Fallon covers COVID-19 diagnostic testing, based on CDC and other regulatory guidance, for members who are in one of the following three categories:
- A health care provider has identified the individual as having COVID-19 related symptoms.
- A local Board of Health, the Massachusetts Department of Public Health, the Community Tracing Collaborative or a health care provider has determined that the individual has been in close contact with someone confirmed or clinically diagnosed with COVID-19.
- An individual is admitted to a health care facility, such as a hospital or skilled nursing facility.
Testing solely to meet back-to-work/school COVID-19 testing requirements is not covered, unless it’s deemed medically necessary by a provider.
The state of Massachusetts is running a strategic testing program called Stop the Spread, which is providing free testing in certain cities and towns. Asymptomatic individuals may be tested at these sites, even if they don’t reside in the particular city or town. The Massachusetts Emergency Management Agency’s COVID-19 Test Site Locator provides information on additional testing locations.