The COVID-19 Vaccine and Network Health

At Network Health, we understand you may have questions and concerns about COVID-19. Below you will find useful information about the virus as well as tips for staying healthy. You may also visit the U.S. Centers for Disease Control (CDC) website to learn more.

The Network Health offices are open to all guests. We are still available to answer your questions via phone, email and member portal. Information about COVID-19 has been changing rapidly.

COVID-19 relief and benefits from Network Health

Network Health is working hard to make sure your health needs are met during the coronavirus and COVID-19 pandemic. For information relating to benefits and your plan, click one of the options below.

If you’re a Medicare member, click here.

If you’re a member with a different plan, click here.

COVID-19 testing information

How can I get reimbursed for a COVID-19 test?

Commercial Group and Individual and Family Plan (IFP) Members

If you are on a Network Health commercial group health insurance plan through your employer or an individual and family health insurance plan, please note the following.

Network Health will cover eight free at-home tests per member per month. This applies to commercial members only.
As of January 15, 2022, ESI is accepting claims for non-proctored, over-the-counter, at-home COVID-19 tests from pharmacies within the Network Health pharmacy network.
Members can purchase up to eight tests per person, per month at an in-network pharmacy
- This applies to tests purchased on or after January 15, 2022
Claims will be reimbursed at a rate of up to $12.
You can also visit COVIDTests.gov and order up to eight at-home tests at no charge
- These tests will be delivered by the United States Postal Service (USPS), with tests expected to ship within 7-12 days of ordering
- If you do not have access to a computer or the internet, you can also call 1-800-232-0233 (TTY 1-888-720-7489) to order your four at-home tests.
ESI currently has delays in real-time prescription claims processing of approximately two weeks.
To submit a claim for an at-home testing kit, you will need to use ESI's specific COVID-19 over-the-counter test claim form.
ESI is currently holding submitted direct claims and will process them once the system allows. This may cause delays in reimbursement.
Click here to view an informational flier from ESI.

Questions - Commercial Group and IFP Members

Do I need to go through my doctor to get a COVID-19 at-home test?
No, you do not need to go through your doctor to get your tests, but you will need to work with an in-network pharmacy.
How do I find an in-network pharmacy?
You can visit networkhealth.com/find-a-pharmacy and choose your plan type from the dropdown. You can then search by pharmacy name, pharmacy type or by location.
The pharmacy is saying I have to pay for my tests, what should I do?
You can ask your pharmacy to submit the claim to ESI. If the pharmacy is unable to do that, you can either pay for the test at the pharmacy then submit for reimbursement or go to a different in-network pharmacy.
How do I submit a manual claim?
Download the COVID-19 over-the-counter test claim form, complete it and submit it, along with a pharmacy receipt, to receive reimbursement.

Medicare Members

Beginning April 4, 2022, Medicare is covering up to eight free over-the-counter tests per beneficiary each calendar month until the COVID-19 public health emergency ends.
- More information about how to get these tests can be found here.
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.
You can visit COVIDTests.gov and order up to eight at-home tests.
- These tests will be delivered by the USPS with tests expected to ship within 7-12 days of ordering.
- If you do not have access to a computer or the internet, you can also call 1-800-232-0233 (TTY 1-888-720-7489) to order your four at-home tests.
At this time, Network Health will not cover/pay for COVID-19 at-home tests for Medicare members.

Questions - Medicare Members

Do I need to go through my doctor to get a COVID-19 at-home test?
No, you do not need to go through your doctor to get your tests.
Can I use my Over-the-Counter (OTC) benefit (either catalog or card) to purchase at-home COVID-19 tests?
No, COVID-19 tests are not covered under either OTC benefit.
Can I be reimbursed for a COVID-19 test through my Pick Your Perks benefit?
No, COVID-19 tests are not covered under the Pick Your Perks benefit.

On February 3, 2022, the White House announced efforts to expand access to free FDA-approved, over-the-counter COVID-19 tests for Medicare plan beneficiaries.

With details expected shortly, we recommend Network Health Medicare Advantage plan members to visit https://covidtests.gov to order eight free household tests until more information and directives are available.

COVID-19 Vaccine FAQ (click + icon to expand)

What is the COVID-19 vaccine?
Is the COVID-19 vaccine effective?
Is the COVID-19 vaccine safe?
What are the side effects of the COVID-19 vaccine?
How does the COVID-19 vaccine work?
How many shots of the COVID-19 vaccine do I need?
What should I know about the COVID-19 booster vaccines?
How much does the COVID-19 vaccine cost?
What should I know about the COVID-19 anti-viral medications?

