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Coverage

Find out how your plan covers treatment and vaccines.

Please note that the content provided within this website is only intended as general summary information and does not constitute your policy of insurance or summary plan description. The information on this website does not guarantee coverage or verify eligibility for benefits. The information provided on this website is designed to support, not replace, the relationship between Health Alliance and the members of the plans it offers and administers. Please see your member materials or contact the number on the back of your ID card for additional details specific to your health plan’s coverage for diagnostic laboratory testing associated with COVID-19. Should a member require subsequent medically necessary treatment for COVID-19-related medical conditions, Health Alliance will cover such treatment pursuant to the terms and conditions associated with the member’s health plan for the plans that Health Alliance itself offers. For self-funded employer plans that Health Alliance acts solely as the administrator, the employer / plan sponsor has the responsibility to make such determinations regarding what benefits are provided for COVID-19 treatment (subject to applicable law). This website’s content is subject to change without notice to the Member. In any situation where the official printed publications of Health Alliance or of a self-funded plan sponsor differ from the text contained in this website, the official printed documents take precedence.

This coverage FAQ is based on the latest information from applicable resources which may include but are not limited to the Illinois Department of Insurance, federal law and CDC guidelines.

Please note that the content provided within this website is only intended as general summary information and does not constitute your policy of insurance or summary plan description. The information on this website does not guarantee coverage or verify eligibility for benefits. The information provided on this website is designed to support, not replace, the relationship between Health Alliance Northwest and the members of the plans it offers and administers. Please see your member materials or contact the number on the back of your ID card for additional details specific to your health plan’s coverage for diagnostic laboratory testing associated with COVID-19. Should a member require subsequent medically necessary treatment for COVID-19 related medical conditions, Health Alliance Northwest will cover such treatment pursuant to the terms and conditions associated with the member’s health plan for the plans that Health Alliance Northwest itself offers. For self-funded employer plans that Health Alliance Northwest acts solely as the administrator, the employer / plan sponsor has the responsibility to make such determinations regarding what benefits are provided for COVID-19 treatment (subject to applicable law). This website’s content is subject to change without notice to the Member. In any situation where the official printed publications of Health Alliance Northwest or a self-funded plan sponsor differ from the text contained in this website, the official printed documents take precedence.

This coverage FAQ is based on the latest information from applicable resources which may include but are not limited to the Washington State Office of the Insurance Commissioner, federal law and CDC guidelines.

Health Alliance Northwest recently issued an insurance policy endorsement to our commercial health plan members explaining some changes to coverage pursuant to the Insurance Commissioner’s Emergency Orders and the Governor’s disaster proclamation. This does not apply to self-funded or Medicare Advantage plans.  To view this insurance policy endorsement click HERE.

  • If I get tested for COVID-19, will my health plan cover the test?*

    If you get tested by a healthcare professional, our health plans will cover – with no member cost-share – appropriate diagnostic laboratory testing for COVID-19 when the test is ordered by a physician for clinical/medical reasons, such as if you have symptoms or known exposure to the novel coronavirus. Cost-sharing is also waived in these above instances for COVID-19 testing-related visits, whether the visit takes place in a healthcare provider’s office, an urgent care center, an emergency department or through telehealth.

    If you are tested for employment purposes, our health plans will not cover the testing or testing-related visit(s).*

    Beginning on January 15, 2022 and continuing through the remainder of the public health emergency, over-the-counter (OTC) at-home COVID-19 diagnostic tests are covered for some members. Please see the FAQ titled “will my health plan cover over-the-counter COVID-19 diagnostic tests for home use?” for more information.

    These actions, guidelines and limits may change as the pandemic evolves. Please call the number on the back of your health plan ID card if you have any questions about your coverage.

    *Some self-funded employer group plans administered by Health Alliance or Health Alliance Northwest may cover employment-based screenings. Consult with your plan administrator for more details about this coverage.

  • Will my health plan cover over-the-counter COVID-19 diagnostic tests for home use?

