Member Coronavirus Information
View information on COVID-19 specific services and relief programs, including resources in your area.
What you need to know about COVID-19
Coronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. People of all ages can be infected. Older adults and people with pre-existing medical conditions like asthma, diabetes and heart disease may be more likely to become severely ill if infected.
We understand you have questions about the COVID-19 vaccine. This is new for everyone and it is okay to feel unsure. To help you feel as comfortable as possible, we created an FAQ with answers to common questions.
Monoclonal Antibody Treatment Therapy
Monoclonal Antibody Treatments (MAB) for COVID-19 are widely available in Florida. The treatment can prevent severe illness, hospitalization and death from the virus. It is available for people 12 and older who are high-risk and have either contracted or been exposed to COVID-19. Learn more about the treatment and how and where to make an appointment.
There is now a vaccine available that will give you the best chance of protecting yourself and your loved ones from getting COVID-19. Some COVID-19 vaccines will have two doses, a few weeks in between each shot. You will get a COVID-19 Vaccination Reminder Card that will help you keep track of which vaccine you receive and when to get a second dose, if needed. If you receive shot. If you receive a vaccine that requires two doses, it is important to get both doses.
The safety of the COVID-19 vaccine is a top priority. COVID-19 vaccines were tested in large clinical trials to make sure they meet safety standards. Top medical experts carefully reviewed results from the trials. The Food and Drug Administration (FDA) approved the vaccine because the benefits outweigh potential risks. And, millions of people around the world have already received the vaccine with minimal side effects.
The vaccine is being administered to different people at different times. When you are able to get the vaccine, call your doctor with any questions. Ask when you can make an appointment with them or at your local pharmacy. Or, find a location near you with the Florida Department of Health’s Vaccine Finder website or at cdc.gov/coronavirus/2019-ncov/vaccines.
While not required, getting your COVID-19 vaccine will give you the best chance of protecting yourself and your loved ones from getting COVID-19 in the future.
Even if you have already had COVID-19, you should still get the vaccine. It may be possible to be infected more than once, so getting the vaccine is a safe choice.
Currently, the Pfizer-BioNTech vaccine is recommended for people ages 12 and older. The Moderna and Johnson & Johnson vaccines are for those ages 18 and older.
The CDC recommends a booster shot of COVID-19 vaccines in certain people:
- If you got the Pfizer-BioNTech or Moderna COVID-19 vaccine, you can get a booster shot at 6 months or more after your second dose if you are:
- 65 years and older
- Age 18+ and live in a long-term care setting
- Age 18+ and have underlying medical conditions
- Age 18+ and work or live in high-risk settings
- If you got the Johnson & Johnson COVID-19 vaccine, you can get a booster shot if you are 18 and older and were vaccinated two or more months ago.
- You may choose which vaccine you receive as a booster dose. You may prefer the vaccine you originally received. Or, you may prefer to get a different booster. CDC recommendations now allow for this type of mix and match dosing for booster shots.
The CDC currently recommends the COVID-19 vaccine for pregnant women. If you have questions about getting the vaccine, it is recommended to discuss with your doctor to make an informed decision.
Fully vaccinated is considered two weeks past final dose, meaning the second dose of the Moderna or Pfizer mRNA vaccine, or, two weeks past the single dose Johnson & Johnson vaccine.
To protect yourself from getting or spreading the Delta variant, wear a mask indoors in public if you are in high-risk area.
Wearing a mask is key if you or someone in your household is at high risk for getting the disease and/or unvaccinated. This includes a weakened immune system, your age or an underlying medical condition. If this applies to you or your household, you might choose to wear a mask regardless of the level of transmission in your area.
Fully vaccinated people who have come into close contact with someone with suspected or confirmed COVID-19 should be tested 3-5 days after exposure. They should also wear a mask in public indoor settings for 14 days, or until they receive a negative test result.
The Delta variant is highly contagious. It’s nearly twice as contagious as previous variants.
Some data suggest the Delta variant might cause more severe illness than previous strains in unvaccinated persons.
Unvaccinated people remain at the greatest risk for severe illness, hospitalization, and death.
Fully vaccinated people with Delta variant breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period of time.
Vaccines are highly effective, including against the Delta variant.
A small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it. These are called “vaccine breakthrough cases.” This means that while people who have been vaccinated are much less likely to get sick, it will still happen. It’s also possible that some fully vaccinated people might have infections, but not have symptoms (asymptomatic infections). Experts continue to study how common these cases are.
If you get COVID-19 after vaccination, your symptoms might be less severe.
Fully vaccinated people are much less likely to be hospitalized or die than people with similar risk factors who are not vaccinated.
