For information on the coronavirus vaccine and your benefits as a Network Health member, click here.

Coronavirus Vaccine Information

The COVID-19 Vaccine and Network Health

According to the Wisconsin Immunization Registry, nearly 87,400 Network Health members have received the COVID-19 vaccine. This includes over 88% of our Medicare population. Thank you for doing your part to keep our communities safe and healthy. 

*For vaccines administered from December 1, 2020, through January 5, 2021.

At Network Health, we understand you may have questions and concerns about the coronavirus and COVID-19. Below you will find useful information about the virus as well as tips for staying healthy. You may also visit the U.S. Centers for Disease Control (CDC) website to learn more.

The Network Health offices are closed to all guests. We are still available to answer your questions via phone, email and member portal. Information about the coronavirus has been changing rapidly. Follow Network Health on Facebook to see our posts about keeping yourself safe and healthy during this pandemic.

COVID-19 relief and benefits from Network Health

Network Health is working hard to make sure your health needs are met during the coronavirus and COVID-19 pandemic. For information relating to benefits and your plan, click one of the options below.

COVID-19 testing information

How can I get reimbursed for a COVID-19 test?

If you are on a Network Health commercial group health insurance plan through your employer or an individual and family health insurance plan, please note the following.

As of January 15, 2022, Express Scripts will accept claims for non-proctored, over-the-counter, at-home COVID-19 tests from pharmacies within the Network Health pharmacy network. This applies to tests purchased on or after January 15, 2022.

Do I need to go through my doctor to get a COVID-19 at-home test?

You do not need to go through your doctor to get your test but you will need to work with a Network Health pharmacy in your health plan network.

Find a pharmacy.

Is there a limit for these tests?

You are able to get eight tests per individual per month at no cost or copay.

I have Medicare, can I still get COVID-19 tests?

At this time, Network Health is not covering over-the-counter COVID-19 tests for Medicare members. Medicare members are able to order home tests through the government's free, four-per-household COVID-19 test ordering system at https://COVIDtests.gov

Can I order COVID-19 tests online?

As of January 19, 2022, individuals will be able to order COVID-19 tests online from https://COVIDtests.gov, with tests expected to ship within 7-12 days of ordering. There is a limit of four tests per residential address.

Those who do not have access to the internet are able to order their household's COVID-19 tests or receive assistance by calling 1-800-232-0233 (TTY 1-888-720-7489). 

We'll have more information relevant to our members as we receive it. Until then, you can learn more directly from the official White House statement by clicking here.

For common questions about COVID-19, the coronavirus and vaccines, click the + icon below to view our FAQ.

 

 COVID-19 Vaccine FAQ (click + icon to expand)

  1. What is the COVID-19 vaccine?
  2. Where can I get the COVID-19 vaccine?
  3. Is the COVID-19 vaccine effective?
  4. Is the COVID-19 vaccine safe?
  5. What are the side effects of the COVID-19 vaccine?
  6. How does the COVID-19 vaccine work?
  7. How many shots of the COVID-19 vaccine do I need?
  8. What should I know about the COVID-19 booster vaccines?
  9. How much does the COVID-19 vaccine cost?
  10. What is being done about fraud with the COVID-19 vaccine?
  11. What restrictions are there once I have been fully vaccinated?
  12. What should I know about the COVID-19 anti-viral medications?
  13. What is herd immunity and why is it important?
  14. Can children get vaccinated against COVID-19?

About the COVID-19 vaccine

The U.S. Food and Drug Administration (FDA) authorized the Pfizer BioNTech vaccine for emergency use for people aged 5 to 15 years. The FDA created a fact sheet with additional information about the safety and recommended use of the Pfizer BioNTech vaccine. This vaccine has full FDA approval for individuals aged 16 years and up and emergency use for people aged 5 to 15 years old.

Moderna has also been granted emergency use authorization from the FDA for people age 18 and older. The FDA created a fact sheet with additional information specific to the Moderna vaccine.