    President Biden recently announced that individuals who purchase over-the-counter (OTC) COVID-19 diagnostic tests beginning on January 15, 2022 and continuing through the remainder of the public health emergency would be able to receive reimbursement from their health plan. As testing is critical to help reduce the spread of the COVID-19 virus, we have developed the following guidelines for members to receive reimbursement for these tests.

    These processes, guidelines and limits may change as the pandemic evolves. Please call the number on the back of your health plan ID card if you have any questions about your coverage.

    Who is eligible for coverage of OTC COVID-19 diagnostic tests?
    Eligibility for reimbursement for OTC COVID-19 diagnostic tests applies to all Fully-Insured and Self-Funded* employer group members and Individual commercial members beginning January 15, 2022.

    The coverage does not apply to Medicare Advantage, Medicare Supplement and Short-Term, Limited-Duration plan members. For members on Medicare Advantage, Medicare Supplement, or Short-Term, Limited-Duration plans, the U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. HHS also has established more than 10,000 free, community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation. The Biden-Harris Administration is purchasing 500 million at-home, over-the-counter tests to be distributed for free to Americans who want them, with the initial delivery starting in January 2022. There will be a website where all Americans can request at-home tests for home delivery – for free. More information on this federal program is expected soon.

    Members of most Health Alliance and Health Alliance administered commercial, employer group and individual health plans can also order up to 8 tests per month shipped directly to their home at no cost. Access to this mail-order direct to consumer shipping program is dependent on supply chain availability and may not be available to certain self-funded groups who have a different pharmacy partner.

    Follow these steps to order at-home Covid-19 tests for a $0 copay.

    1. Log into hally.com.
    2. Click Plan & Benefits at the top.
    3. Click Compare prices, find a pharmacy, look up drugs and more under the Pharmacy Benefits section. This will take you to our pharmacy partner, Optum Rx’s mail order pharmacy page.
    4. If you do not already have an account with Optum, you will need to create one.
    5. Once you have created an account, select Get at-home Covid-19 tests with a $0 Copay.
    6. Add up to eight single $0 at-home Covid-19 tests or four two-packs to your cart.
    7. Check out as a guest or create an Optum Store account.

    *Consult with your plan administrator for more details about this coverage.

    Are there other resources available to get at-home COVID-19 tests?
    Yes. The Biden-Harris Administration will be providing free, at-home tests to community health centers and Medicare-certified health clinics to distribute at no cost to patients and community members. Additionally, the federal government has committed to making tests available for shipping directly to your home at no cost to anyone in the U.S. by visiting covidtests.gov. We encourage you to explore these no-cost resources.

    What type of COVID-19 tests or testing does my health plan coverage apply to?
    This coverage applies to FDA-authorized at-home COVID-19 diagnostic tests which display results directly to the consumer in their home and are purchased over-the-counter at these preferred pharmacies listed here: Preferred Pharmacies for COVID-19 Over-the-Counter Diagnostic Tests. We will cover up to eight (8) tests per member per month.

    Tests that are administered by a healthcare professional, or that require processing at a laboratory, are subject to the coverage requirements previously outlined by your health plan.

    Testing for employment purposes, including OTC tests purchased to satisfy employment-based screening requirements, are not covered by our health plans.*

    *Some self-funded employer group plans administered by Health Alliance or Health Alliance Northwest may cover employment-based screenings. Consult with your plan administrator for more details about this coverage.

    Where can I purchase OTC COVID-19 diagnostic tests?
    We encourage you to purchase these diagnostic tests at any of these preferred pharmacies listed here: Preferred Pharmacies for COVID-19 Over-the-Counter Diagnostic Tests. At the time of purchase, you will need to present your health plan ID card at the pharmacy counter. Doing so will allow you to purchase the test at $0 cost to you. Check back for additional pharmacies added to the list of preferred pharmacies for COVID-19 OTC diagnostic tests.

    Please be aware that supply chain disruptions beyond our control may limit the availability or cost of tests through any given retailer at any given time. We encourage members to check with the retailer for product availability and be aware that numerous options exist.

