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coronavirus (COVID-19) 

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Frequently asked questions

Updated January 12, 2022

The safety and well-being of our members is a top priority for Fallon Health, so we've worked to remove barriers and improve access to health care services for our members who may be impacted by COVID-19.

Fallon has implemented the following:

  • Coverage for over-the-counter COVID-19 tests for all Fallon members whose plan includes a pharmacy benefit
  • Relaxed prior authorization requirements generally in compliance with regulatory bulletins. These bulletins also specifically state that there can be no prior authorization requirements on any telehealth services delivered that are related to COVID-19.
  • Coverage of medically necessary coronavirus testing, treatment and counseling with no cost-sharing for all members until further notice.
  • Waived cost-sharing for all COVID-19 related medically necessary telehealth services only for all members. This will also be effective until further notice.
  • Waiving early refill limits on non-scheduled control drug prescriptions for all Fallon members—with the exception of Berkshire Fallon Health Collaborative, Fallon 365 Care and Wellforce Care Plan members—who fill their medications, including specialty medications, at any in-network pharmacy. Some restrictions may apply.*
  • A dedicated hotline (1-877-835-8440, TRS 711) to connect members with representatives who can address questions about the coronavirus, discuss available benefits and provide phone numbers for additional help.

COVID-19 tests

Fallon Health will be covering over-the-counter COVID-19 tests for all Fallon members whose plan includes a pharmacy benefit. We will cover the cost of up to eight over-the-counter FDA-emergency use authorized tests per member per month without prior authorization. We are working on how best to implement this process, and we will have more details available soon. In the meantime, please hold on to any receipts you have that are dated on or after January 15. 

In addition to over-the-counter tests, Fallon is covering diagnostic tests known as polymerase chain reaction (PCR) and antigen tests. These tests identify whether a person has active COVID-19 infection, and will be covered at no cost-sharing for you as long as your healthcare provider identifies that you are symptomatic with COVID-19 related symptoms.

Vaccines for COVID-19

Getting the vaccine

Now that COVID-19 vaccines are available, we know there are a lot of questions about the vaccines and about who will be able get a vaccine and when.

Vaccine safety

It’s important to know that vaccines go through more testing than any other pharmaceuticals. Before any vaccine is made available, it must go through rigorous development and testing. For more information regarding vaccine safety, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html.

Coverage for COVID-19 vaccines

Once eligible to receive a vaccine based on the phased approach above, Fallon members will have no cost sharing if they choose to be vaccinated. Fallon also covers the flu shot vaccination in full and we recommend that all members receive the flu shot.

Be aware of scams

If you receive a message about being eligible for a vaccine, look carefully. Ask yourself who is sending the message? Is it your PCP? Your pharmacy? The local Department of Public Health? If the message is from one of these entities that you know, call them back at the number you have for them to make sure the message was from them. But your best bet to make sure that you sign up only for a valid vaccine clinic is to visit https://www.mass.gov/covid-19-vaccine to find vaccination locations near you and to sign up for a vaccine.

Coverage for care

Fallon members will have no cost-sharing (deductibles, copays, coinsurance) for medically necessary COVID-19 testing, counseling and treatment. Fallon is also relaxing our prior authorization requirements for medically necessary COVID-19 related services until further notice.

Telehealth services

  • Fallon members can access telehealth services from all network providers who are offering these services. To schedule a telehealth visit, you can contact your provider at the same phone number you would use to request an in-office visit.
  • Fallon members who have the Teladoc benefit can also use that service.
  • Fallon is waiving cost-sharing for all COVID-19 related medically necessary telehealth services only for all members. This will also be effective until further notice.
  • Members who have the CareConnect (our 24/7 nurse call line) benefit can also use this channel to receive medical services or advice at no cost to the member.  Members of Berkshire Fallon Health Collaborative can call 1-877-219-0872; Fallon 365 Care members can call 1-877-219-0874; and Wellforce Care Plan members can call 1-877-219-0873. All other members can call 1-800-609-6175 (TDD/TTY: 1-800-848-0160).
  • Members can access physical therapy/occupational therapy/speech therapy (PT/OT/ST) services through both telephonic telehealth visits and video telehealth visits. Member cost sharing will be the same as an in-person visit.

