Skip to Main content

Zika virus benefits and policies

AmeriHealth Caritas Pennsylvania, in accordance with Centers for Disease Control and Prevention (CDC) guidelines, has outlined coverage and benefit recommendations for the Zika virus.

AmeriHealth Caritas Pennsylvania will cover:

  • Testing in appropriate cases.
  • Over the counter (OTC) insect repellent with a prescription, and 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 1-800-521-6007.

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.

Over-the-Counter Benefits

AmeriHealth Caritas Pennsylvania will cover (according to the plan’s approved OTC benefit limits) Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients:  DEET, picaridin, IR3535 oil of lemon eucalyptus, or para-menthane-diol.  A prescription from the member’s health care provider is (is not) required. 

Indications

  • Members of any age who traveled to or resided in an affected area within the previous two weeks and 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:

    • 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 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 born to a mother who was exposed to Zika virus while she was pregnant.

For more information, view AmeriHealth Caritas Pennsylvania's Zika virus clinical policy (PDF)