COVID-19 Member Resources

Everything you need to know about your coverage and COVID-19

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. The federal public health emergency for COVID-19 is currently in place through June 30, 2021 but may be further extended by the US Dept. of Health and Human Services.

COVID-19 (Coronavirus) - 4 Steps We're Taking to Support Members


The vaccine is available at no cost to all members


No cost-sharing for COVID-19 doctor visits, testing and related treatments1

Coverage for Telehealth, phone, or virtual visits with primary care and specialty doctors

Members will not need prior authorization for COVID-19 testing or services related to COVID-19 through June 30, 2021


Don't delay. Get the care you need now.

It’s important to keep your total health top-of-mind during this time. If you have a chronic illness, an emergency or need health care for something else, don’t delay your care. Call your doctor to learn any protocols they are following and schedule visits that you feel comfortable with. Ask about virtual visits or contactless waiting to make sure you get the care you need in a way that you feel safe. Doctor’s offices are following strict health and safety guidelines to make sure you can feel comfortable getting routine care.

Care that should not be delayed:

  • Flu Shots
  • Routine Physicals
  • Cancer Screenings
  • Childhood Vaccinations
  • Mental Health Screenings and Treatment
  • Preventive Care

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.2

How will these coverage changes affect you?

COVID-19 Vaccine Coverage

The COVID-19 vaccine will be available at no cost to all Blue Cross NC members. This means you’ll pay nothing out of pocket for the vaccine once it’s available.

Even after the COVID-19 crisis has ended, the vaccine will still be covered for you at no cost as part of our preventive care benefits. This is similar to a yearly flu shot or other vaccinations.

Note: We have identified an issue with COVID-19 vaccine administration claims pulling member liability in error. The impacted claims will be adjusted, please allow at least 30 days for adjustments to be made.

Availability

All adults, aged 16 and older, are eligible to get the COVID-19 vaccine today. Visit the NCDHHS website for more information.

Members who live outside North Carolina will need to follow their local and state guidelines to figure out when and how they can receive the vaccine.

Covering virtual doctor's visits and care (Telehealth)

We are increasing your ability to use virtual (video or over-the-phone) appointments with your in-network doctor.3

Blue Cross NC will cover all telehealth visits at the same cost as face-to-face visits. This means, what you normally pay when you visit a doctor in-office is what you’ll pay for a telehealth visit.

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.

To use your telehealth benefits you should:

  • Call your doctor before going into the office to see if telehealth is available. This will help prevent the spread of illness.
  • Make sure the doctor you are using is in-network. These benefits are only for in-network doctors.
  • Check to see if you have MDLive or Teladoc services. You can find this information on your ID card.

See a doctor from home with mdlive.bcbsnc.com

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.

 

No prior approval on COVID-19 testing

COVID-19 tests will not need prior approval. That means, your doctor doesn’t need to ask us for approval before you’re tested for COVID-19. 

For tests performed at an in-network lab, we will cover, at no cost-share to you, COVID-19 testing methods that meet all three criteria:

  • It’s ordered by a doctor or health care provider
  • Your doctor has deemed it medically necessary; in order for them to provide you with the right care and treatment 
  • Has been cleared, approved, or given emergency authorization (EUA) by the U.S. Food and Drug Administration (FDA).

If you think you have COVID-19, please call your doctor. Be ready to answer questions about your symptoms and if you could have been exposed to the virus. 

Coverage and no cost-sharing for COVID-19 testing and treatment

Blue Cross NC will provide coverage and will not apply cost-sharing for COVID-19 tests and COVID-19 treatments. See the full details below. 

COVID-19 Doctor Visits and Testing4

Doctor Visits: 

For visits to an in-network provider, we will provide coverage and waive your costs (like deductibles, copays, and coinsurance) for services you have to determine if you have COVID-19.

We will also cover all COVID-19 related visits whether virtually, outpatient, urgent care, or ER visits.

COVID-19 Testing:

For tests performed at an in-network lab or at-home, we will cover, at no cost-share to you, COVID-19 testing methods that are consistent with CDC guidance and meet all three criteria:

  • It’s ordered by a doctor or health care provider
  • Your doctor has deemed it medically necessary; in order for them to provide you with the right care and treatment 
  • Has been cleared, approved, or given emergency authorization (EUA) by the U.S. Food and Drug Administration (FDA).

Most testing prescribed by your doctor will automatically meet these requirements with no additional work from you.  

For an out-of-network visit to a doctor for a COVID-19 screening, or lab testing as a result of the screening appointment, keep in mind: 

  • Blue Cross NC does not have a contract with the out-of-network provider to limit their ability to charge you for amounts beyond what Blue Cross NC pays the provider.
  • The provider may bill you to collect the difference. This practice is known as balance billing.
  • You should refer to our Find a Doctor tool, Blue Connect, or other resources to avoid this financial risk. 
  • For Medicare Advantage members, Blue Cross NC will pay the out-of-network providers directly. In the case that you make a payment to the provider upfront, Blue Cross NC will reimburse you. 

 

COVID-19 Treatment

Blue Cross NC will continue waiving member cost-sharing (copays, deductibles and coinsurance) through June 30, 2021, for COVID-19-related treatment that is medically necessary and consistent with guidance from the Centers for Disease Control and Prevention (CDC).

This measure applies to all fully-insured Blue Cross NC commercial plans (individual and group plans), the State Health Plan, the Federal Employee Program, Medicare Supplemental plans, and Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. 

Self-funded employer groups have the option to apply this extension to their employees' plans. We will work quickly with groups interested in extending this benefit provision. Members should contact the Blue plan listed on their ID card for information about their COVID-19 benefits.

 

Updates for members on employer plans

The Department of Labor and the IRS have issued guidance that provides extended claim and appeal filing deadlines for individuals on employer-sponsored group health plans. You may now be able to submit claims or appeals for services that otherwise would have passed their timely filing date. Blue Cross NC will review your request based on your current plan benefits. Please reach out to your employer if you have additional questions or visit EBSA Disaster Relief Notice 2021- 01. This extension does not apply to State Health Plan, FEP, Medicare or Individual plans - including Dental and Vision.

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