    What if I purchase an OTC COVID-19 diagnostic test at a pharmacy or retail site other than the preferred network listed above?
    If you choose to utilize a retailer other than those on our list of preferred pharmacies for COVID-19 OTC diagnostic tests or if there is difficulty processing your claim during the retail transaction, please keep your original sales receipt and the original UPC proof of purchase panel from the OTC COVID-19 test box. OptumRx can reimburse members for tests purchased on or after January 15 if you submit the OptumRx COVID-19 Over-the-Counter Test Reimbursement Form.

    Please be aware that costs for OTC COVID-19 diagnostic tests vary. OptumRx will reimburse up to $12 per test or the purchase price of the test, whichever is less.

    *This reimbursement form is not to be used on OTC COVID-19 diagnostic test purchases for employment purposes.

    Where can I learn more about testing and the Family First Coronavirus Response Act?
    As a reminder, free testing remains available for community members. Resources to help community members find available free testing can be found through your state or local public health agency.

    NOTE: Before traveling to a site for testing, check availability as sites may close during inclement weather conditions.

    Additional information about the Families First Coronavirus Response Act (FFCRA) can be found here.

    FAQs from the Centers for Medicare & Medicaid Services (CMS) can be found here.

  • I have a High Deductible Health Plan with a Health Savings Account. Will my plan cover testing for COVID-19 even if I haven’t yet met my deductible? Will I lose my tax incentives if I get tested before meeting my deductible?

    All fully-insured and self-funded High Deductible Health Plans will cover medically necessary diagnostic laboratory testing as described in the previous question/answer, even if you haven’t yet met your deductible. Usually, your plan cannot cover medical services that are not classified as preventive care until you meet your deductible. However, the Internal Revenue Service (IRS) has allowed us to cover services related to COVID-19 without jeopardizing the tax benefits associated with your Health Savings Account (HSA), even if deductibles have not been met. Call the number on the back of your member ID card if you have any questions about your coverage.

  • When I become eligible for a COVID-19 vaccine, will my health plan cover it?

    Health Alliance wants our members to know that, in most cases, they’ll have no out-of-pocket costs when they get any of the COVID-19 vaccines authorized for use by the United States Food and Drug Administration (FDA).

    In accordance with the recent federal rule, most Health Alliance members and members of self-funded group health plans administered by Health Alliance will – when they’re eligible to receive the vaccine – be able to get the shot(s) at no out-of-pocket cost to them. Cost-sharing may apply for members covered under short-term, limited-duration or grandfathered plans.

    The vaccine isn’t yet available to everybody. Very young children and individuals with certain underlying conditions may not be eligible for the vaccine according to the FDA. As the vaccine becomes available to more people, we and your providers will keep you informed. Please remember to bring your insurance ID card or the Hally® app (on your mobile device) when you go in to receive the vaccine.

    As of this time, the federal government is covering the cost of the vaccine. It’s a $0* cost to you.

    * Providers may charge a fee for the administration of the vaccine, and the cost of this administration fee will be covered without applying copays, coinsurance or deductibles for most Health Alliance plans and self-insured plans administered by Health Alliance. Cost-sharing may apply for members covered under short-term, limited-duration plans or certain grandfathered group health plans. If you have questions about your specific coverage, please call the number on the back of your member ID card.

  • Will my health plan provide benefits for treatment of COVID-19?

    Your health plan will continue to provide benefits for medically necessary healthcare costs to treat infectious diseases, including COVID-19, based upon the terms of your specific health plan. Call the number on the back of your member ID card if you have any questions.

    Your health plan will continue to provide benefits for medically necessary healthcare costs to treat infectious diseases, including COVID-19, based upon the terms of your specific health plan. Prior authorization requirements for any service ordered by a healthcare provider to treat COVID-19 will be waived until at least November 24, 2020, consistent with guidance from the Washington Office of the Insurance Commissioner and the Washington Healthcare Authority. Call the number on the back of your member ID card if you have any questions.

  • What if I get the virus and require emergency services – will my health plan provide benefits for these?

