Monitoring the Coronavirus
Horizon NJ Health continues to monitor the latest updates related to the novel coronavirus (COVID-19) provided by these credible resources:
- World Health Organization (WHO)
- Centers for Disease Control and Prevention (CDC)
- National Institutes of Health
- New Jersey Department of Health
As a Horizon NJ Health member, you will continue to have access to the services and support you need. We have a detailed plan in place to reduce any service disruptions, if needed.
Our best shot at stopping COVID-19 is here
Since the start of the COVID-19 pandemic, we’ve all been searching for light at the end of the tunnel. Now, with the rollout of vaccines that have been authorized by the Food and Drug Administration (FDA), we’re one step closer to getting back to normal.
We realize you may have questions or concerns about the vaccine, and we are here to make sure you have the information you need to take care of your health.
That’s why we created a COVID-19 Vaccines brochure that can help you learn more about:
- What we know today
- How vaccines build immunity
- How the vaccines were developed so quickly What to expect after the shot
- Why you might need two doses
- COVID-19 facts, fictions & fakes
Remember, you can get the vaccine at no cost to you.
Below are answers to some questions you may have.
Coronavirus Basics
WHAT IS COVID-19?
COVID-19 is a respiratory disease caused by a specific strain of coronavirus (SARS-CoV-2). Coronaviruses are a large family of viruses often causing mild to moderate upper-respiratory tract illnesses, similar to the common cold or flu.
WHAT ARE THE SYMPTOMS?
Respiratory symptoms, such as a cough, difficulty breathing and fever. People who are elderly and/or have underlying health conditions are more at risk for severe complications. Symptoms of coronavirus may appear two to 14 days after exposure.
HOW DOES IT SPREAD?
The virus is thought to spread from person-to-person through droplets produced when someone with the virus coughs or sneezes. This can happen when people are in close contact with one another (within six feet), usually for a prolonged period of time.
HOW CAN I PROTECT MY FAMILY?
As soon as you are able, and if the vaccine is appropriate for you, get vaccinated against COVID-19. In addition, continue to follow common-sense steps to help improve your chances of avoiding exposure to the virus.
If you begin to experience symptoms, call your Primary Care Provider (PCP). If you don’t know your doctor’s phone number, you can find it on your member ID card or look it up using our online Doctor & Hospital Finder. It is important to call your PCP’s office or other health care facility before you go there. When you call, you can inform them of your concerns, and they will give you further directions.
You can also download the CDC’s information sheet about what to do if you are sick with COVID-19.
Questions about coverage
Horizon NJ Health covers FDA-authorized antibody testing performed by a lab that has appropriate Clinical Laboratory Improvement Amendments (CLIA) certification when testing is performed consistent with the Centers for Disease Control and Prevention’s (CDC’s) Interim Guidelines for COVID-19 Antibody Testing.
The test must be for a diagnostic purpose consistent with CDC guidelines and ordered by your licensed doctor or other health care professional. These CDC guidelines specifically note Serologic testing should not be used to determine immune status in individuals until the presence, durability, and duration of immunity is established. Currently, the clinical use of serologic or antibody testing for COVID-19 is to support a diagnosis of COVID-19 in patients who are seeking care late in their course of illness or in patients who are seeking care for late complications, such as multisystem inflammatory syndrome in children.
Antibody tests should not be used as a sole basis for diagnosis. When antibody testing is covered, members will have no cost sharing during the COVID-19 public health emergency.
Watch this video from the FDA about antibody testing.
At this time, there is no specific antiviral treatment for coronavirus. Members should call their PCP to ask about care to help relieve symptoms, like for any other viral respiratory infections. Horizon NJ Health will continue to cover health care costs to treat infectious diseases.
We cover vaccines recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) and the U.S. Preventive Health Services Task Force (USPSTF). That means you will not pay any money out of your pocket to get the vaccine.
During the COVID-19 public health emergency, COVID-19 vaccines will be covered 100% through in- and out-of-network doctors, hospitals, pharmacies and other health care professionals, as well as through vaccine administration sites.
Vaccines are being administered in a phased rollout according to the priority groups established by the New Jersey Department of Health. For information on New Jersey’s vaccine administration phases, please visit the New Jersey COVID-19 Information Hub.
You can register for a vaccine on the NJ Vaccine Scheduling System (NJVSS). The NJVSS lets you find a vaccination site, pre-register and schedule an appointment. You will be notified when the vaccine is available for you.
As the vaccine becomes more widely available, you will be able to get vaccinated by in- and out-of-network doctors, hospitals, pharmacies and other approved vaccination sites, including New Jersey’s six state-coordinated mega sites.
Vaccines will be administered according to the New Jersey Department of Health’s designated priority groups. Registration for appointments is required at this time.
