COVID-19 Information for Employers and Brokers 

The COVID-19 vaccine and boosters will continue to be covered under all MVP Commercial fully insured plans after the end of COVID-19 PHE effective May 12, 2023.

Self-funded plans determine their COVID-19 vaccine and booster coverage.

Fully insured and self-insured groups who carve-out pharmacy from MVP will follow standard rules, and administration costs for the vaccine administered by a pharmacist will be covered by the group’s pharmacy plan.

MVP does not cover COVID-19 tests performed solely to assess health status, even if required by parties such as government/public health agencies, employers, common carriers, schools, or camps, or when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status. MVP does not cover occupational testing. 

Effective May 12, 2023, MVP Commercial fully insured plans will cover COVID-19 diagnostic lab tests at the plan’s standard cost share and over the counter COVID-19 tests will no longer be covered. 

Self-funded plans determine their cost-share for COVID-19 test coverage.

Effective May 12, 2023, MVP Commercial fully insured plans will no longer waive out-of-network COVID-19 services.

Self-funded plans can determine out-of-network service coverage for COVID-19 services.

Effective May 12, 2023, MVP Commercial fully insured plans will no longer waive ambulance transportation claims for COVID-19 diagnosis or symptoms.

Self-funded plans determine their ambulance transportation coverage.

New York State

Individuals may continue to enroll directly with MVP or enroll through the NY State of Health until the end of the public health emergency. Enrollment must be completed by the 15th of the month for coverage effective the 1st of the following month. For example, enrollment must be completed by March 15 for coverage effective April 1. Individuals who qualify for financial assistance or subsidies should contact the NY State of Health.

 

Vermont

The extended Open Enrollment Period for Vermont Individual plans has concluded.

Individuals who recently had a life changing event, like marriage or the birth of a child, may qualify for a Special Enrollment Period.

The most important thing to know is that clinical trial data shows that the COVID-19 vaccine is safe and effective for children ages 5-11. Side effects may occur and could include pain at the injection site, fatigue, and/or headache, which are likely to resolve within 1-2 days and are similar to the side effects seen with other vaccines children routinely receive.

While children are less likely than teens and adults to have severe disease from COVID-19, they are not immune to the disease. Some children have become very sick and required hospitalization, including healthy children who did not have underlying conditions – nearly one third of those children hospitalized have needed care in the ICU. Experts have concluded that the known benefits of receiving the vaccine outweigh the risks of contracting COVID-19.

Children between the ages of 5-11 receive a lower dose of the vaccine than people over the age of 12. The Pfizer vaccine (currently available and approved for use) is a two-dose series, separated by three weeks.

Learn more about COVID-19 vaccines for children ages 5-11 by visiting the CDC’s website.

Parents should also speak with their health care provider to discuss any questions or concerns they may have.

Treatment for any adverse reactions is medically necessary and covered by MVP. Members should refer to their schedule of benefits or call the Customer Care Center at the number located on the back of their MVP Member ID card for cost share information. Cost share is dependent upon place of service.

MVP Commercial fully insured plans cover COVID-19 treatment at the plan’s standard cost share.

Self-funded plans determine their COVID-19 treatment coverage.

When traveling abroad (outside of the United States), MVP provides benefits for emergency services if your condition is an emergency medical condition. This includes any symptoms resulting from COVID-19 with sufficient severity to place your health in serious jeopardy or cause serious bodily impairment or disfunction. Emergency coverage is subject to applicable plan deductibles and cost shares. Members should refer to their Certificate of Coverage for specific coverage details.

Members often have less expensive, more convenient options than the hospital emergency room. The chart below details estimated costs based on site of service for an upper respiratory infection. 

Hospital Emergency Room	$1,150
Urgent Care	$173
Gia®	$0

The costs above show averages of all rates in the MVP service area. They do not represent a specific region or county in the MVP service area, or any single MVP participating provider’s contracted rates. 

Gia® virtual care services are $0 on most plans, including 2023 qualified high-deductible health plans (QHDHDPs).  

Members with a 2022 QHDHP must meet the plan’s annual deductible before virtual care services are $0. While costs may vary, virtual care services are generally lower cost than the in-person alternative, so it is important to review how much your visit will be before choosing a provider. Download the Gia mobile app today. 

Self-funded plans can determine the cost-share for virtual care service coverage.

MVP is committed to making sure you have the health insurance coverage you need during the COVID-19 State of Emergency. While you are no longer able to defer premium payments, if you have experienced financial hardship please call your broker, MVP Account Representative, or MVP Premium Billing Representative to discuss your options.

The Consolidated Appropriations Act (CAA) and the American Rescue Plan Act (ARPA) extend many relief measures that were created by the Families First Coronavirus Response Act (FFCRA) and the Cares Act. The CAA and ARPA provide temporary relief for Medical FSAs, Dependent Care FSAs, and Limited Purpose FSAs. Groups are not required to apply these amendments, but they can be used to provide members with additional flexibility. If you would like to make a change to your FSA, please review the available options and complete the FSA Amendment Form for Employers. Once completed, please return the form to your MVP Account Manager.