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Member Coronavirus Information

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. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness

COVID-19 is a respiratory disease that is caused by a new virus called a coronavirus, which 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 United States at this time. 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 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).
  • 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.

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

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:

Additional resources:

Florida Department of Health, COVID-19 Call Center: 1-866-779-6121(available 24/7) or email COVID-19@flhealth.gov.