COVID-19 Provider Coverage and Policies

When referenced, the following information applies to all Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health.

1. VIRTUAL CARE

We will pay for virtual visits at parity including visits through secure video, by phone, or by audio-only (audio-only may have benefit exclusions) through March 31, 2022. On March 6th, 2020, we announced we were making telehealth easier for our members and clinicians to use. And, we meant it.

You can even use telehealth options with hospital and ED physicians. Behavioral health too. Click for a detailed guide on clinical scenarios and how to file claims here. 

This measure applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. 

2. COSTS (Testing, Treatment and Vaccine)

Clinical Visits and Testing

Blue Cross NC will waive member cost-sharing (including deductibles, copayments, and coinsurance) for allowed charges for COVID-19 testing or for a doctor visit or call to determine if testing is necessary as long as COVID-19 testing meets all three criteria:

1. Ordered by a licensed health care provider,
2. Determined as medically necessary by a licensed health care provider for the diagnosis and management of a member’s medical condition
3. Have been cleared, approved or given emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA)

Specifically, there will be no member cost-share for COVID-19 testing or clinical visits to determine if a testing is needed through virtual care visits, outpatient office visits, urgent care visits or ER visits. These changes are required by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. (As of today, the federal government has not set an end date for this measure.)

We continue to encourage the use of virtual visits as the first step to seeking testing. For details and coding guidance, please click here.

This measure will remain in place through the Public Health Emergency for Blue Cross NC’s fully-insured individual and group plans, Federal Employee Program members and members of self-funded groups that did not opt out. Members should contact the Blue plan listed on their ID card for information about their COVID-19 benefits. This measure will remain in place through December 31, 2021 for Medicare Advantage plans offered by Blue Cross NC.

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.

COVID-19 Vaccine

Blue Cross NC will cover COVID-19 vaccines that are FDA approved for emergency use authorization (EUA) at no cost for all members - both during the public health emergency and after. 

During the public health emergency, the federal government will pay for the cost of the COVID-19 vaccine for all individuals. Additional costs associated with administering the vaccine (such as vaccine supplies, storage and provider costs) will be covered by either the federal government or the member’s health plan, depending on the member.

• For members over 65 (Medicare and Medicare Advantage), the federal government will pay all vaccine-related costs, with no cost to members.
• For commercial members, the cost to administer the vaccine will be covered by the member’s health plan, with no cost to members.
• For customers on a grandfathered group plan, vaccines will be available at no member cost-share. Because of differences in the federal rule related to grandfathered plans, we're working on additional details around how we will handle provider reimbursement for vaccine administrative fees. We will provide more details as soon as possible.

After the public health emergency, Blue Cross NC will cover the cost of the COVID-19 vaccine with no cost-sharing to members, as part of our routine preventative care and immunization benefits in accordance with federal laws and regulations.

Members who live outside of North Carolina will need to follow their local and state guidelines to determine how they should receive the vaccine. States will determine the appropriate staging on who gets the vaccine first and how it will need to be administered based on supply.

We believe the distribution of a safe, effective and clinically approved COVID-19 vaccine is of utmost importance. We will work with providers in our network to support capacity to meet member demand.

For full details on provider reimbursement for vaccine administrative fees according to Blue Cross NC segment, see our Provider News article.

3. WAIVING MEDICARE ADVANTAGE COPAYS

Blue Cross NC is waiving all copays for in-network primary care and outpatient behavioral health visits for Medicare Advantage members from June 1 through the end of 2020. Visits do not have to be related to COVID-19 and can be done in person or virtually through telehealth.

The copay waiver is specific to the primary care medical visit or behavioral health therapy visit. Members may have costs for other services unless they are related to COVID-19 treatment or testing.