You cannot get COVID-19 from the vaccine. But, you may feel some mild side effects. You could get a fever, headache or body aches. This is normal and shows the vaccine is working. Side effects prove your body is building immunity to fight COVID-19 in the future.
No. Both doses of the COVID-19 vaccine will be at no cost to you. You do not need to get a prior authorization for your vaccine.
You will get a COVID-19 Vaccination Record Card after your first shot. The card has details about which vaccine you got. And it’s an important reminder for your second shot. Keep the card in your wallet. Mark the date for your second shot in your calendar.
Please call the facility/provider you received your first dose. Ask about your vaccine details and verify your second appointment/location.
The provider should schedule a second appointment with you at the same facility when you receive the first dose. However, you can receive your second dose from another provider/facility. Bring your COVID-19 Vaccination Record Card to the second appointment.
Transportation may be available. Call the number on the back of your ID card for details.
On Jan.7, 2021, HHS Secretary Alex Azar renewed the COVID-19 Public Health Emergency (PHE) for another 90 days. The extension went into effect on Jan. 21, 2021.
With this, various COVID-19 coverages will be extended, including:
This will continue until the PHE is either terminated or extended again.
Do you have any questions about this extension or the covered benefits impacted by it? Please contact Member Services at 1-866-796-0530 (TDD/TTY 1-800-955-8770).
Coronavirus and Symptoms
COVID-19 is a respiratory disease that is caused by a new virus called a coronavirus. It has become a public health emergency. The number of cases continue to increase nationally and globally.
The symptoms of coronavirus include mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. COVID-19 can be contagious before a person begins showing symptoms.
Influenza (the flu), a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the Fall/Winer months.
Everyone 6 months of age and older should get a flu vaccine.
If you have been exposed or begin showing symptoms of the virus or flu, contact your healthcare provider or health department immediately.
Telehealth is a convenient way for Sunshine Health members to obtain telehealth services. You will receive access to in-network healthcare providers for non-emergency medical issues. Get medical advice, a diagnosis or a prescription by video or phone.
- Medicaid/Long Term Care telehealth providers (PDF)
- Child Welfare telehealth providers (PDF)
- Ambetter (Marketplace) telehealth providers (PDF)
- Allwell (Medicare) telehealth providers (PDF)
Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362.
We all have a role to play in protecting our communities and families from the spread of coronavirus. It is similar to other communicable viruses. You can also follow these tips to prevent infection:
- Wash your hands thoroughly and frequently. Use soap and water for at least 20 seconds.
- Use an alcohol-based hand sanitizing rub (must contain at least 60 percent alcohol).
- Wear a face covering or mask in public and/or around others who do not live in your home if you are not fully vaccinated.
- Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow.
- Promptly dispose of tissues in a wastebasket after use.
- Clean public surfaces thoroughly.
- Stay home when you are sick.
- Avoid shaking hands.
- Avoid close contact with people who are sick.
- Get a flu vaccine once a year.
Your Healthcare Coverage
Yes. When medically necessary diagnostic testing, medical screening services and/or treatment is ordered and/or referred by a licensed health care provider, we will cover the cost of medically necessary COVID-19 tests, screenings, associated physician’s visit(s) and/or treatment. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment.
No. We will not require prior authorization, prior certification, prior notification and/or step therapy protocols for medically necessary COVID-19 diagnostic testing, medical screening services, and/or treatment when medically necessary services are ordered and/or referred by a licensed health care provider.
Medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment and the associated physician’s visit will be covered when ordered, referred and/or performed in the following In-Network locations:
- Physician’s/Practitioner’s Office
- Independent Laboratory/Diagnostic Facility
- Urgent Care Facility
- Emergency Department Facility
Are you unsure if you have been exposed to or at-risk of being infected with COVID-19? Schedule a virtual care visit with a provider. It is a good option for non-urgent care to limit potential exposure in a physician’s office or other healthcare facility.
No. We will cover medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment at no charge to you, when such services are ordered and/or referred by a licensed health care provider. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment, along with the associated physician’s visit.
Any medically necessary treatment related to COVID-19 would be considered a covered benefit. We are committed to ensuring access to COVID-19 treatment services in accordance with federal and state law.
Members will be able to refill prescriptions prior to the refill date.
Patients who have asthma or other breathing problems may be at increased risk for complications from COVID-19. One of the best ways to stay healthy is by using your medication as directed by your doctor.
The Sunshine Health Pharmacy Department is here to help with:
- Calling your doctor(s) for refills
- Calling your pharmacy for refills
- Getting your medicine filled at the same time
- Getting medicine mailed to your home (where available)
For help or more information, please call the Sunshine Health Pharmacy Department at 1-877-505-3907, Monday through Friday from 8 a.m. to 6 p.m. Eastern.