In our mission to create healthy and strong Wisconsin communities, we’re doing everything we can to get our members access to immunizations for the new coronavirus and COVID-19 as they become available.

Where can I get the COVID-19 vaccine in Wisconsin?

The Wisconsin Department of Health Services is using VaccineFinder to help people more easily find and connect with vaccine providers in their area. 

People without internet access can call the hotline number at 844-684-1064 for this information.

Is the COVID-19 vaccine effective?

According to the New England Journal of Medicine, the two-dose Pfizer vaccine indicates 95 percent protection against COVID-19 in people age 16 and older. The two-dose Moderna vaccine provides 94.1 percent protection against COVID-19 in people age 18 and older. The single-dose Johnson & Johnson vaccine is 67 percent effective overall and 85 percent effective in preventing severe and critical cases of coronavirus.

This level of protection occurs one to two weeks after the second dose of the vaccine (for the two-dose vaccines) and two weeks after receiving the Jonnson & Johson vaccine.

On April 5, 2021, Pfizer-BioNTech provided data demonstrating that their COVID-19 vaccine remains highly effective six months after the second dose. Volunteers who took part in the initial study will be monitored by the pharmaceutical company for two years in an effort for Pfizer to determine long-term vaccine effectiveness.

Is the COVID-19 vaccine safe?

The safety of the COVID-19 vaccine is a top priority. This vaccine had to go through the same approval process as any other vaccine. The FDA only authorizes a vaccine when the expected benefits outweigh the risk. You can learn about how the FDA, CDC and other government bodies are working together to ensure the safety of the vaccine.

I've already had COVID-19. Do I still need the vaccine?

Yes, since we don’t know how long someone who has already been infected is protected and how long protection lasts, we believe the recommendation will be to get vaccinated even if you previously had coronavirus.

What are the common side effects of the vaccine?

You may experience side effects when you receive the COVID-19 vaccine. This is normal and can be a sign that the vaccine is working. These are the most common side effects.

  • Fever
  • Chills
  • Tiredness
  • Headaches
  • Pain or swelling at the vaccination site

If you have these side effects, drink plenty of fluids and rest. Even if you experience side effects from the first dose, for the two-dose vaccines, it's important to get your second dose, so you can be fully protected from coronavirus.

Contact your personal doctor if redness or tenderness increases after 24 hours or if your side effects are extreme or last longer than a few days. If you feel you are experiencing a medical emergency, call 911 or go to the nearest emergency room.

How does the COVID-19 vaccine work?

The Pfizer and Moderna COVID vaccines are mRNA vaccines, not conventional vaccines. mRNA technology is new in vaccine production but has been studied in cancer treatments for over ten years.

The Johnson & Johnson COVID vaccine is a viral vector vaccine.

Conventional vaccines

Like the annual flu vaccine, conventional vaccines need the virus to be inactivated in a lab first. This can take months to years to develop.

mRNA vaccines 

Unlike conventional vaccines, mRNA vaccines are made in a lab, without having the virus present. The coronavirus mRNA vaccine causes our cells to create a spike protein. This is a harmless protein that is found on the surface of the coronavirus. Once it's in our system, our body realizes it shouldn't be there, so it creates antibodies to fight the virus if we're infected in the future.

Froedtert and the Medical College of Wisconsin has a webpage with more information about the safety and development of the coronavirus vaccine.

Viral vector vaccines

These vaccines use a common cold virus that has been modified (called an adenovirus) to deliver the genetic material for our cells to create the spike protein. The adenovirus has been modified so it will not cause a cold and will not cause COVID. 

Once our cells create the spike protein, our body begins to create antibodies to fight the virus if we're infected in the future.

Which COVID-19 vaccines have full FDA approval?

As of September 27, 2021, only COMIRNATY — the licensed COVID-19 vaccine from Pfizer and BioNTech — has received full FDA approval for individuals 16 years and older to prevent COVID-19.

This vaccine is also authorized under EUA for the following administrations to prevent COVID-19.

