Page last updated on 1/22/2022
Free At-Home COVID-19 Tests from the Federal Government: Beginning Wednesday, Jan. 19, 2022, the federal government’s website for Americans to order free at-home COVID-19 tests will be live. The site can be found at covidtests.gov.
Continue to check this page for updates. We will be providing new information as it becomes available.
Medical Mutual’s top priority is the health and wellbeing of our members. We are closely monitoring the recent novel coronavirus disease 2019 (COVID-19) outbreak. It’s important to know the precautions and safety measures you can take to protect you and your family.
Reimbursement for Over-the-Counter (OTC) COVID-19 Tests
On Jan. 10, health insurance plans, like Medical Mutual, received additional guidance from the federal government regarding coverage that makes OTC COVID-19 tests available to our members at no cost. Requirements for insurance coverage began on Saturday, Jan. 15th.
To process your claim, we will need:
- This completed claim form
- The UPC bar code found on the packaging of each test
- Receipt for each test
COVID-19 Vaccine Information
We have developed a dedicated page to provide you with information and updates on the COVID-19 vaccine. Visit MedMutual.com/COVIDVaccine.
Benefit Information for Medical Mutual Members
Benefit information included below applies to all Medicare Advantage plans, fully insured commercial members, Medicare Supplement and individual members. For members covered by self-funded plans, benefits may be different, and you should verify your coverage. If you have questions about your self-funded plan, contact your employer.
Medical Mutual is waiving member cost sharing associated with medically necessary COVID-19 testing. The waiving of member cost sharing may also apply for the office visit/telehealth appointment, emergency department visit, or urgent care visit when the COVID-19 test was administered. Waiving of cost-sharing for the office visit/telehealth appointment, emergency department visit, or urgent care visit only applies when the primary purpose of the visit is to determine if you have COVID-19.
If you are given a COVID-19 test at an office visit/telehealth appointment, emergency department visit, or urgent care visit that took place for any other health reason, cost sharing may NOT be waived. This applies to services provided by both in-network and out-of-network providers and is in effect through the end of the national public health emergency declared by the U.S. Department of Health and Human Services.
Members who paid up front for COVID-19 testing may be eligible for reimbursement. To request reimbursement, you must submit a Medical Claim Form with detailed information about the services you received. Click here to find out more.
COVID-19 Testing at an Out-of-Network Facility
If you are tested at a facility that is not in your Medical Mutual network, there is still no cost to you. In this situation, please be aware that payment for the test will be sent to you and not to the testing facility. You will then be responsible for paying the testing facility directly. You will only have to pay the testing facility the amount Medical Mutual provides to you. The testing facility should not charge you more.
Travel-related COVID-19 Testing
If you are tested for COVID-19 for the purposes of entering another country OR returning to the United States, please note that Medical Mutual does not cover this testing at 100%. You may responsible for some or all of the cost related to this test depending on your plan.
General Workplace Health and Safety and Employment Surveillance Testing
Medical Mutual continues to follow guidance issued to implement the Families First Coronavirus Response Act (FFCRA), which states that health insurance carriers are NOT required to cover testing for general workplace health and safety, including employment surveillance programs.
Effective Jan. 1, 2021, COVID-19 treatment for Medical Mutual members is covered similarly to how treatment for other medical conditions is covered. Member cost-sharing (copays, coinsurance and deductibles) apply as outlined in your plan's certificate book. To review your coverage, log on to your My Health Plan account and select Benefits & Coverage. You can also call Medical Mutual Customer Care at the number listed on your ID card.
Please keep in mind that during the state of emergency in Ohio enacted by Gov. DeWine on March 9, 2020, health insurance plans regulated by the State of Ohio cover treatment for COVID-19 administered by out-of-network providers the same as treatment administered by in-network providers. There are no penalties for going out of network at this time. Please contact your company’s Human Resources department if you are not sure if your plan is regulated by the State.
Early Prescription Drug Refills and Mail Order
Please note: This only applies to members who have Express Scripts as their pharmacy benefit manager through an arrangement with Medical Mutual.
The Centers for Disease Control and Prevention recommends having at least a two-week supply of any medications you take regularly. As a Medical Mutual member, you can get your prescriptions filled as you normally would. We will also allow early fills, should you want to receive your medication prior to your next refill. Pharmacies have been given the ability to use their judgement to allow an exception and refill prescriptions early.
You can receive what your plan allows you to fill at retail pharmacies and through mail order. Most plans allow a 30-day supply at retail and a 90-day supply through mail order. Members should check their specific plan limitations. If you experience any issues trying to refill your medication, call the Rx Information number listed on your ID card.
Using Mail Order to Get Your Prescriptions
For more information on using mail order to have your prescriptions delivered right to your home, view our flier.