Worry and anxiety can rise about the spread of COVID-19. Concern for friends and family who live in places where COVID-19 is spreading or the progression of the disease is natural.
- Take care of your body. Take deep breaths, stretch or meditate.
- Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.
- Share the facts about COVID-19 and the actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.
- For more information, see the CDC’s suggestions for mental health and coping during COVID-19
Tip #1: Clean your phone right now
Drop what you’re doing! Clean your phone and case right now! You can use disinfecting wipes or sprays.
Why is this important?
It’s easy to say “I can always clean my phone later”. If you do it right now, you won’t forget! We’ve also told you how so you don’t have to figure that out on your own.
Tip #2: Use an alarm
Set a phone alarm called “clean phone.” Set an alarm on your phone called “clean phone” once per day. When it goes off, clean your phone right then and there!
Why is this important?
Even if you just cleaned your phone right now, you’re going to forget later! That’s why reminders are so important. You’ll have to clean.
For more information about cleaning and disinfecting visit the CDC Cleaning And Disinfecting Your Home page.
Protect yourself and those around you. Please consider the following before returning to adult day services.
- If you feel sick, stay home.
- Avoid public places.
- Contact your health care provider.
- Practice healthy habits.
- Wash your hands after touching public surfaces.
- Avoid touching your face.
- Sneeze or cough into a tissue. You can also use the inside of your elbow.
- Clean frequently used items and surfaces as much as possible.
- Use a face mask while in public.
- Personal Protective Equipment (PPE) and frequent hand washing
- Your provider may require a face covering and gloves during a visit. They may also require frequent hand washing.
- Your service plan may be updated based on how you tolerate these changes.
- This has been a stressful time. If it’s affecting your mental health, you may need to speak to someone.
As a Sunshine Health member, you have access to health professionals 24/7. You can call the 24/7 Nurse Advice Line for non-emergencies. For more information about this service, call us at 1-866-796-0530.
It’s important to change how we use public spaces. Consider whether you need to touch certain objects and surfaces. Be sure to wipe public items before and after you touch them.
Things to be aware of while at your adult day center.
We have all had to make changes to reduce the spread of COVID-19. To reopen, we will need to continue these safe practices.
- Social distancing
- Stay 6 feet away from others when going into a shared space.
- Wash your hands.
- Wash hands with soap and water for at least 20 seconds.
- Use sanitizer with at least 60% alcohol when soap and water are not available
- Wear a face covering.
- Avoid touching your eyes, nose, and mouth.
- Stay home when sick.
- Clean frequently touched items and surfaces.
It’s important to follow state and local guidance as we reopen. This will help you to change your plan as situations change.
Make sure your provider has a plan to maintain a safe environment.
When you return home from your adult day center.
We should think about our safety and the safety of others. The following can help reduce the spread of COVID-19.
- Disinfect “high touch” surfaces and items every day.
- This includes personal devices and electronics.
- Be sure to follow the cleaning product’s instructions.
- Consider changing your clothes before entering your home.
If you cannot return to your adult day center
As a Sunshine Health member, you may have respite hours available for your caregiver. These may be used if you cannot return to your day service program. For more information, call us at 1-866-796-0530.
All Florida Medicaid recipients should be extra cautious and not fall victim to Coronavirus Disease 2019 (COVID-19) fraud schemes that might expose you to potential harm. Please be aware that people might target you to get your personal information, including Medicaid recipient information, to commit health care fraud. These individuals will try to benefit themselves by getting Medicaid recipient information to bill the Florida Medicaid program for services not provided to you and commit medical identity theft.
Tips for Florida Medicaid recipients on how to prevent Medicaid fraud and abuse:
- DO NOT share personal information, including your Medicaid number, with anyone other than your trusted healthcare professional.
- Be cautious of anyone offering you cash payments, free or low-cost medical services, or gifts in exchange for your Medicaid information.
- Florida Medicaid will not use door-to-door visits or calls, such as telemarketing or robocalls, to provide COVID-19 information to Medicaid beneficiaries.
- Be careful with links included in unsolicited texts, emails, or on social media platforms.
- Review your Explanation of Medicaid Benefits (EOMB) statement for accuracy by paying close attention to the services and dates listed in the medical summary and verifying if you have received those services; return only those EOMBs with services listed that you did not receive.
Report any suspicious Medicaid fraud or abuse activity:
- Bureau of Medicaid Program Integrity at the Florida Agency for Health Care Administration
- Florida Office of Attorney General Fraud complaint
Florida Department of Health, COVID-19 Call Center: 1-866-779-6121(available 24/7) or email COVIDemail@example.com.