Talk to your doctor about what is right for you.
The CDC and every state have established specific plans to distribute vaccines, which will initially be in limited supply, and to identify the priority populations for vaccination. Please follow the guidance issued by public health authorities on when and how to be vaccinated.
Visit the CDC website for up-to-date information on COVID-19 vaccines.
Q. Will Horizon NJ Health cover medical supplies such as masks, gloves or disinfectants for members?
These supplies are not currently covered.
Q. Will Horizon NJ Health waive prior authorization requirements for testing and treatment of COVID-19?
Horizon NJ Health will waive prior authorization for:
- Diagnostic tests and covered services that are medically necessary and consistent with CDC guidance; and
- Lab or diagnostic testing required during an ER evaluation or inpatient hospital stay.
Q. If my coverage with Horizon NJ Health requires a copay, will it be waived for costs related to COVID-19 testing or treatment?
We are waiving the copay for a visit to an in-network PCP or urgent care center or an in-network or out-of-network emergency room for:
- Evaluation of symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough and shortness of breath).
- COVID-19 testing for members who know they have been exposed to an individual diagnosed with COVID-19.
Also, we are waiving copays at in-network and out-of-network labs for charges associated with the delivery of services connected to CDC-approved lab studies or tests for COVID-19 for members who:
- Know they have been exposed to an individual diagnosed with COVID-19 or;
- Have symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough and shortness of breath).
Q. Does Horizon NJ Health have any resources that can connect me to a health care professional by phone?
Members can call our 24/7 Nurse Line to get reliable health information. The nurses are experienced professionals who can provide doctor-approved information to help you make informed health care decisions. To access the 24/7 Nurse Line by phone, please call 1-800-711-5952 (TTY 711).
Member can continue to use ModivCare for transportation services. To make a reservation, call ModivCare at 1-866-527-9933 (TTY 1-866-288-3133) or visit ModivCare.com. If you are experiencing issues with transportation services, please let us know.
Yes, members will continue to receive PCA services as normal. If you have any concerns or issues with your PCA service, please call your Care Manager.
We will work closely with our members to make sure needs are met. If your Adult Medical Day Care Program is closed and you need assistance with services you normally receive when you are attending that program, please contact us at 1-844-444-4410 (TTY 711).
Members should not see any disruption in services. In the event that you are not receiving services according to your care plan, please call 1-844-444-4410 (TTY 711) to speak to your MLTSS Care Manager.
Yes. You will still receive your approved DME equipment. If you are experiencing any issues, we can connect you to your Care Manager for assistance in receiving your needed supplies. To access the 24/7 Nurse Line by phone, please call 1-800-711-5952 (TTY 711).
Q. I’ve heard that treatment for COVID-19 may be covered under Workers’ Compensation benefits. Is that true?
A. For some people in New Jersey, yes. On September 14, 2020, a state law went into effect affecting workers’ compensation (WC) benefits. The law created a rebuttable presumption that “essential workers” who contract COVID-19 during the public health emergency, contracted it in the workplace. That means, essential workers’ treatment of COVID-19 may be covered under their WC benefits. This law is retroactively effective March 9, 2020.
A. Under this law, “essential workers” include employees who, during the Governor-declared State of Emergency, are:
- Public safety workers/first responders (for example, fire, police or other emergency responders);
- Workers providing medical/health care services, emergency transportation or social services, including services in health care facilities, residential facilities or homes; and
- Workers performing services in physical proximity to members of the public and who are essential to the public’s health, safety and welfare, including transportation services, hotel and other residential services, financial services, and the production, preparation, storage, sale and distribution of essential goods such as food, beverages, medicine, fuel and supplies for conducting essential business and work at home.
A. For essential workers diagnosed with COVID-19, it’s beneficial to have treatment handled as a WC claim because WC covers 100% of medical costs, without copays or deductibles, from the first date of injury or illness to the date that maximum medical improvement is achieved. Under WC, this period may extend for one day or a lifetime. This is important since many COVID-19 cases appear to have long-lasting medical implications.
In addition, under WC benefits, partial wage replacement is also available.
Q. How can I take advantage of coverage for COVID-19 treatment under Workers’ Compensation benefits?
A. If you are an essential worker as described above, and you have tested positive for COVID-19 and have received or need treatment for COVID-19, talk with your employer about having your case covered through WC benefits. Your employer should refer you to the company’s WC insurer who will review your case for coverage for all medical care required to treat the covered illness until you achieve maximum medical improvement. This includes medical care for “long haul” COVID-19 claims that may require treatment for months or even longer. In addition to medical care, WC benefits may also include partial wage replacement.