    Many individuals who have contracted COVID-19 have not required any emergency services. However, in circumstances where emergency services are required, most health plans will provide benefits for these services at in-network levels regardless of which provider performs the services. Call the number on the back of your member ID card if you have any questions.

  • Will my health plan provide benefits for expenses incurred for protective equipment such as facemasks, gloves and disinfectants?

    Most of these supplies are not covered by health plans. Call the number on the back of your member ID card if you have specific questions.

  • Will my health plan provide benefits for a hospital quarantine stay if I’m diagnosed with COVID-19?

    Your health plan will continue to provide benefits for medically necessary healthcare costs to treat infectious diseases, including COVID-19, based upon the terms of your specific health plan. Call the number on the back of your member ID card if you have any questions. Custodial care is not a covered expense.

    Your health plan will continue to provide benefits for medically necessary healthcare costs to treat infectious diseases, including COVID-19, based upon the terms of your specific health plan. Treatment, including inpatient hospitalization, for COVID-19 is not subject to prior authorization requirements pursuant to the Emergency Order in place through November 24, 2020. Call the number on the back of your member ID card if you have any questions. Note: custodial care is not a covered expense.

  • Will my health plan allow early medication refills of prescription medications? I might want extra medication on hand if there’s an outbreak of the virus in my community.

    Yes, fully-insured plans and some self-funded group health plans do – with exceptions. You must have an active prescription available for refill. Please notify your prescriber if you don’t have an active prescription on file with your pharmacy. Inform the pharmacy that you wish to have your medication filled to ensure you have 30-days’ worth of medication on hand in case of COVID-19. Exclusions include requests for most opioids and specialty medications, and instances where the member already has 30 or more days of medicine remaining. We recommend filling maintenance medications for 90-day supplies if possible. Call the number on the back of your member ID card if you have any questions.

  • Is it possible to have my prescription medications delivered by mail, in case my pharmacy closes or I don’t want to leave the house?

    Yes. You can enroll in our Prescription Benefit Manager (PBM) OptumRx’s mail-order program by calling (855) 209-1292 or by visiting hally.com selecting the “Plan & Benefits” tab, and choosing “Compare prices, find a pharmacy, look up drugs, and more” under the Pharmacy Benefits section. This will take you to the OptumRx website, where you can select “Home delivery” under the Member Tools section on the right-hand side of the page. You can select which medications you’d like to transfer to Home Delivery, and OptumRx will work with your provider to obtain a new prescription for mail-order.

    You can learn more about the mail-order program by calling OptumRx at (855) 209-1292.

    Please note: some self-funded groups may have a different Prescription Benefit Manager or might be unable to offer medication by mail. If your group has a different PBM, visit their website for information about whether they offer mail-order.

    For our members in the Yakima County service area, Virginia Mason Memorial now offers home delivery of prescription medications through its Pharmacy at Creekside. Call (509) 573-3808 to get started.

  • Does my health plan cover any type of telehealth and/or virtual doctor visits?

    Most Health Alliance and Health Alliance-administered plans provide benefits for telehealth and/or virtual doctor visits. For Health Alliance plans, we’re temporarily broadening our telehealth codes to cover additional services, including behavioral therapy, in response to the COVID-19 pandemic. With regard to the plans we administer, some of these self-funded employer plans have temporarily expanded telehealth codes in a similar manner. Call the number on the back of your ID card to validate if your plan has temporarily expanded telehealth benefits. Telehealth services are a great way to avoid unnecessary travel to a doctor's office and are in line with the practice of social distancing. Call the number on the back of your member ID card if you have specific questions about the types of telehealth services that are eligible, or questions about cost-sharing or in-network restrictions that may apply.

    Your plan may specifically offer virtual visits with a doctor through your Hally™ mobile app or hally.com account. Member cost-sharing may apply. Additionally, your plan may also offer the services of our Nurse Advice Line at (855) 802-4612 at no cost to you. Certain self-funded employer group plans may offer alternative platforms for virtual doctor visits and telephone help lines.