  • A two-dose primary series for those individuals aged 5 through 15 years
  • A third primary series dose for those individuals aged 5 years and older who have been determined to have certain types of immunocompromise
  • A single booster dose in individuals who meet the following criteria
    • Those aged 65 years or older
    • Those aged 18 through 64 years who are identified to be at high risk of severe COVID-19
    • Those aged 18 through 64 years whose frequent institutional or occupational exposure to the coronavirus puts them at high risk of contracting COVID-19 and developing complications such as severe COVID-19

How many shots do I need for the COVID-19 vaccine?

Pfizer BioNTech and Moderna

The FDA's Pfizer BioNTech fact sheet and Moderna fact sheet are the best sources for information about protection, safety and side effects of each vaccine.

According to the FDA, these vaccines have been shown to prevent the coronavirus when two doses are given three to four weeks apart. It generally takes about two weeks for the body to generate an immune response and full protection is not obtained until the two-dose series is complete. 

Some individuals may be recommended by their health providers to receive a booster immunization. Please refer to the CDC website by clicking here for more information.

Make a plan to ensure you get the second dose when it's most effective. VaxText is a free text messaging service that will email you a weekly reminder to get your second dose of the COVID-19 vaccine if you're overdue for your second dose. Text ENROLL to 833-829-8398 to get signed up.

Johnson & Johnson

The Johnson & Johnson Janssen vaccine requires one shot. The FDA's fact sheet provides information about the protection, safety and side effects of this vaccine. About two weeks after receiving the single-dose shot, your body will generate an immune response and begin being protected from the coronavirus. 

Do I need to get a COVID-19 booster vaccine?

On November 19, 2021, officials at the United States Food and Drug Administration (FDA) officially cleared all Americans aged 18 and over, who are fully vaccinated, to receive booster vaccinations from Pfizer or Moderna.

If you received your initial vaccination round from the Pfizer or Moderna vaccines, you are eligible for a third-dose COVID-19 booster vaccination a minimum of six months following the latter of your COVID-19 vaccination round.

If you received your initial vaccination from the Johnson & Johnson Janssen vaccine, you are eligible for a second-dose COVID-19 booster vaccination a minimum of two months following your last COVID-19 vaccination.

How much will the COVID-19 vaccine cost me?

Medicare Advantage plan COVID-19 vaccine costs

  • As of January 1, 2022, administration fees are billed to Network Health. 
  • Please present your Network Health Medicare Advantage card at time of vaccine administration.

Commercial group and health insurance exchange COVID-19 vaccine costs

  • The administration fee will be billed to Network Health
  • Be prepared to show your Network Health member ID when you go to get the vaccine

If you are charged an administration fee for your vaccine, complete the Member Reimbursement Form and send it in to get reimbursed.

How do I know a COVID-19 vaccine offer is legitimate?

Fraudsters are using the COVID-19 vaccine to get your health insurance information and are using it to submit false claims. They may try to contact you via phone calls, social media platforms and door-to-door visits. If you are contacted by someone asking you to pay an out-of-pocket amount for your vaccine or requesting a deposit or fee to receive your vaccine, do not give that person any information.

No one from your doctor's office or insurance company will request a payment or deposit for you to receive the vaccine. If you feel you may be the victim of fraud, please call our member experience team at the number listed on the back of your member ID card or send an email to paymentintegrity@networkhealth.com

What restrictions are there once I've been fully vaccinated?

On March 8, 2021, the United States Centers for Disease Control and Prevention (CDC) issued guidance for individuals who have been fully vaccinated. A page the CDC published on the organization's website highlights these changes. Among them, those who have been fully vaccinated should take note of the following updates.

Once vaccinated and following the recommended amount of post-immunization waiting time, you can engage in the following.

  • You may gather indoors with fully vaccinated people without wearing a mask.
  • You may gather indoors with unvaccinated people from one other household without masks as long as nobody in the gathering is at an elevated risk for complications from the coronavirus or COVID-19.
  • If you've been around somebody who has tested positive for the coronavirus, you do not need to self-isolate or get tested unless you experience symptoms.