When getting care for COVID-19, be sure to provide your doctors with your WC carrier details so your medical bills are handled appropriately under WC insurance coverage.
u What we know today
u Vaccines build immunity
u How were the vaccines
developed so quickly?
u What to expect after the shot
u Why two doses?
u COVID-19 facts, fictions
& fakes
Every shot counts ?
the COVID-19 vaccines
What?s inside:
1
As the COVID-19 pandemic disrupted our lives,
we searched for the light at the end of the
tunnel. With several vaccines now available,
that light seems to be just around the corner.
At Horizon BCBSNJ, we want you to have
the facts about the vaccines and help remove
uncertainty about being vaccinated.
? There are vaccines available to
help combat this disease.
? The vaccines are available at
no cost to you.
? Vaccination will help create
herd immunity.
Protecting yourself and your loved ones
Until enough people become immune to a
disease through vaccination or natural infection
(called herd immunity), it?s important to protect
yourself and others from the COVID-19 virus.
Remember to:
? Keep social distancing.
? Wear a multi-layered mask.
? Avoid crowds.
? Wash your hands.
? Stay home if you are sick.
Even after getting vaccinated, you will still
need to follow these safeguards.
What we know today
A message from Don Liss, MD
Vice President and Chief Medical Officer,
Horizon Blue Cross Blue Shield of New Jersey
Your health and safety are our top priorities. That?s why Horizon Blue Cross Blue Shield
of New Jersey (Horizon BCBSNJ) encourages you to follow the recommendations of the
Centers for Disease Control and Prevention (CDC) and the New Jersey Department of
Health to get a Food and Drug Administration (FDA) authorized COVID-19 vaccination.
The COVID-19 vaccine is available at no cost to you. The FDA requires extensive testing
for safety and effectiveness before vaccines are used. Until the virus is under control, you
should continue to avoid people who are sick, social distance, wear a multi-layered mask in
public and wash your hands often to avoid spreading infection.
Learn more about how Horizon BCBSNJ is responding to COVID-19.
For over 200 years, vaccines have been the answer to ending the spread of contagious and
deadly diseases like smallpox, polio and measles. To help stop the public health emergency and
protect us against COVID-19, pharmaceutical companies around the world are racing to roll out safe,
effective vaccines.
How does it work?
Researchers have studied vaccines for decades. They?ve found that once infected or vaccinated,
our bodies recognize parts of the virus, and then can build a response (antibodies) to protect us
from the disease. This means that vaccines help our bodies remember how to fight the virus if we?re
infected in the future.
Understanding herd immunity
Herd immunity is the ultimate goal, right? Yes, but that?s achieved only after a large
portion of our entire population has been infected or vaccinated. Current estimates
are that at least 85% of our population will need to be infected or vaccinated for COVID-19 herd
immunity. Since many people have medical conditions that will prevent them from getting
the vaccine, it?s up to the rest of us to do our part and get vaccinated.
If you?ve already had a bout with COVID-19, you may be thinking, I don?t need to get a vaccine, right?
Wrong! Experts do not yet know how long you are protected from getting sick again after recovering
from COVID-19. Even if you have already recovered from COVID-19, it is possible ? although rare ?
that you could be infected with the virus again, so when it?s your turn, get vaccinated.
2
When it?s your turn, sign up for the vaccine.
Vaccines build immunity
Developing and testing of the
COVID-19 vaccines follow the same
thorough process as every other
approved vaccine:
? Testing in large clinical trials
? Rigorous reviews of the data by the FDA
? Independent advisory committees of medical
and public health experts
The FDA then granted emergency use
authorization to each COVID-19 vaccine once it
was determined that each vaccine was safe and
effective, and that the known benefits of each
vaccine outweighed the known risks.
COVID-19 vaccines go through the same rigorous safety assessment as all vaccines
before being authorized for use in the United States by the FDA.
COVID-19 vaccines are being developed quickly because there was already research on similar
viruses. In addition, there are new and faster ways to create vaccines. The funding and the
worldwide focus also allowed the process to move quickly. The FDA assures that the expedited process
does not sacrifice scientific standards, integrity of the review process or safety.
The science behind the vaccines
COVID-19 is one of many different coronaviruses. Long before COVID-19, researchers at the
National Institutes of Health studied coronaviruses and ways to protect against them. They focused
on one coronavirus ?prototype? and created a vaccine for it. The idea was that this vaccine could
eventually be changed to fight different coronaviruses, like the one that causes COVID-19.
Using the prototype coronavirus, researchers focused on the spike protein, which is on the surface
of coronaviruses. The coronavirus uses these spikes to latch onto cells in our body. Our body makes
antibodies to fight against the virus when it sees the spike protein.
The COVID-19 vaccines that are currently available were studied across a population
of diverse ages, races and genders.
3
How were the vaccines
developed so quickly?
4
Some people may experience mild side effects, but that?s a sign
the vaccine is working.
