Here's what we're doing for our members
Blue Cross NC is taking steps to help our members prepare, stay healthy and get the care they need. We will continue to respond to this crisis to best serve our members and support doctors, nurses and hospitals.
We are committed to carrying out actions to assist our members and community in the face of COVID-19. We will continue to reevaluate and take recommendations from the CDC into consideration.1
How will these coverage changes affect you?
We are expanding virtual access to health care providers. Blue Cross NC will cover Telehealth visits, including those done by phone, the same as face-to-face visits according to a member's health plan.
Virtual (or telehealth) visits include appointments with primary care providers, specialists, behavioral health providers, and any NC licensed providers who can provide services via secure video or telephone.
To use this telehealth benefit do the following:
Please call your doctor’s office and ask about virtual appointment options. If you are feeling unwell, call ahead before showing up in person. This will help prevent the spread of illness.
Rest assured knowing that we will cover telehealth services offered by in-network providers.
Many members have additional telehealth benefits included in their plans. Look for MDLive or Teladoc listed on the back of your member identification card and call for more information.
These virtual visits must be medically necessary and meet the qualifying criteria.
This measure applies to all Blue Cross NC members and Experience Health members.
Eligible fully insured group and IU65 members can earn a $25 gift card from Blue RewardsSM by activating your MDLIVE account*. Just visit mdlive.bcbsnc.com - or text "bcbsnc" to MDLIVE (635483) to set up your account with help from Sophie, MDLIVE's personal health assistant chatbot.
MDLIVE AND TELADOC TELEHEALTH VISITS
The following changes are in effect through June 4, 2020.
We are waiving cost sharing for all telehealth visits conducted through MDLive and/or Teladoc for 90 days, effective March 6, 2020 through June 4, 2020, for eligible members (see below). Note that this is a further expansion of telehealth services we’re providing to our members, first announced on March 4, 2020.
Eligibility is as follows: if you’re on a Blue Cross NC individual or family plan, this applies to the MDLive or Teladoc benefits offered through your Blue Cross NC benefit plan. If you receive coverage through your employer, please check with your employer to determine if this applies to you. (Not all self-funded employer groups provide MDLive or Teladoc benefits through their Blue Cross NC benefit plan.) This is applicable to high deductible health plans (HDHPs).
We will waive early medication refill limits. This way, members can have the medicines they need on hand.
This change is in effect through May 31, 2020.
- You can ask your doctor to order a 90-day prescription of your maintenance medication(s) for ongoing conditions or needs.
- You can even ask for these to be mail-ordered for delivery to your home.
- State and federal laws, formulary and quantity limits, and prior authorizations regarding prescriptions will still apply.
Note: Only available to members with pharmacy benefits through Blue Cross NC.
This early medication refill policy is set to expire when the North Carolina state of disaster expires on May 31, 2020. Beginning on June 1, 2020, members can still ask their doctor to order a 90-day prescription of maintenance medication(s) for ongoing conditions or needs and can even ask for these to be mail-ordered for delivery to their homes.
Testing for COVID-19 will not need prior approval. If you believe you need COVID-19 testing, call your doctor.
Be prepared to answer questions about your symptoms and if you may have been exposed to the virus.
Blue Cross NC will provide coverage and waive cost-sharing for the COVID-19 test and related treatment.
COVID-19 Doctor Visits and Testing
COVID-19 Doctor Visit: Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will provide coverage and waive cost-sharing (including deductibles, copayments, and coinsurance) for a doctor’s visit to determine if testing is necessary.
Specifically, there will be no member cost-share for COVID-19 testing or doctor visits to determine if a testing is needed through virtual care visits, outpatient office visits, urgent care visits and ER visits.
COVID-19 Testing: Blue Cross NC will cover, at no cost-share to the member, COVID-19 testing methods that meet all three criteria:
- Ordered by a licensed health care provider,
- Determined as medically necessary by a licensed health care provider for the diagnosis and management of a member’s medical condition
- Have been cleared, approved or given emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA)
These changes are in line with the federal coronavirus relief package approved and signed into law on March 18, 2020. This applies to fully-insured, State Health Plan, and Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. Similarly, FEP will waive any copays or deductibles for diagnostic tests that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. Blue Cross NC will be consulting with self-insured employer groups with regard to revising their benefits.
COVID-19 Related Treatment
The following changes are in effect through July 31, 2020.
Blue Cross NC will waive member cost-sharing for COVID-19 related treatments for both in-network and out-of-network providers. The company will reimburse providers in full at its in-network or Medicare rates in an effort to support them financially and administratively during this emergency.
The member cost-share waiver of COVID-19 related treatments applies to all fully insured, State Health Plan, and Medicare members. Similarly, FEP will waive any copays or deductibles for COVID-19 related treatments that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. Self-funded employer groups will be given the option to apply these changes to their employees’ plans.
The member cost-share waivers for COVID-19 related treatments are effective immediately through July 31, 2020. We are committed to carrying out actions to assist our members and community in the face of COVID-19. We will continue to re-evaluate this and other measures.
If you receive a bill from an out-of-network provider stating that you owe additional money for a COVID-19-related service, please contact Customer Service at the number on the back of your Blue Cross NC ID card.
*Medicare members will need to submit a refund request for COVID-19 medications. The form is available here.
What is Cost Sharing?
Cost sharing means you pay some of your health care costs and your insurance company pays some of your health insurance costs. Your costs are usually better known as copays, deductible, or coinsurance. No cost share would mean Blue Cross NC covers all your costs except your premium payment.
If you are diagnosed with COVID-19, Blue Cross NC will not require prior approval for medically necessary services.
The following change is in effect through June 30, 2020.
Blue Cross NC is waiving prior authorization requirements for emergent non-elective inpatient admissions, durable medical equipment and post-acute care services that are medically necessary for COVID-19 related services. This measure applies to all Blue Cross NC members.
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