If you're not fully vaccinated, continue to social distance, wear a mask in public, wash your hands frequently and avoid indoor gatherings. 

The CDC updated their post-vaccination guidelines during the first week of April in 2021 to include advice that fully vaccinated individuals can take part in the following items.

  • Fully vaccinated people can resume domestic travel. They do not need to get tested before or after travel or self-quarantine afterward.
  • Fully vaccinated people do not need to get tested before leaving the United States. Some countries may still require testing prior to travel. 
  • Fully vaccinated people do not need to self-quarantine following international travel upon arrival in the United States.
  • Refrain from quarantine and testing following a known exposure unless you're experiencing symptoms.

What about COVID-19 anti-viral medications?

In December 2021, two new COVID-19 anti-viral agents were granted Emergency Use Authorization by the FDA. Those anti-viral medications are Paxlovid and molnupiravir.

Paxlovid is approved for use in those 12 and older and weighing 88 lbs. or more. Molnupiravir is approved for use in those 18 and older.

As of January 5, 2022, these medications are only used in mild to moderate COVID-19 cases where there is a high risk for progression leading to hospitalization or death. Examples of high-risk patients or situations include physical frailty, being in a high-risk age group, being immunocompromised and having chronic conditions like heart disease, lung disease or diabetes.

As initial supplies were purchased and provided by the United States government, there is no cost for the drug, if prescribed. Since access to the drug is limited, you may need to work with several pharmacies to find stock. Adding to that, the pharmacy that does have it in stock is likely to request you use the drive-through to pick it up if they have one.

These medications are not authorized for initiation of treatment in patients requiring hospitalization due to severe or critical COVID-19. They are not authorized for pre-exposure or post-exposure prophylaxis for the prevention of COVID-19. They are not authorized for use longer than 5 consecutive days.

Once prescribed, this medication is taken twice a day for five days. 

If you have questions about being prescribed one of these medications, please contact your doctor.

What is herd immunity?

According to the CDC, herd immunity happens when enough people have protection—either from previous infection or vaccination—that is unlikely a virus or bacteria can spread and cause disease

  • As a result, everyone within the community is protected even if some people don’t have any protection themselves
  • The percentage of people who need to have protection in order to achieve herd immunity varies by disease
    • Scientists initially estimated that 70 percent of the population needed to acquire resistance to the coronavirus to prevent further spread—this estimate requires further research

Even after receiving the vaccine, experts have stated that people shouldn’t stop mask-wearing or social distancing until we have reached 70% of the population vaccinated.

When will the COVID-19 vaccine be available for people under age 16?

As of November 2, 2021, Pfizer-BioNTech has received emergency use authorization for children aged 5 to 15 to begin receiving the vaccine. 

On June 10, 2021, Moderna applied for U.S. authorization of its vaccine for use in adolescents (ages 12-17 years old). 

What is the Delta variant of COVID-19?

The Delta variant is an infectious strain of the new coronavirus that is replacing the main strain (alpha) as the predominant strain in the United States and in many places around the world. Network Health manager of pharmacy benefits, Dr. Andy Wheaton, shares more about the Delta variant in this article which you can read by clicking here.

What should I know about the COVID-19 Omicron variant?

As the latest coronavirus variant to be labeled a Variant of Concern by the World Health Organization (WHO), SARS-CoV-2, B.1.1.529 (named Omicron) was first identified in the United States on December 1, 2021.

As more information is continually being discovered about the Omicron variant, the United States Centers for Disease Control and Prevention (CDC) is frequently updating their page with information such as where the Omicron variant has been detected, how easily the Omicron variant spreads and what tools we have to prevent or treat infection from the Omicron variant.

Network Health cares

We're working hard to keep our members and our communities up to date on any developments surrounding the administration of vaccines for the coronavirus and COVID-19. If you have any questions for us or suggestions on how we can make this information more clear, please reach out to us today.

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