Coverage and support
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) continues to help support doctors, nurses and hospitals, as well as to help members stay healthy and get the care they need in the fight against COVID-19.
We’re currently covering, with no cost-share to members, COVID-19 tests performed in labs or at-home that are consistent with current CDC guidance and have been cleared, approved or given emergency use authorization (EUA) by the US Food and Drug Administration (FDA).
COVID-19 treatments are covered based on each individual’s insurance plan. Members may be responsible for a portion of their treatment costs, including copayments, coinsurance and deductible amounts.
The CDC encourages everyone to contact a health care provider right away to determine treatment eligibility, even if symptoms are mild. According to the North Carolina Department of Health and Human Services (NCDHHS), anyone who has symptoms of or has been exposed to COVID-19 should get tested as soon as possible.
Find out where you can get treatment by visiting the North Carolina Health and Human Services website.
To find COVID-19 medications, go to the Department of Health and Human Services’ medication location tool.
For up-to-date information on COVID-19 treatment, the Center for Disease Control (CDC) is the best resource.
COVID-19 vaccines: what you need to know
COVID-19 vaccines and boosters are FDA approved, including for emergency use authorization (EUA).
COVID-19 vaccines are now available to everyone 6 months and older.
Vaccines and boosters are important tools to stop the spread of COVID-19. They are a safe and effective way to achieve this goal. We encourage everyone to get vaccinated.
Visit myspot.nc.gov for the most up-to-date information about COVID-19 vaccines and boosters.
Frequently asked questions
COVID-19 vaccines given at pharmacies are covered for Blue Cross NC members, as part of our preventive care services, and reimbursement will be determined based on whether the provider is in-network or out-of-network.
Commercial members can purchase over-the-counter (OTC) tests with their health flexible spending arrangements (health FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), or Archer medical savings accounts (Archer MSAs).
We encourage members to speak with their primary care provider about the COVID-19 vaccine and staying current on recommendations.
Individuals can also refer to the CDC’s website, which includes an easy-to-use tool to determine when they are due for a COVID-19 vaccine or booster.
Virtual (or telehealth) visits can be used with your primary care doctors, specialists, and behavioral health providers. Or any licensed NC provider who can provide telehealth services. Call your doctor before going into the office to see if telehealth is available.
The American Medical Association (AMA) has provided this table (PDF) to link the COVID-19 vaccine product codes to their associated immunization administration codes, manufacturer name, vaccine name(s), 10 and 11-digit National Drug Code (NDC) Labeler Product ID, and interval between doses. These codes are also located in the Medicine section of the CPT code set.
Blue Cross NC is currently covering telehealth services for behavioral health, primary care and outpatient visits, which accounted for more than 97% of telehealth claims received during the last two years.
The policy applies to all Blue Cross NC fully insured and administrative services only (ASO) plans, including the State Health Plan. It does not apply to Blue Cross NC members receiving care from out-of-state providers. Members who do not have a commercial plan can find more information about their telehealth coverage below.
Effective May 12, 2023, COVID-19 tests administered by a provider that are consistent with CDC guidance and has been cleared, approved or given emergency use authorization (EUA) by the FDA are covered based on each individual’s insurance plan, and members may be responsible for a portion of their costs to include copayments, coinsurance and deductible amounts.
For more information on testing and how to find a COVID-19 test, visit NC Department of Health and Human Services.
Effective May 12, 2023, Blue Cross NC and ASO groups will cover both the cost of the vaccine and vaccine administration at 100% when members receive the COVID-19 vaccine at an in-network provider as part of our preventive care services.
If members receive the COVID-19 vaccine at an out-of-network provider, they may be responsible for the cost of the vaccine and/or vaccine administration based on their individual preventative care benefits.
The federal government has invested in a large supply of COVID-19 vaccines and will continue to cover the cost of the COVID-19 vaccine until that supply is exhausted.
COVID-19 treatments are covered based on each individual’s insurance plan, and members may be responsible for a portion of their treatment costs to include copayments, coinsurance and deductible amounts.
Blue Cross NC Medicare Advantage members will continue to be covered under the Part B preventive vaccine benefit when receiving monoclonal antibodies until the end of the calendar year that the EUA declaration ends. Blue Cross NC Medicare Advantage members will be responsible for cost sharing when receiving treatment at an out-of-network facility, as specified under the plan benefit, beginning on June 10, 2023. COVID-19 treatment is covered with no cost-sharing for Healthy Blue members through September 30, 2024.
COVID-19 tests do not need prior approval. That means your doctor doesn’t need to ask us for approval before you’re tested for COVID-19.
Point of Blue
See the latest information on COVID-19 vaccines, treatments and more in the Point of Blue blog.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
© 2023 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.