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Zika Virus Benefits and Policies

Prestige Health Choice, in accordance with Centers for Disease Control and Prevention (CDC) guidelines, has outlined coverage and benefit recommendations for the Zika virus.

Prestige Health Choice will cover:

  • Testing in appropriate cases.
  • Over-the-counter (OTC) insect repellent in accordance with the plan's OTC drug benefit.
  • Clinically appropriate ultrasounds for pregnant women diagnosed with Zika virus.

For more information on coverage recommendations, view our Zika virus clinical policy (PDF) or contact Provider Services at 1-800-617-5727.

About the Zika virus

Zika virus is transmitted to humans primarily from being bitten by a mosquito carrying the virus or from having unprotected sex with someone who carries the virus. According to the CDC, approximately one in five people infected with Zika virus becomes symptomatic. Transmission of Zika from a pregnant woman to the fetus has been documented, but uncertainties remain about Zika virus in pregnancy.

For more information about the Zika virus, visit the CDC's Zika virus information page. For advice on Zika specific to living in or visiting South Florida, visit the CDC's Florida update page.

OTC benefits

Prestige Health Choice will cover insect repellents as detailed below. A prescription from the member’s health care provider is not required.

The following products will be added to the expanded OTC benefits list:

Product Ounces UPC
OFF!® Family Care 2.5 oz. 46500710377
OFF! Deep Woods 4 oz. 46500717642
OFF! Deep Woods 6 oz. 46500018428
OFF! Active 6 oz. 46500018107
Cutter® Skinsations® 6 oz. 16500540106
Cutter Backwoods™ 6 oz. 71121962805
Repel® Insect Sportsmen 6.5 oz. 11423941375
Repel Sportsmen Max Formula® 6.5 oz. 11423003387

Approved OTC purchases for Prestige members are limited to a maximum of $50 per household per year.

Indications

  • Members of any age who traveled to or resided in an affected area within the previous two weeks and who present with two or more of the following symptoms consistent with Zika virus disease: fever, rash, conjunctivitis, or arthralgia.
  • Any pregnant woman with possible Zika virus exposure regardless of the presence of clinical illness.
  • Any woman who may become pregnant who has had unprotected sex with someone who carries the virus.
  • Any person attempting conception who presents with one or more symptoms consistent with Zika virus disease within two weeks of possible Zika virus exposure.
  • An infant who meets any of the following criteria:
    • Was born to a mother with a positive or inconclusive test result for Zika virus infection.
    • Presents with symptoms of Zika virus disease in the first two weeks of life and was born to a mother who traveled to or resided in an affected area within two weeks of delivery.
    • Presents with evidence of microcephaly or intracranial calcifications and was born to a mother who was exposed to Zika virus while she was pregnant.

For more information, view Prestige Health Choice's Zika virus clinical policy.