About the COVID-19 vaccine

The U.S. Food and Drug Administration (FDA) authorized the Pfizer BioNTech vaccine for emergency use for people aged 5 to 15 years. The FDA created a fact sheet with additional information about the safety and recommended use of the Pfizer BioNTech vaccine. This vaccine has full FDA approval for individuals aged 16 years and up and emergency use for people aged 5 to 15 years old.

As of January 31, 2022, Moderna's Spikevax COVID-19 vaccine has full approval from the FDA for individuals 18 years and older. Although the Spikevax name is new, the formula remains unchanged from the previously-emergency-use-authorized immunization.

On May 15, 2022, the FDA updated the authorization of the Janssen COVID-19 vaccine to individuals 18 years of age and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate, and to individuals 18 years of age and older who elect to receive the Janssen COVID-19 vaccine because they would not otherwise receive a COVID-19 vaccine.

On July 13, 2022, the FDA issued an emergency use authorization (EUA) for the Novavax COVID-19 vaccine, Adjuvanted for the prevention of COVID-19 in individuals 18 years of age and older.

Is the COVID-19 vaccine effective?

According to the New England Journal of Medicine, the two-dose Pfizer vaccine indicates 95 percent protection against COVID-19 in people age 16 and older. The two-dose Moderna vaccine provides 94.1 percent protection against COVID-19 in people age 18 and older. The single-dose Johnson & Johnson vaccine is 67 percent effective overall and 85 percent effective in preventing severe and critical cases of coronavirus.

This level of protection occurs one to two weeks after the second dose of the vaccine (for the two-dose vaccines) and two weeks after receiving the Jonnson & Johson vaccine.

On April 5, 2021, Pfizer-BioNTech provided data demonstrating that their COVID-19 vaccine remains highly effective six months after the second dose. Volunteers who took part in the initial study will be monitored by the pharmaceutical company for two years in an effort for Pfizer to determine long-term vaccine effectiveness.

Is the COVID-19 vaccine safe?

The safety of the COVID-19 vaccine is a top priority. This vaccine had to go through the same approval process as any other vaccine. The FDA only authorizes a vaccine when the expected benefits outweigh the risk. You can learn about how the FDA, CDC and other government bodies are working together to ensure the safety of the vaccine.

I've already had COVID-19. Do I still need the vaccine?

Yes, since we don’t know how long someone who has already been infected is protected and how long protection lasts, we believe the recommendation will be to get vaccinated even if you previously had coronavirus.

What are the common side effects of the vaccine?

You may experience side effects when you receive the COVID-19 vaccine. This is normal and can be a sign that the vaccine is working. These are the most common side effects.

Fever
Chills
Tiredness
Headaches
Pain or swelling at the vaccination site

If you have these side effects, drink plenty of fluids and rest. Even if you experience side effects from the first dose, for the two-dose vaccines, it's important to get your second dose, so you can be fully protected from coronavirus.

Contact your personal doctor if redness or tenderness increases after 24 hours or if your side effects are extreme or last longer than a few days. If you feel you are experiencing a medical emergency, call 911 or go to the nearest emergency room.

How does the COVID-19 vaccine work?

The Pfizer and Moderna COVID vaccines are mRNA vaccines, not conventional vaccines. mRNA technology is new in vaccine production but has been studied in cancer treatments for over ten years.

The Johnson & Johnson COVID vaccine is a viral vector vaccine.

The Novavax COVID-19 vaccine uses a combination of spike proteins and an immune stimulant to generate a better immune response. In comparison to mRNA and viral vector vaccine technology, Novavax uses older technology. In such vaccines, the protein is made outside the human body and then injected which generates an immune response.

Conventional vaccines

Like the annual flu vaccine, conventional vaccines need the virus to be inactivated in a lab first. This can take months to years to develop.

mRNA vaccines

Unlike conventional vaccines, mRNA vaccines are made in a lab, without having the virus present. The coronavirus mRNA vaccine causes our cells to create a spike protein. This is a harmless protein that is found on the surface of the coronavirus. Once it's in our system, our body realizes it shouldn't be there, so it creates antibodies to fight the virus if we're infected in the future.

Froedtert and the Medical College of Wisconsin has a webpage with more information about the safety and development of the coronavirus vaccine.

Viral vector vaccines

These vaccines use a common cold virus that has been modified (called an adenovirus) to deliver the genetic material for our cells to create the spike protein. The adenovirus has been modified so it will not cause a cold and will not cause COVID.

Once our cells create the spike protein, our body begins to create antibodies to fight the virus if we're infected in the future.

Which COVID-19 vaccines have full FDA approval?

As of September 27, 2021, only COMIRNATY — the licensed COVID-19 vaccine from Pfizer and BioNTech — has received full FDA approval for individuals 16 years and older to prevent COVID-19.