? Get some rest. You might need to take
a step back from your regular activities for
a day or two until you?re feeling well again.
? OTC medication. Over-the-counter medication,
such as acetaminophen or ibuprofen have been
effective in reducing the minor aches and pains
that may be associated with the vaccine.
Contact your doctor if:
? The injection site becomes more red or sore
after 24 hours.
? Your side effects last more than a few days
and are worrying you.
As with any vaccine introduced into
your body, there could be mild side
effects, including:
? Soreness at the injection site
? Fever
? Muscle aches
? Fatigue
? Headaches
Tips to help with side effects:
? Cool it off. Apply a cool, damp washcloth
to the injection site if you feel soreness.
? Fight a fever. If your temperature is elevated,
drink plenty of fluids and dress lightly.
What to expect after the shot
The first two COVID-19 vaccines authorized by the FDA ? Moderna and Pfizer-BioNTech ?
both require two doses at the right intervals to achieve the highest possible levels of immunity.
A third vaccine, developed by Johnson & Johnson, requires only one dose.
Like many vaccines, getting the required doses is crucial to the vaccine working properly. It?s the
same with the COVID-19 vaccine. The first shot starts to build immunity; the second shot ensures near
maximum protection. By getting both shots, we protect not only ourselves, but those around us.
If you receive one of the two-dose vaccines, schedule your second appointment before leaving the
vaccination site. Your second dose must be from the same manufacturer. Remember to ask if you
need a second dose. Some vaccines may only need one dose.
The COVID-19 vaccines are proven to be effective against preventing
infection from the virus. So when you get vaccinated, you can feel good
about it keeping you and your loved ones safe.
5
Why two doses?
? Rigorous testing process
? Safe ingredients
? Doesn?t contain the live virus
? Minimal side effects
? Effective across different
populations
? Get the second dose
if required
? Wear a mask even after
vaccination
? Get the vaccine
even if previously infected
? Follow CDC guidelines
to prevent infections
EFFECTIVE NECESSARYSAFE
Facts about COVID-19
? There is currently no cure for COVID-19,
only treatments.
? Vaccines are now available at no cost to you.
? Vitamins, mineral supplements and certain
foods cannot cure or prevent COVID-19.
? Antibiotics cannot prevent or treat
COVID-19 because it is viral, not bacterial.
Antibiotics fight bacterial infections.
Avoiding scams and harmful ?cures?
The Internet can be full of misinformation.
A quick Internet search will pull up information
on cures and treatments for COVID-19 that are
not only false, but in some cases, dangerous
and deadly.
There are also people ready to scam those who
may not know the facts, making phone calls and
requesting personal information. Be wary of
anyone who may call, text or email you asking
for personal information or requesting money.
How to avoid COVID-19 scams
There are ways to stay safe and avoid falling
victim to a scam or fake cure.
? Before seeking any treatment to help fight
or prevent COVID-19, speak to your doctor.
? Visit the official NJ State COVID-19 website
to find authorized vaccination sites.
? Visit the CDC?s website and the FDA?s
resources to get the most up-to-date
information on COVID-19.
In times of crisis, it?s not uncommon for some to take advantage of a situation by offering
false hope, fake cures and scams. It?s important to stay informed and educated about what
is out there, what is real, what is fake, and what could cause more damage than help.
COVID-19 facts, fictions & fakes
6
SOURCES
Products are provided by Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey
in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees
of the Blue Cross and Blue Shield Association. The Blue Cross? and Blue Shield? names and symbols are registered marks
of the Blue Cross and Blue Shield Association. The Horizon? name and symbols are registered marks of Horizon Blue Cross
Blue Shield of New Jersey. ? 2021 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark,
New Jersey 07105. (0321) 086-21-33 ECN002808A
? vaccines.gov/diseases/covid/8-things
? health.com/condition/infectious-diseases/coronavirus/difference-between-pfizer-
moderna-vaccine
? ama-assn.org/delivering-care/public-health/which-covid-19-vaccine-should-i-get-what-
tell-your-patients
? cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html
? cdc.gov/coronavirus/2019-ncov/vaccines/faq.html
? cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html
? who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
? consumer.ftc.gov/blog/2020/07/cracking-down-fake-covid-19-cures
? ftc.gov/coronavirus/scams-consumer-advice
? NYTimes.com
? What does a multi-dose series-mean for-the covid-19 vaccination effort
? What is being done to distribute COVID-19 vaccines?
Cover, Every shot counts - the COVID-19 vaccines
Page 1, What we know today
Page 2, Vaccines build immunity
Page 3, How were the vaccines
developed so quickly?
Page 4, What to expect after the shot
Page 5, Why two doses?
Page 6, COVID-19 facts, fictions & fakes
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