinated. Fallon also covers the flu shot vaccination in full and we recommend that all members receive the flu shot.

Be aware of scams

If you receive a message about being eligible for a vaccine, 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.

Fallon members will have no cost-sharing (deductibles, copays, coinsurance) for medically necessary COVID-19 testing, counseling and treatment.

Referrals
Fallon Health is waiving referral requirements for ACO members and relaxing them for Community Care members. Fallon Health is reinstating referral requirements for Fallon Medicare Plus and NaviCare members on July 1, 2023. Members will receive a written notification 30 days prior of this change.

Prior authorization
Fallon Health is relaxing our prior authorization requirements for medically necessary COVID-19 related services. Fallon Health is reinstating prior authorization requirements for Fallon Medicare Plus and NaviCare members on July 1, 2023. Members will receive a written notification 30 days prior of this change.

Telehealth
Fallon Health members can access telehealth services from all network providers that are offering these services. Fallon Health members can call the CareConnect phone number listed on their ID cards to receive advice on where to obtain medical services, and for help setting up either a telehealth or an in-person appointment.

Fallon Health will continue to waive all member cost-sharing for COVID-19 related medically necessary telehealth services only, until further notice. For non-COVID related telehealth visits, member cost-sharing will be the amount reflected in their plan documents. For Fallon Medicare Plus Medicare Advantage: Starting July 1, 2023, Fallon Health is reinstating copayments for telehealth visits with specialists for both COVID-19 and non-COVID related services.

• 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. Any information you provide on the Buoy tool is 100% secure, and will not be shared with anyone.
  
  
• If you have any of the symptoms below, you should contact your primary care provider. Many in-network physicians are conducting telehealth visits (doctor visits by phone or online) so you may not have to go into the office.
• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• Sore throat
• New loss of taste or smell
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea
• 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.

You should:

• Get vaccinated and boosted as directed by your doctor.
• If you have COVID-19, 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.

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.

• 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. You will have no cost-sharing for medically necessary telehealth visits.
• 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.
• If you have behavioral health benefits through Fallon Health, you can call the Carelon Behavioral Health phone number on the back of your Fallon ID card to find a behavioral health provider and schedule a telehealth visit. You can also visit the Carelon Behavioral Health website for more information and resources to help you.

You can find additional information and resources at https://www.mass.gov/info-details/maintaining-emotional-health-well-being-during-the-covid-19-outbreak.

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.