COVID-19 Benefit Information
SAMBA is continually monitoring the impact COVID-19 is having on our health plan members. Below are key facts regarding your coverage related to COVID-19 vaccines and testing, along with other helpful information.
Vaccines and Booster Shots
SAMBA Health Benefit Plan covers 100% of FDA-approved COVID-19 vaccines and booster shots. These vaccines are widely available to adults and children 5 years and older.
For help finding where you can receive a vaccination location near you, visit: Vaccines.gov
For a list of Frequently Asked Questions regarding the vaccines and boosters provided by the CDC, click here.
SAMBA covers COVID-19 testing performed by your health care professional or pharmacist at 100%.
Patients who get ill from the virus may need a variety of inpatient and outpatient services. Normal copay, coinsurance and deductible amounts would apply to these services.
Over-the-Counter At-Home Tests
The Biden-Harris Administration has announced an end to the Public Health Emergency related to the coronavirus disease-2019 (COVID-19). Based on this announcement, effective May 11, 2023, SAMBA has reduced the number of over-the-counter (OTC) COVID-19 test kits the SAMBA Health Plan will cover from eight (8) to four (4) monthly. SAMBA will continue to cover OTC COVID-19 tests for free at your local participating pharmacy.
How to get free at-home COVID-19 tests
Use your Express Scripts® pharmacy benefit to obtain up to four (4) OTC tests per month for a $0 copay. Here’s how:
Visit a participating pharmacy and select a COVID-19 at-home test.
Purchase your test kit at the pharmacy counter (not the general check-out register) and present your SAMBA ID card to the pharmacist. The pharmacist will process the test for a $0 copay.
Submit a paper claim (receipt required)
If the COVID-19 Test does not process for $0 copay at the pharmacy (and you have not used your allotment of four tests per month), do not worry. You can submit a paper claim for reimbursement for COVID-19 at-home tests purchased on or after May 11, 2023.
To submit a paper claim, please visit https://express-scripts.com/covid-19/resource-center. You will need to complete the claims form and submit it along with a receipt to receive reimbursement.
Note: OTC tests purchased from an out-of-network pharmacy/provider will be covered up to $12 for the allotment of four tests per month.
Due to the COVID-19 pandemic, SAMBA lifted its telemedicine restriction related to telehealth services provided by providers outside of the Teladoc network.
We are pleased to inform our members that our expanded telehealth coverage has become a Plan benefit! Members will continue to enjoy telehealth services offered by their PPO or Non-PPO providers. Regular cost sharing will apply based on the services received. Additionally, members can still enjoy the convenience of telehealth services through Teladoc – wherein the Plan will waive the cost for two visits per person, per year.
For members and dependents with Medicare Part B coverage, lab tests for COVID-19 are covered with no out-of-pocket costs when it is ordered by a doctor or other health care provider that accepts Medicare. Medicare has also temporarily expanded its coverage of telehealth services to ensure patients are able to visit with their doctors from their homes, without having to go to a doctor’s office or hospital, which could put the patients and others at risk of exposure to COVID-19. The CARES Act stipulates that Medicare is required to cover COVID-19 vaccines under Part B with no cost sharing. Click here for the latest information on how Medicare is responding to Coronavirus (COVID-19).
For the most up-to-date information about Coronavirus (COVID-19), please visit cdc.gov.