    As always, please visit a hospital emergency department for all serious conditions and call 911 for all emergencies.

  • Can my health insurance carrier – or my self-funded employer/plan sponsor – cancel my insurance policy or health plan, or refuse to renew it, if I’m diagnosed with COVID-19 in connection to a preexisting respiratory illness?

    No. Most insurance policies and self-funded group health plans cannot impose any preexisting condition exclusions, including in connection with COVID-19. Health Alliance, in particular, will not deny an application for a short-term, limited-duration or excepted benefit plan based on a diagnosis of COVID-19..

    Note: Certain limited-duration health insurance coverage or excepted benefit policies offered by other insurance plans may exclude coverage for certain preexisting conditions. Even in these scenarios, a COVID-19 diagnosis is not a reason that coverage would be denied.

  • I’m the administrator of my company’s Small Group plan. Can my company have an extension on paying our premiums?

    Health Alliance will temporarily extend the grace period from 31 days to 60 days for all fully-insured Small Group Employers, as defined by the Department of Insurance, for all markets we serve, who have premiums due between (and including the dates of) March 1 and May 1, 2020.

    The policy does not apply to any Large Group, Balance, self-funded Group, Individual or Medicare plans. The policy is also not permanent.

    For any questions, please call Client Support at (217) 902-8151 or email ClientSupport@healthalliance.org.

    If you’re an administrator of a Large Group Plan or on a Health Alliance Individual or Family plan, please call the number on the back of your ID card if you have concerns about your coverage or your premium payment.

  • I’m a member of Health Alliance on an Individual plan. Is any help offered if I can’t pay my premium this month?

    For members who purchased their plans on the Federally Facilitated Marketplace AND receive an Advanced Premium Tax Credit to help pay premiums: Following recent flexibility offered by the Federally Facilitated Marketplace (FFM), Health Alliance will provide an additional month of coverage, prior to placing them in grace, for our members who receive Advanced Premium Tax Credits (APTC) through the FFM and who have premiums due between (and including the dates of) March 1 and May 1, 2020. Normal grace period rules will apply once they enter the grace period, and their coverage will terminate back to the end of the first month of their grace period if they fail to pay. Health Alliance cannot reinstate these members’ coverage after termination, similar to those members whose grace period has expired earlier in 2020. Please note that this temporary policy only applies to those who receive the APTC subsidy, and to premiums due between (and including the dates of) March 1 and May 1, 2020.

    To all of our valued members, if you have any questions or concerns about your coverage or your premium payments, please do not hesitate to call the number on the back of your member ID card.

  • I’m a member of Health Alliance on an Individual plan. Is any help offered if I can’t pay my premium this month?

    Health Alliance Northwest will temporarily extend the grace period from 31 to 60 days for fully-insured Individual members in Washington State who have premiums between (and including the dates of) March 1 and May 1, 2020.

  • Marketplace Special Enrollment Period (SEP) for individuals and families.

    The Centers for Medicare & Medicaid Services (CMS) announced that any Marketplace-eligible consumer can enroll in coverage through the Federally Facilitated Exchange (a.k.a. the Marketplace) by starting a new application, or amending an existing application, at HealthCare.gov. This SEP is available from February 15 – August 15, 2021, and there’s no requirement to provide proof or evidence that you’ve been impacted by the pandemic-related emergency.

    To get started, visit HealthCare.gov or call (877) 686-1168 for more information. Health Alliance offers Marketplace plans in Illinois.

    This SEP is available from February 15 – August 15, 2021. There is no requirement to provide proof or evidence that you've been impacted by the pandemic-related emergency. To get started, visit wahbexchange.org or call (877) 561-1527 for more information.

  • Will Assist America commit to transporting a member home if they’re found to be infected with the virus overseas?

    Assist America cannot commit to transporting a member infected with the coronavirus, as this decision may be outside of the company’s control. Currently, each case will be assessed on a case-by-case basis. Additionally, Assist America must follow all local government regulations pertaining to the situations that exist in each country.