Employer, Family & Individual Plan Members
COVID-19 vaccines are here. We’ve created a guide to answer some of your questions. Here’s what you need to know.
We’re here for you during this unusual time. It doesn’t feel good, but together we’ll get through this. We’ve compiled answers to your most asked questions. Look below for info about your health plan’s COVID-19 coverage, ways to protect your health, signs of COVID-19 fraud and more.
Your Health Plan
Yes. We’ll cover and waive member costs for any US FDA-approved tests, as well as those currently pending FDA approval, if your doctor recommends it. We’re also waiving member copays and deductibles for the visit to your provider, urgent care center or emergency room related to a COVID-19 test, as long as the provider is in your network. We’ll still cover the COVID-19 testing and services if you see a provider out of your network, but they may bill you for the difference in their visit charge and our payment to them. Please note that, if you receive additional services or testing in addition to just COVID-19-related testing, your normal costs for that setting will apply.
Please call us at the Member Service number on the back of your Member ID card if you get a bill for COVID-19 testing that you weren’t expecting.
Through new federal government rules, we’ll reimburse you for up to eight rapid over-the-counter at-home COVID-19 tests per month that you pay for out of pocket. These tests must be for personal use, and they can’t be used for any return-to-work testing or work-related testing required by your employer. The eight-test limit is per person on your plan. A package of two tests counts as two toward the limit of eight, and taxes and shipping costs are ineligible for reimbursement.
Any test you take at home that must be sent to a lab for results isn’t currently eligible for reimbursement. However, this type of test when ordered by a provider is covered under your BlueCross medical benefits.
Here’s a list of FDA-approved, -authorized or -cleared tests eligible for reimbursement if purchased on or after Jan. 15, 2022.
Please follow these steps for your reimbursement.
- Download and fill out the COVID-19 OTC At-Home Testing Reimbursement Form here
- Cut out the UPC label (the bar code) from your test box
- Mail the completed form, UPC label and original receipt from the test kit purchase to us at BlueCross BlueShield of Tennessee, Claims Service Center, 1 Cameron Hill Circle, Suite 0002, Chattanooga, TN 37402-0002.
Each item above must be the original. Reimbursement requests without all items or with copies or photos of the items won’t be accepted.
Reimbursement for eligible tests will continue throughout the COVID-19 public health emergency.
Yes. We encourage you to use your Teladoc™ Health telehealth benefit to stay home as much as possible. Your normal costs for a Teladoc appointment will apply.
In many cases, yes. If you get your insurance through your employer, new rules give you more time to file claims and appeals during the COVID-19 national emergency.
You usually have one year plus three months to file a claim from the date of service, and 180 days to file an appeal from the date of a benefit decision, like a claim denial. The new rule lets you “pause” the deadline during the outbreak period and start counting again when it’s over.
The outbreak period started on March 1, 2020, and will end 60 days after the end of the COVID-19 national emergency, or one year from the date of the triggering event, whichever is earlier.
If your insurance is from a state or local governmental plan, you may not be eligible for extra time. To check, please call us at the number on the back of your Member ID card.
COVID-19 and Fraud
Moms and Babies
Pregnant women are considered to have an increased risk for COVID-19 complications. Women with higher-risk pregnancies may be more at risk. Continue your prenatal appointments so your provider can manage any symptoms you may have.
However, looking at past viruses, like the flu and SARS, the Centers for Disease Control and Prevention warns that pregnant women who contract COVID-19 could be more likely to have severe respiratory problems, like pneumonia. This is because pregnant women already have increased heart rates and diminished lung capacity.
According to the Centers for Disease Control and Prevention, you may have a higher risk of miscarriage or premature delivery if you contract COVID-19.
It’s not clear yet whether cases of newborns with COVID-19 are born infected, or are becoming infected after birth. It’s likely that if you’re infected with COVID-19, your baby will be placed in isolation after birth to prevent the disease from passing from you to them.
Some BlueCross members may have benefits for a home birth with a certified nurse midwife. Home births are recommended only for low-risk pregnancies, and you must have a detailed birthing plan that includes a hospital and doctor, in case of complications. If you’re unsure if your plan covers home births, call us at the Member Services number on the back of your Member ID card.
It’s important to note that licensed and accredited hospitals and birth centers are still safe places to deliver your baby. If you’ve already chosen your delivery provider, talk with them about your concerns to ensure you’re making the right birth choice for you and your family.
In a newborn, a fever of 100.4° F is considered high enough to seek medical treatment in the first two months of your child’s life. As always, double-check the environment to make sure your baby’s temperature is accurate. Wearing extra warm clothes or being bundled in blankets, as well as being in a very warm room or in a hot car, could make their temperature reading higher.
If you’re worried about your baby’s temperature, your safest bet is always to call your pediatrician for advice on next steps.
COVID-19 and Enrolling in a Health Plan
In many cases, yes. If you get your insurance through your employer, new rules give you more time to elect COBRA and pay COBRA premiums during the COVID-19 national emergency.
You usually have 60 days to elect COBRA from the day you lose your insurance. Once you elect COBRA, you normally have 45 days to pay the initial premium and 30 days after that to pay monthly premium. The new rule lets you “pause” these deadlines during the outbreak period and start counting again when it’s over. But it’s important to know that, if you get behind on premium payments at any point and lose your COBRA coverage, we won’t be able to pay any claims unless you pay premiums on time and your COBRA coverage is reinstated. We also won’t pay any claims until you have elected and paid for COBRA coverage.
The outbreak period started on March 1, 2020, and will end 60 days after the end of the COVID-19 national emergency, or one year from the triggering event date, whichever is earlier.
If your insurance is from a state or local governmental plan, you may not be eligible for extra time. If you have questions about this and we administer your COBRA benefits, please call us at 1-800-364-6121 to check. You can also ask your employer.
In many cases, yes. If you’re eligible for insurance through your employer, new rules give you more time to enroll if you have certain life-events during the COVID-19 national emergency.
You usually have 30 days to request a special enrollment if you lose other coverage, get married, have a baby or adopt a child, including a child being placed for adoption. You usually have 60 days to request a special enrollment if you or an eligible dependent lose your Medicaid or CHIP coverage. The new rule lets you “pause” the deadline during the outbreak period and start counting again when it’s over.
The outbreak period started on March 1, 2020, and will end 60 days after the end of the COVID-19 national emergency, or one year from the triggering event date, whichever is earlier.
Please contact your employer if you have questions. Your employer will be able to tell you more about the extra time you may have to enroll, what your effective date of coverage will be and any premiums you may be responsible for. If your employer’s plan is a state or local governmental plan, you may not be eligible for extra time.
COVID-19 and Health Accounts
Your Health
The first step is to stay home and separate yourself from other people or animals as much as possible. That’ll help keep germs from spreading until you can get tested and advice from a doctor.
Next, check with your county health department to schedule at a free testing site or call your primary care provider. If your doctor thinks you need to be tested, they can give you instructions for where to go for testing if their office doesn’t offer it. Many pharmacies and urgent care centers offer testing.
Other than for testing, please stay at home, wear a mask and isolate yourself from others in your home, if possible.
If you’re up to date with vaccination or had confirmed COVID-19 within the past 90 days:
- Wear a high-quality mask or respirator (e.g., N95) as soon as you find out you were exposed and any time you are around others inside your home or indoors in public.
- You don’t need to stay home unless you develop symptoms.
- Get tested five days after exposure, even if you don’t get symptoms. Start counting from Day 1:
- Day 0 is the day of your last exposure to someone with COVID-19
- Day 1 is the first full day after your last exposure
- Watch for symptoms for 10 days following your exposure.
- If you develop symptoms, isolate immediately, get tested, stay home until you know your results, and wear a mask around others.
If you’re unvaccinated:
- Wear a high-quality mask or respirator (e.g., N95) as soon as you find out you were exposed and any time you are around others inside your home or indoors in public . You don’t need to stay home unless you develop symptoms.
- Get tested five days after exposure, even if you don’t get symptoms. Start counting from Day 1:
- Day 0 is the day of your last exposure to someone with COVID-19
- Day 1 is the first full day after your last exposure
- Watch for symptoms for 10 days following exposure.
- If you develop symptoms, isolate immediately, get tested, stay home until you know your results, and wear a mask around others.
The first step is to stay home and separate yourself from other people or animals as much as possible. That’ll help keep germs from spreading until you can get advice from a doctor.
Next, check with your county health department to schedule at a free testing site or call your primary care provider. If your doctor thinks you need to be tested, they can give you instructions on where to go for testing if their office doesn’t offer it. Many pharmacies and urgent care centers offer testing.
Other than for testing, please stay at home, wear a mask and isolate yourself from others in your home, if possible.
If you test positive, stay home for five days, and wear a mask if you have to be around others in your home. Day 1 of five is the first full day after you got symptoms or when you tested. Wear a mask around others until Day 10.
If you have symptoms:
- You can end isolation after Day 5 if you haven’t had a fever for at least 24 hours – without using a fever-reducing medicine – and your symptoms are improving.
If you didn’t have symptoms:
- You may end your isolation after Day 5 of a positive test.
If you had severe symptoms:
- Isolate for 10 days. Talk to your doctor before ending isolation.
Yes. Providers are following some safety social distancing guidelines, so be sure to call their office before your appointment to know what extra safety steps they’ll want you to follow when you get there. You also should take some personal safety measures, including wearing a mask if you’re not fully vaccinated and making sure you don’t have a fever or any signs of COVID-19 before going in person. If you are vaccinated and do not have any symptoms, be sure to consult the level of risk in your area to see the CDC’s guidelines for mask-wearing. If you have any symptoms or have been exposed to someone with COVID-19, you’ll need to reschedule your appointment.
If you have health issues that put you at higher risk of COVID-19 complications or simply don’t feel comfortable going out in person, many providers are still offering telehealth appointments.
Protecting Yourself and Others
Getting a vaccine and booster are your best protection against COVID-19. Until you’re fully vaccinated, social distancing and wearing a mask are the best ways to protect yourself. Even if you’re vaccinated, the CDC recommends wearing a mask in many situations, depending on the level of risk in your area. Stay up to date on the latest mask guidelines here.
Wash your hands with soap and water frequently, especially if you’re out of your home. