General News
Published August 10, 2020
We understand that there are a lot of differing dates surrounding COVID-19 testing and treatment. To help you and your clients better understand their coverage, we have reminded you of when COVID-19 benefits, testing, treatment, and virtual care expire under their Premera Blue Cross plan.
COVID-19 benefits and testing: October 1, 2020
The new Families First Coronavirus Response Act requires all group health plans to provide coverage for diagnostic testing. This includes FDA-approved COVID-19 diagnostic testing products, items, and services related to testing during an office, telehealth, urgent care center or emergency room visit. We have removed the group waivers that were previously in place to comply with this mandate. As additional guidance is issued, a business decision may be made to allow opt-outs of additional criteria.
For members: For dates of service January 1, 2020 through October 1, 2020, Premera will waive the in-network cost shares (coinsurance, copays, and deductibles) for FDA-authorized diagnostic COVID-19 and influenza testing. The waivers apply for testing and the related provider visit at in- and out-of-network facilities and laboratories. All other treatments and services, including hospitalization, will be subject to the usual benefits and cost shares. Any additional care related to a COVID-19 diagnosis is covered consistent with the member’s benefits.
Pre-authorization isn’t required for medically necessary and FDA-authorized COVID-19 or influenza testing.
N95 masks and hand sanitizer may be an FSA- and HSA-eligible expense with a letter of medical necessity from your provider.
For groups, including self-insured and OptiFlex: The IRS issued guidance allowing COVID-19 testing and treatment cost-share waivers for high deductible health plan and non-high deductible health plan members.
Treatment related to COVID-19: October 1, 2020
We know these are difficult times for many, and the worry about medical bills, especially as they relate to COVID-19, is great. To ease some of the burden for our members, effective today Premera will be waiving cost shares including copays, deductibles, and coinsurance for all COVID-19 related treatment (both inpatient and outpatient), in addition to our previous waiver for COVID-19 testing and related provider visit. This cost share waiver will continue through October 1, 2020.
Learn more about cost-share waivers.
Virtual care cost share: December 31, 2020
Premera expanded its telehealth network to give members greater access and address the increased demand related to COVID-19. This benefit has been further extended to December 31, 2020 for fully insured, OptiFlex, and self-funded groups who have opted in.
A full look at those expanded providers can be found here.
Who’s eligible for this benefit?
This benefit will apply to members of insured groups, individual, grandfathered, non-grandfathered, associations and OptiFlex. Self-funded plans have the option to participate.
This will not apply Shared Admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, Medicare Advantage, and self-funded plans who opt-out.
What’s the cost of these new providers to the member?
Telehealth cost shares will be waived for all in-network providers. If a telehealth provider charges you a copay, deductible, or coinsurance for telehealth services through December 31, 2020, the provider is responsible for reimbursing the member once the claim is processed and the provider is paid.
Are brick and mortar in-network offices covered?
Yes. All in-network providers who offer telehealth options are covered under this expansion.
When should I use telehealth services and what can they help me with?
If you’re feeling ill with non-COVID-19 symptoms, you can contact a telehealth provider. Telehealth providers can answer questions, diagnose, and treat acute and chronic illness for non-COVID-19 related symptoms. They can also fulfill necessary prescriptions or order lab tests at local facilities.