This vaccine is also authorized under EUA for the following administrations to prevent COVID-19.

A two-dose primary series for those individuals aged 5 through 15 years
A third primary series dose for those individuals aged 5 years and older who have been determined to have certain types of immunocompromise
A single booster dose in individuals who meet the following criteria
- Those aged 65 years or older
- Those aged 18 through 64 years who are identified to be at high risk of severe COVID-19
- Those aged 18 through 64 years whose frequent institutional or occupational exposure to the coronavirus puts them at high risk of contracting COVID-19 and developing complications such as severe COVID-19

How many shots do I need for the COVID-19 vaccine?

Pfizer BioNTech and Moderna

The FDA's Pfizer BioNTech fact sheet and Moderna fact sheet are the best sources for information about protection, safety and side effects of each vaccine.

According to the FDA, these vaccines have been shown to prevent the coronavirus when two doses are given three to four weeks apart. It generally takes about two weeks for the body to generate an immune response and full protection is not obtained until the two-dose series is complete.

Some individuals may be recommended by their health providers to receive a booster immunization. Please refer to the CDC website by clicking here for more information.

Make a plan to ensure you get the second dose when it's most effective. VaxText is a free text messaging service that will email you a weekly reminder to get your second dose of the COVID-19 vaccine if you're overdue for your second dose. Text ENROLL to 833-829-8398 to get signed up.

Johnson & Johnson

The Johnson & Johnson Janssen vaccine requires one shot. The FDA's fact sheet provides information about the protection, safety and side effects of this vaccine. About two weeks after receiving the single-dose shot, your body will generate an immune response and begin being protected from the coronavirus.

Novavax

The Novavax COVID-19 vaccine is a two-dose vaccine, given three to eight weeks apart. It is recommended for people 18 years and older. Learn more about the new Novavax COVID-19 vaccine by viewing the FDA's fact sheet here.

Do I need to get a COVID-19 booster vaccine?

On November 19, 2021, officials at the United States Food and Drug Administration (FDA) officially cleared all Americans aged 18 and over, who are fully vaccinated, to receive booster vaccinations from Pfizer or Moderna.

If you received your initial vaccination round from the Pfizer or Moderna vaccines, you are eligible for a third-dose COVID-19 booster vaccination a minimum of six months following the latter of your COVID-19 vaccination round.

If you received your initial vaccination from the Johnson & Johnson Janssen vaccine, you are eligible for a second-dose COVID-19 booster vaccination a minimum of two months following your last COVID-19 vaccination.

For information on subsequent COVID-19 vaccine booster doses, please refer to the CDC guidelines, which are frequently updated here.

Who can get a COVID-19 booster shot?

Those 12 and over who have received their primary series of COVID-19 vaccines are eligible for one booster.

Those 50 and older, those 12 and older who are moderately or severely immunocompromised and those who got two doses of Johnson & Johnson's Janssen vaccine are now eligible for a second COVID-19 booster.

How much will the COVID-19 vaccine cost me?

Medicare Advantage plan COVID-19 vaccine costs

As of January 1, 2022, administration fees are billed to Network Health.
Please present your Network Health Medicare Advantage card at time of vaccine administration.

Commercial group and health insurance exchange COVID-19 vaccine costs

The administration fee will be billed to Network Health
Be prepared to show your Network Health member ID when you go to get the vaccine

If you are charged an administration fee for your vaccine, complete the Member Reimbursement Form and send it in to get reimbursed.

What about COVID-19 anti-viral medications?

In December 2021, two new COVID-19 anti-viral agents were granted Emergency Use Authorization by the FDA. Those anti-viral medications are Paxlovid and molnupiravir.

Paxlovid is approved for use in those 12 and older and weighing 88 lbs. or more. Molnupiravir is approved for use in those 18 and older.

As of January 5, 2022, these medications are only used in mild to moderate COVID-19 cases where there is a high risk for progression leading to hospitalization or death. Examples of high-risk patients or situations include physical frailty, being in a high-risk age group, being immunocompromised and having chronic conditions like heart disease, lung disease or diabetes.

As initial supplies were purchased and provided by the United States government, there is no cost for the drug, if prescribed. Since access to the drug is limited, you may need to work with several pharmacies to find stock. Adding to that, the pharmacy that does have it in stock is likely to request you use the drive-through to pick it up if they have one.

These medications are not authorized for initiation of treatment in patients requiring hospitalization due to severe or critical COVID-19. They are not authorized for pre-exposure or post-exposure prophylaxis for the prevention of COVID-19. They are not authorized for use longer than 5 consecutive days.

Once prescribed, this medication is taken twice a day for five days.

If you have questions about being prescribed one of these medications, please contact your doctor.

COVID-19 Vaccine Information