If You Have Recently Lost Coverage
If you have lost prescription drug coverage because of the current circumstances, please talk with your healthcare provider or pharmacist. They will have information on pharmacy chain discount cards, manufacturer copay cards available for brand name drugs, assistance programs, and other options. You can also visit RxAssist.org/Patients or NeedyMeds.org/pap.
Telehealth (Telemedicine) Appointments
Telehealth (telemedicine) visits are covered just like other medically necessary office visits. They are for patients needing routine care for chronic or general health conditions, including behavioral health. Telephonic visits, in addition to web or app, will be covered.
During the COVID-19 state of emergency in Ohio, Medical Mutual will allow occupational and physical therapy, as well as speech pathology and applied behavioral analysis (ABA), visits to be conducted via telehealth (telemedicine) when audio and visual encounters are included. Telephonic-only visits will NOT be covered. Chiropractic services are NOT included. Services performed by home health agencies are NOT included.
For members covered by self-funded plans, benefits may be different, and you should verify your coverage. If you have questions about your plan’s telehealth (telemedicine) coverage, check your benefit documents by logging in to My Health Plan or call Medical Mutual Customer Care using the phone number listed on your ID card.
Member Appeals During the National Emergency Period
Medical Mutual members have 180 days from the date they receive the original denial notice to file an appeal of a denied claim, requested service or eligibility. As we are currently in a national emergency period, there is an important note about that timing.
At this time, the appeal period remains 180 days, but for members enrolled in certain plans as defined by the U.S. Department of Labor and the Internal Revenue Service, Medical Mutual will pause counting days for one year or until 60 days after the end of the national emergency period, whichever is earlier.
To determine if you are enrolled in a plan affected by this, please contact your HR department.
Resources for Individuals and Families Without Coverage
The coronavirus disease known as COVID-19 may have impacted your life in many ways. If you lost, or are losing, your employer health insurance coverage because of these unprecedented circumstances, Medical Mutual is here to help. You may be eligible for an individual health insurance plan.
Medical Mutual has helpful licensed sales agents available to answer your questions and discuss your coverage options. You can call us toll free at 1-866-488-3266 (TTY 711 for hearing impaired) Monday through Friday, 8 a.m. to 8 p.m. You can also learn more about our plans in our Plans & Products section.
For information about qualifying for individual coverage because of circumstances related to COVID-19, please review this Individual Health Insurance FAQ.
Frequently Asked Questions About COVID-19
COVID-19 is a respiratory disease caused by the most recently discovered coronavirus. The new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. This is a rapidly evolving situation and the Centers for Disease Control and Prevention (CDC) and the Ohio Department of Health (ODH) continue to provide updated information as it becomes available.
What are the symptoms of COVID-19?
The most common symptoms of COVID-19 are fever, cough and shortness of breath. Some people become infected but don’t develop any symptoms and don't feel sick.
Illness is generally mild, especially for children and young adults. Most people recover without needing special treatment. However, the elderly and people with underlying medical problems, such as high blood pressure, heart disease and diabetes, are more likely to become seriously ill and may need to be hospitalized.
How does the virus spread?
People can catch COVID-19 from others who have the virus. The virus spreads when a person with COVID-19 coughs or exhales, releasing small droplets from their nose or mouth. Others breathe in the droplets containing the virus, or touch objects or surfaces around the person, then touch their eyes, nose or mouth.
How long does the virus survive on surfaces?
Studies suggest coronaviruses (including preliminary information on COVID-19) may persist on surfaces for a few hours or up to several days. If you think a surface may be infected, clean it with a disinfectant. Then wash your hands with soap and water for at least 20 seconds or clean them with an alcohol-based hand sanitizer that contains at least 60% alcohol, if soap and water are not available.
How long is the incubation period?
Most commonly, the incubation period, which refers to the time between catching the virus and beginning to have symptoms of the disease, is around five days. Current estimates for COVID-19 range from one to 14 days.
What should I do if I think I may have symptoms of COVID-19?
Call your doctor right away if you feel sick and are concerned about your symptoms.
How can I protect myself and prevent spreading the virus?
The best way to prevent illness is to avoid being exposed to this virus. Following the actions listed below can help prevent the spread of respiratory diseases, including COVID-19:
- Wash your hands. Wash your hands frequently with soap and water for at least 20 seconds or clean them with an alcohol-based hand sanitizer that contains at least 60% alcohol. This kills viruses that may be on your hands.
- Keep your distance. Practice social distancing by maintaining at least six feet distance between you and others when in public. In general, try your best to avoid crowds, shaking hands, and going to work or school when you're feeling ill.
- Don't touch your face. Avoid touching your eyes, nose and mouth. Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth.
- Follow good respiratory hygiene. Cover your mouth and nose with your bent elbow or use a tissue when you cough or sneeze. Then dispose of the used tissue immediately.
- Wear a cloth mask. Wear a cloth face mask in public settings where maintaining six feet distance between others is difficult. You can make your own cloth face mask following these steps: