COVID-19 Benefit Updates
Please review the current special benefit provisions outlined below.
Contract College Plans for Active and Retired Faculty & Staff (NYSHIP)
NYSHIP Virtual Care (Telemedicine)
Coverage effective May 12, 2023
EMPIRE PLAN
Empire offers LiveHealth Online to allow you to access care on your smartphone, tablet, or personal computer, with a board-certified doctor or licensed therapist. A $0 copay applies for in-network providers. If using out-of-network providers, reimbursement is 80% of reasonable and customary charges after deductible. Empire does not maintain a list of providers who have agreed to offer telehealth, but you can speak to your provider to see if they offer telehealth services. To register for LiveHealth Online, go to www.empireblue.com/nys to access and enter your Empire Plan identification number and name exactly as they appear on your identification card. This will ensure you and your covered dependents receive care, free of charge.
HMO-BLUE CNY
HMO-Blue CNY offers MDLive to allow you to access care on your smartphone, tablet, or personal computer, with a board- certified doctor or licensed therapist. A $0 copay applies for in-network providers. Instructions on how to register for MDLive and schedule a visit can be found at https://www.excellusbcbs.com/find-a-doctor/telemedicine.
MVP
MVP offers myVisitNow to allow you to access care on your smartphone, tablet, or personal computer, using in-network providers, with a board-certified doctor or licensed therapist. A $0 copay applies for in-network providers. To register, log in at https://myvisitnow.com/landing.htm, and choose My Account.
COVID-19 Lab Testing
Coverage effective May 12, 2023
EMPIRE PLAN
Normal plan cost-share applies, including deductible.
HMO-BLUE CNY
Members pay $0.
MVP
Normal plan cost-share applies, including deductible.
COVID-19 Over-the-counter (OTC) Self-Test Kit
Coverage effective May 12, 2023
EMPIRE PLAN
COVID-19 over-the-counter (OTC) tests are not to be covered.
Claims / Receipt Submission Information for Over-the-Counter (OTC) Tests purchased prior to May 12, 2023:
Note: A deadline applies for OTC tests purchased in 2023. Claims for OTC tests purchased in 2022 must be submitted to United Healthcare (UHC) by June 9, 2023. The deadline to submit claims for OTC tests purchased in 2022 to CVS Caremark has passed.
Claims for OTC tests purchased in 2023 (through May 11, 2023), must be submitted to CVS or UHC by April 30, 2024.
Process for submitting OTC claims: If you are charged for a test at a participating network pharmacy, submit a claim for reimbursement through Caremark.com or through the paper claim process.
If a test is paid for out-of-pocket at a nonparticipating network pharmacy (e.g., Amazon or other online retailer), then Empire Plan members can submit an online claim for the maximum reimbursement through UnitedHealthcare (UHC) at www.myuhc.com. After signing into your myuhc.com account, go to the Health & Wellness tab. There you will find a link to the COVID-19 Resource page. Once on the COVID-19 Resource page, you can submit a claim for reimbursement of At-Home COVID-19 OTC tests.
Plan members can also mail or fax a claim form to UHC, using the OTC At-Home COVID-19 Test Kit Reimbursement Form. The claim form and proof of payment must be mailed to UnitedHealthcare P.O. Box 1600, Kingston, NY 12402-1600 or faxed to (845) 336-7716.
Questions: If you have any questions, please call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program. Representatives for the Medical Program (UHC) are available Monday-Friday, from 8:00a.m. to 4:30p.m., ET. Representatives for the Prescription Drug Program (CVS Caremark) are available 24 hours a day, 7 days a week.
HMO-BLUE CNY
COVID-19 over-the-counter (OTC) tests are not covered.
MVP
COVID-19 over-the-counter (OTC) tests are not covered.
COVID-19 Vaccines & Boosters
Coverage Effective May 12, 2023
EMPIRE PLAN
Members pay $0 for in-network physician or in-network pharmacy.
HMO-BLUE CNY
Members pay $0 for in-network physician or in-network pharmacy.
MVP
Members pay $0 for in-network physician or in-network pharmacy.
Endowed Plans for Active Faculty & Staff (Aetna and OptumRx)
Aetna Virtual Care (Telemedicine)
2023 coverage detail (no PHE impact)
AETNA
Teletherapy with an Aetna participating provider for telephonic, audio or video services related to outpatient Behavioral & Mental Health care are covered at 100%*.
Contact your current provider or call the Aetna dedicated behavioral health line at 800-424-4047 (TTY: 711) for help finding providers, confirming availability, confirming in-person or teletherapy services, etc.
*Note: Aetna HDHP w/ HSA members will continue paying their applicable copay, coinsurance, and/or deductible.
Telemedicine services (other than Behavioral & Mental Health care) normal co-payments/coinsurance apply based on medical necessity and participating provider network.
Contact your current medical provider to see if telephonic or televideo services would be an option for you or go to www.aetna.com or call 877-371-2007 (TTY:711) to find an Aetna telemedicine provider.
COVID-19 Lab Testing
Coverage Effective May 12, 2023
AETNA COVID-19 Lab Testing
Normal cost-share provisions apply after the federal Public Health Emergency for COVID-19 expires on May 11, 2023.
COVID-19 Vaccines & Boosters
Coverage Effective May 12, 2023
AETNA
Members pay $0 for the COVID-19 vaccine with in-network providers. Aetna HDHP w/HSA members pay a $20 copayment, no deductible.
Normal plan cost-share applies to all Aetna medical plans for the COVID-19 vaccine with out-of-network providers.
OPTUMRX
Members pay $0 for the COVID-19 vaccine at any pharmacy.
COVID-19 Over-the-counter (OTC) Self-Test Kit
Coverage effective May 12, 2023: maximum four (4) tests per policy per month for enrolled members from OptumRx (e.g., a package contains two (2) tests, you may request coverage for two (2) boxes for a total of four (4) tests).
Aetna Medical Plans
Reimbursement is no longer available through Aetna, please refer to OptumRx for benefit coverage and/or utilizing a Payflex spending account (if applicable).
OptumRx*
Retail Pharmacy: Over-the-counter (OTC) COVID-19 FDA approved self-tests available through OptumRx Retail Network with a quantity limit of up to 4 tests per policy per month at $0 member cost-share through 12/31/2023. Visit the pharmacy counter, present your OptumRx member ID card and request to submit to OptumRx.
Manual claims: OptumRx would also accept direct member reimbursement claim submissions for FDA approved COVID-19 OTC test kits with a quantity limit of 4 tests per policy per month. Reimbursement must be requested within 365 days from the date of purchase for claims between 5/12/2023 to 12/31/2023. Keep your purchase receipt(s) and submit your reimbursement request using this online form. The DMR payment for such claims will follow the contractual rate.
OptumRx Online Store: OTC COVID-19 Test kits are available at member cost-share through the OptumRx Online Store. In order to receive reimbursement of the maximum 4 tests per policy per month, you would need to submit your receipt and request reimbursement using this online form.
*All requests for insurance coverage must be submitted to the OptumRx prescription plan.
Endowed Plans for Retired Faculty & Staff (Aetna and OptumRx)
Aetna Virtual Care (Telemedicine)
2023 coverage detail (no PHE impact)
Aetna Retiree Pre-Medicare Health Plan (RPHP)
Teletherapy with an Aetna participating provider for telephonic, audio or video services related to outpatient Behavioral & Mental Health care are covered at 100%*.
Contact your current provider or call the Aetna dedicated behavioral health line at 800-424-4047 (TTY: 711) for help finding providers, confirming availability, confirming in-person or teletherapy services, etc.
Telemedicine services (other than Behavioral & Mental Health care) normal co-payments/coinsurance apply based on medical necessity and participating provider network.
Contact your current medical provider to see if telephonic or televideo services would be an option for you or go to www.aetna.com or call 877-371-2007 (TTY:711) to find an Aetna telemedicine provider.
Aetna Retiree 80/20 or Aetna Medicare Advantage PPO (MAPD)
Coverage available, please refer to your Summary of Benefits or contact Aetna Retiree Solutions at 800-338-4533
COVID-19 Lab Testing
Coverage Effective May 12, 2023
Aetna Pre-Medicare Health Plan and Retiree 80/20
Normal cost-share provisions apply after the federal Public Health Emergency for COVID-19 expires on May 11th.
Aetna Medicare Advantage PPO (MAPD) Coverage
In-network: $0 co-payment through 12/31/2023
Out-of-network: Normal plan cost-share applies
COVID-19 Vaccines & Boosters
Coverage Effective May 12, 2023
Aetna Pre-Medicare Health Plan
Members pay $0 for the COVID-19 vaccine with in-network providers.
Normal plan cost-share applies to Aetna medical plans for the COVID-19 vaccine with out-of-network providers.
Aetna Medicare Advantage PPO (MAPD) Coverage and Retiree 80/20 Plan
Members pay $0 for the COVID-19 vaccine at any location.
OptumRx
Members pay $0 for the COVID-19 vaccine at any pharmacy.
COVID-19 Over-the-counter (OTC) Self-Test Kit
Coverage effective May 12, 2023
Maximum four (4) tests per policy per month for enrolled members from OptumRx (e.g., a package contains two (2) tests, you may request coverage for two (2) boxes for a total of four (4) tests).
Aetna Retiree Pre-Medicare Health Plans and Retiree 80/20 Plans
Reimbursement is no longer available through Aetna, please refer to OptumRx for benefit coverage and/or utilizing a Payflex spending account (if applicable).
OptumRx* for Aetna Retiree Pre-Medicare Health Plan and Retiree 80/20 Plans
Retail Pharmacy: Over-the-counter (OTC) COVID-19 FDA approved self-test kits available through OptumRx Retail Network with a quantity limit of up to 4 tests per policy per month at $0 member cost-share through 12/31/2023. Visit the pharmacy counter, present your OptumRx member ID card and request to submit to OptumRx.
Manual claims: OptumRx would also accept direct member reimbursement claim submissions for COVID-19 OTC FDA approved tests with a quantity limit of 4 tests per policy per month. Reimbursement must be requested within 365 days from the date of purchase for claims between 5/12/2023 to 12/31/2023. Keep your purchase receipt(s) and submit your reimbursement request using this online form. The DMR payment for such claims will follow the contractual rate.
OptumRx Online Store: OTC COVID-19-19 Test kits are available at member cost-share through the OptumRx Online Store. In order to receive reimbursement of the maximum 4 tests per policy per month, you would need to submit your receipt and request reimbursement using this online form.
*All coverage requests must be submitted to OptumRx prescription plan, not through Aetna medical insurance
Endowed Retiree Aetna Medicare Advantage PPO (MAPD) Coverage
Medicare covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you, until the Public Health Emergency ends on May 11, 2023.
Medicare A & B Primary Coverage
Medicare covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you, until the Public Health Emergency ends on May 11, 2023. Please refer to OptumRx coverage for COVID-19 OTC tests beginning May 12, 2023.
PayFlex Spending Accounts
Using your PayFlex Medical Care Flexible Spending Account (MCFSA)
The MCFSA funds can be used to purchase over-the-counter (OTC) Self-Test Kits with no quantity limit. Please be sure to review your insurance plans to find out if there is coverage of the OTC kits under the plan. If there is coverage, MCFSA should only be used to reimburse expenses after claims have been processed through insurance.
Using your PayFlex Health Spending Account (HSA)
The HSA funds can be used to purchase over-the-counter (OTC) Self-Test Kits with no quantity limit. Please be sure to review your insurance plans to find out if there is coverage of the OTC kits under the plan. If there is coverage, HSA should only be used to reimburse expenses after claims have been processed through insurance.
Contribution Rules and Claim Deadlines
To review the contribution rules and claim deadlines information for the Medical and Dependent Care accounts, please see our page on Flexible Spending Accounts:
https://hr.cornell.edu/understand-your-benefits/finances/flexible-spending-accounts-fsas.
For reimbursement benefits processed under Cornell University's various plans, in the case of a discrepancy between this summary and the official Plan Document(s), the Plan Document(s) will take precedence.
After reviewing your current benefits and needs, please contact the Benefits Provider member service telephone number for your specific insurance plan.
If you have additional questions, please contact HR Services and Transitions Center (HRSTC), at (607) 255-3936 or via email: hrservices@cornell.edu.