Expanded coverage for COVID-19

In response to the worldwide COVID-19 pandemic, for those with BCBSND coverage, we’re expanding benefits to include: 

Testing

BCBSND will waive out-of-pocket costs for medically necessary laboratory COVID-19 testing—that includes co-pays, deductibles and co-insurance.

Coverage for COVID-19 testing includes:

  • Molecular Testing: This category includes tests for people who seek medical care and are tested because they show symptoms of COVID-19, determined to have come into close contact (as defined by the CDC) with a positive individual. These tests are considered medically necessary and ordered by a health care provider.
  • Antigen Testing: An antigen test reveals a current COVID-19 infection and provides results much faster than a molecular test. Tests must be ordered by a health care provider. 
  • Pre-operative Testing: Completed prior to an operation occurring. This is deemed medically necessary for the safety of the patient and those caring for the patient.

Note: Public testing events provided by the State are free of charge for patients; tests are not run through health insurance.

Non-Covered (member liable):

  • At-Home Tests: These tests are not ordered by a health care provider and are not covered.
  • Tests Requested by Asymptomatic Individuals: Tests requested by individuals for the purpose of receiving test results for personal reasons (travel, visiting family, etc.) are not covered.
  • Public Health Testing: This category includes broad testing of asymptomatic individuals to determine the extent of COVID-19’s spread. Public health testing may also be used to help design appropriate public health strategies.
  • Occupational Health Testing: This category includes tests conducted under the auspices of employers to ensure that they are providing a safe place to work, which may encompass testing of asymptomatic individuals.
  • Antibody Testing for surveillance purposes: Tests completed to determine if a patient has previously been infected. If an antibody test is deemed medically necessary, then the test will be covered.

Travel

  • Testing for COVID-19 for travel is not covered because it is not deemed medically necessary or ordered by a health care provider. Members can receive a free COVID-19 test through public testing events provided by the State.
  • Expenses for lodging as a result of a positive COVID-19 test are the responsibility of the member.
  • If a member needs COVID-19 testing due to exposure or exhibiting symptoms or medical treatment for COVID-19 while traveling, they are a covered expense because they would be deemed medically necessary and ordered by a health care provider.

Treatment

BCBSND will waive out-of-pocket costs for the treatment of COVID-19, including hospital stays and outpatient treatment. This applies to BCBSND members on fully insured employer sponsored plans and individual plans.

  • Out-of-pocket costs include incremental medical co-pays, deductibles and co-insurance charges related to the treatment for COVID-19 and will be paid at in-network rates.

Vaccine

FDA-approved COVID-19 vaccines are free of charge for BCBSND members. BCBSND will cover administration costs associated with the vaccine and the federal government has indicated they will cover the cost of the vaccine, resulting in no charge for the member.

While coverage for the administrative cost for the COVID-19 vaccine has been mandated by the federal government for all non-grandfathered plans, BCBSND has independently decided to extend that coverage to all lines of business, including grandfathered plans.

Prescription medications

Effective March 10, BCBSND asked pharmacies to refill prescriptions earlier than typically allowed. In addition, most plans allow members to fill maintenance medications for up to a 90-day supply through local or mail-order pharmacies.

  • BCBSND asked pharmacies to waive “refill too soon” limits on prescriptions
  • In addition, we are working closely with our pharmacy benefit manager, Prime Therapeutics, to monitor a possible shortage of raw materials for prescription drugs. Our pharmacy partner is working directly with our entire network of suppliers, wholesalers, manufacturers and pharmacies (both chains and smaller purchasing entities) to proactively collaborate and identify medication shortages before members are impacted.

Durable Medical Equipment (DME) Supplies

Effective March 10, BCBSND allows suppliers to refill DME supplies earlier than typically allowed. Members may receive up to an additional 90-day supply through local or mail-order suppliers.

Expanded telehealth coverage

To lessen the pressure on our health care system during the pandemic, we are expanding coverage for telehealth for all BCBSND members to include video calls, phone calls, email or online chats, including FaceTime or Skype calls.

In addition, we’re covering cost shares for all telehealth visits for Fully Insured and Individual members. Those services may include, but are not limited to:

  • Urgent Care Visits
  • Office visits for patients
  • Physical therapy (PT) plan evaluation
  • Occupational therapy (OT) plan evaluation
  • Speech therapy (ST) plan evaluation
  • Behavioral health and substance use disorder treatment
  • Diabetes education
  • Nutrition counseling

Extended grace periods for premiums

Effective March 24, 2020, BCBSND is allowing customers to have 62 days to pay their premiums (which is an extension from the current 31-day requirement) for all members with individual plans or small group coverage (businesses with under 50 employees).

In support of the larger businesses (those with 50 or more employees), BCBSND representatives will work with them directly on a case-by-case basis to determine alternative payment plans. 

Advanced Premium Tax Credit program

Members who experience a reduction in income or are laid off due to the pandemic may qualify for premium relief through the federal government’s Advanced Premium Tax Credit (APTC) program as a qualifying event.

BCBSND encourages members to learn more about the program online or by calling BCBSND Member Services at by calling 844-363-8457.

Flexibility in eligibility requirements

As businesses around the country are forced to reduce hours or lay off employees, BCBSND is also allowing greater flexibility in eligibility requirements:

  • As long as premiums are paid, BCBSND will work with employers to keep employees on their health plan, even when their hours fall below current eligibility guidelines;
  • BCBSND will allow employers to remove or reduce current probationary periods for new employees, thereby allowing new employees access to their health plan sooner.

Waiver of Precertification of Authorization for Post-Acute/Alternative Care

To support the increased needs of patient transfers from one health care provider to another, BCBSND will temporarily waive the precertification process for all in-state post-acute/alternate care service requests when transferring from acute care hospitals. The waiver is effective November 12, 2020 through March 31, 2021.

The waiver includes patient transfers between the following locations:

  • Skilled Nursing Facilities
  • Long Term Acute Care Facilities
  • Home Health Care
  • Hospice Care
  • In-patient Rehab Facilities
  • Transitional Care Units