What to do if you have symptoms

  • Check your symptoms with Buoy, a free online tool available to all Massachusetts residents.
    You can use Buoy to check your symptoms, figure out if you should be tested for coronavirus, and learn about care options available to you. Any information you provide on the Buoy tool is 100% secure, and will not be shared with anyone.

  • If you have any of the symptoms below, you should contact your primary care provider. Many in-network physicians are conducting telehealth visits (doctor visits by phone or online) so you may not have to go into the office.
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • Sore throat
  • New loss of taste or smell
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Multisystem inflammatory syndrome (in children only).

    If you or a loved one begin to exhibit any of the following signs, seek emergency medical care immediately:
    trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, and/or pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone.

Preventing illness

You should:

  • Get vaccinated as soon as you can
  • Wear a mask in public settings, and make sure your mask covers your nose and mouth and fits snugly against your face.
  • Maintain good social distance (about 6 feet) from other people. You should avoid crowds and poorly ventilated spaces.
  • Test to prevent the spread to others
  • Wash your hands often with soap and water. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • If you are wearing a mask, you can cough or sneeze into your mask and then put on a new, clean mask as soon as possible and wash your hands. If you are not wearing a mask, cover coughs and sneezes with a tissue or your elbow.
  • Monitor your health daily, stay home when you feel sick and avoid contact with others who are ill.
  • Routinely clean and disinfect frequently touched surfaces.

Maintaining emotional health and well-being

Taking care of your emotional health and well-being during this time is important. Decreasing stress can help bolster your immune system and can help keep you and others around you healthy.

  • During this time of social distancing, consider creative ways to fight isolation and loneliness which can worsen some mental health symptoms.
  • There's a lot of information being shared about COVID-19. Not all of it is accurate and the bombardment of news and updates can add to an already stressful situation. To stay informed, but not overwhelmed, bookmark the websites in the "For more information" section below.
  • If you need mental health support
  • Contact your behavioral health provider to see if they can schedule a telehealth visit. Telehealth is a virtual therapy session. Many providers are now offering this option. You will have no cost-sharing for medically necessary telehealth visits.
  • Contact SAMHSA's Disaster Distress Helpline. The Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters. Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.
  • Contact the Massachusetts Emergency Services Program/Mobile Crisis Intervention (ESP/MCI) - 1-877-382-1609.
  • If you have behavioral health benefits through Fallon Health, you can call the Beacon Health Options phone number on the back of your Fallon ID card to find a behavioral health provider and schedule a telehealth visit. You can also visit the Beacon Health Options website for more information and resources to help you.

You can find additional information and resources at https://www.mass.gov/info-details/maintaining-emotional-health-well-being-during-the-covid-19-outbreak.

Be aware of scams

Unfortunately, during this time, there is a greater risk of people trying to run scams. Here are a few tips that you should keep in mind:

  • Do not respond to unsolicited texts, emails or calls requesting your personal information in exchange for a vaccine/booster, home testing kit, or PPE.
  • Ignore offers for a COVID-19 cure or treatment. Remember, if there is a medical breakthrough, you won’t hear about it for the first time through an email, online ad or unsolicited sales pitch.
  • If you receive a message about being eligible for a vaccine/booster, look carefully. Ask yourself who is sending the message? Is it your PCP? Your pharmacy? The local Department of Public Health? If the message is from one of these entities that you know, call them back at the number you have for them to make sure the message was from them. But your best bet to make sure that you sign up only for a valid vaccine clinic is to visit https://www.mass.gov/covid-19-vaccine to find vaccination locations near you and to sign up for a vaccine
  • Research any charities or crowdfunding sites soliciting donations in connection with COVID-19 before giving. An organization may not be legitimate even if it uses words like “CDC” or “government” in its name.
  • Be cautious of purchasing personal protective equipment (PPE) from unknown third-party vendors. Verify that the company is legitimate before ordering their products or sending money.
  • Never click on a link or open an email attachment from an unknown or unverified source. Links and attachments may be embedded with a virus that will infect your computer or mobile device. To better protect yourself against malware, make sure your anti-virus software is operating and up-to-date.

For more information

Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Fallon Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-800-868-5200.

Se você, ou alguém a quem você está ajudando, tem perguntas sobre o Fallon Health, você tem o direito de obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1-800-868-5200.

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