COVID-19 Vaccines, Testing and Treatment

As mentioned in the Sept. 24 Employer Update, when the COVID-19 public health emergency (PHE) is lifted, the services required to be covered (with cost shares waived) by the CARES Act will return to the plan’s standard cost shares.

Vaccinations

The U.S. Food & Drug Administration (FDA) has approved three COVID-19 vaccines, from Pfizer-BioNTech, Moderna and Johnson & Johnson. Blue Cross and Blue Shield of Nebraska (BCBSNE) members are able to get the vaccine at no cost during the COVID-19 PHE.

Coverage for Testing

BCBSNE is continuing to waive member cost-sharing for medically appropriate in-network COVID-19 testing and related services through May 11, 2023. This means members will pay nothing for medically appropriate in-network testing and related services in a telehealth session, doctor’s office, urgent care facility or emergency room.

This waiver of cost shares applies to all fully insured and self-funded groups and individual health plan members, along with those who receive their insurance through our Medicare Supplement and Medicare Advantage plans.

Medically appropriate COVID-19 tests must be ordered by a doctor or health care provider for the purpose of diagnosing COVID-19. This includes COVID-19 drive-through test sites or home test kits purchased with an order from a doctor.

Typically, the most appropriate test is the single component rapid (antigen) or PCR test, which tests only for COVID-19. Members should avoid having multiple or unnecessary tests, including large panel tests. Many conditions are tested for in large panel tests, only one of which is COVID-19. These may not be covered under your health plan and your employees could be responsible for the entire fee (approximately $1,000). 

Over-the-counter COVID-19 tests

Test kits that do not require a doctor’s order or a lab to read the results are considered over-the-counter (OTC). Beginning Jan. 15, 2022, there will be a $0 cost share for up to eight individual OTC COVID-19 tests per member per 30 days. This applies to all fully insured and self-funded groups that use BCBSNE’s pharmacy benefits manager, Prime Therapeutics, as well as individual health plan members. People with Medicare should reference the Centers for Medicare and Medicaid Services (CMS) for information on obtaining OTC COVID-19 tests. 

All FDA-approved OTC COVID-19 tests are eligible for reimbursement. Tests purchased prior to Jan. 15, 2022, are not eligible for reimbursement.

View the list of eligible tests here

Tests purchased from a non-preferred pharmacy, online retailer or retail store can be submitted for reimbursement through the pharmacy paper claims process for OTC COVID-19 tests. These claims will be reimbursed up to $12 per individual OTC COVID-19 test. Reimbursement includes tax and shipping, if any, as long as the tax and shipping can be readily identified on the receipt. For example, a box that includes two tests would be reimbursed at a maximum of $24 (including tax and shipping). If a large pack of tests is purchased for multiple members, a claim form is required for each member, and they may use the same receipt.

COVID-19 testing for public surveillance or employment is not covered. This includes testing for work, school, travel and other public surveillance reasons, unless reimbursement becomes required by law. 

*Some pharmacies may not yet be able to bill insurance directly for OTC COVID-19 tests. Members should check with their pharmacy on its policies regarding OTC COVID-19 tests. If pharmacies are not able to support direct billing, members should keep their receipt and use the pharmacy paper claims process for OTC COVID-19 tests to request reimbursement.

Coverage for Treatment 

• Fully insured and BlueFlex products
  • Starting Jan. 1, 2021, BCBSNE will apply member cost shares for treatment of COVID-19.  
• Self-funded (traditional ASO and ASO Block)
  • Groups that previously waived member cost shares for treatment of COVID-19 had the opportunity to extend their cost share waiver past Dec. 31, 2020. If your group did not indicate by Nov. 30, 2020, that it would like to continue to waive cost shares for COVID-19 treatment, cost shares for COVID-19 treatment went into effect on Jan. 1, 2021.

Additional Resources 

Download and distribute this flier to your employees to share information about BCBSNE coverage for COVID-19 vaccinations and testing. 

Visit our Newsroom for more information about COVID-19 vaccinations, testing and treatment, telehealth services and more. 

If you have any questions, contact a member of your BCBSNE account management team.