Mountain Health CO-OP is now reimbursing covered members for Over-The-Counter Covid-19 testing
Coverage will be provided for up to 8 tests per month per member.
Coverage of Covid-19 testing is not a guarantee of test availability. By submitting a reimbursement claim form, you acknowledge the COVID-19 test is for diagnosis or treatment purposes only and is not being used for other purposes including work requirements or travel requirements. Proof of delivery of online purchases is required for reimbursement. Mountain Health CO-OP will not reimburse postage costs for online purchases.
It has been a privilege to work with our members and providers through the pandemic to remove barriers to care related to COVID-19 as well as promoting continuous access to needed care.
The CO-OP did a number of things to support our membership during this time including removing all cost-share related to COVID treatment and telehealth services.
Our standard benefit plan design has resumed effectiveness as of June 1, 2022, with a few exceptions: we will continue covering COVID testing according to federal guidelines.
Mountain Health CO-OP is concerned about the health and well-being of our members. Our hearts go out to all people in the US and worldwide who are suffering directly from COVID-19 or indirectly by the measures that have been taken to contain its spread.
Avoid reimbursement issues by making sure your test kit is FDA- authorized.
Be aware of test scams or fraudulent sales of Covid-19 tests. Unsure if your test is FDA-authorize? Ask your pharmacist for help.
Purchase through the pharmacy rather than the normal check out counter to avoid extra step. The purchase is billed directly to us, rather than paying out-of-pocket and waiting for a reimbursement.
COVID-19 Vaccine Information
Who can get vaccinated?
Anyone over the age of 5 can get the vaccine.
Where do I get vaccinated?
When you become eligible, you can get your COVID-19 vaccine at your local health department, pharmacy or medical provider. Call or visit your county’s health department website to schedule a vaccination appointment.
The following is a list of benefits that have temporarily been updated in order to support our members.
If you have any questions about these updated benefits, please call the customer service phone number listed on your health insurance ID card.
The following list of benefits have been updated in response to COVID-19 and will be extended through June 2022 and applies to all CO-OP members.
Tools and Resources
|Booster (when available)||Covered 100%|
|Home-Based testing when ordered by a physician (frequency limit: 1 test every 6 months)||Covered 100%|
|Serology (Antibody) testing ordered by a physician||Covered 100%|
At-Home Over-the-Counter FDA-approved COVID-19 Tests for diagnostic use only not travel or work related (up to 8 tests per member per month). For a list of FDA-approved OTC COVID-19 tests or for help to get reimbursed for a test, call pharmacy customer service at 855-885-7695.
For more information, see the CMS FAQ here
|Covered 100% if purchased on January 15, 2022 or later|
|In-person office visits, urgent care and emergency room related to acute COVID-19||Covered 100% at an in-network provider|
|Testing related to COVID-19 ordered by a physician (no limit on the number of tests)||Covered 100%|
Tools and Resources
Important Info for Providers
COVID-19 Vaccines Payment Policy
Mountain Health CO-OP payment policy for the administration of the COVID-19 Vaccines will follow CMS recommendations to reimburse these services at the reasonable rate which CMS considers equivalent to Medicare.
The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about fraud schemes related to the COVID-19, commonly referred to as coronavirus.
Fraudsters are offering COVID-19 tests in exchange for personal details, and are targeting members in a number of ways, including telemarketing calls, social media platforms, and door-to-door visits. The personal information the fraudsters collect may be used to fraudulently bill health plans or commit medical identity theft. The following ways have been recommended for members to protect themselves from fraud:
- Beneficiaries should be cautious of unsolicited requests for their Medicare, Medicaid, or insurance numbers.
- Be suspicious of any unexpected calls or visitors offering COVID-19 tests or supplies. If your personal information is compromised, it may be used in other fraud schemes.
- Ignore offers or advertisements for COVID-19 testing or treatments on social media sites.
- A physician or other trusted healthcare provider should assess your condition and approve any requests for COVID-19 testing.
If you think you are a victim of a scam or attempted fraud involving COVID-19, you can report it by calling a Mountain Health Coop Customer Service Advocate at the number on your health insurance card.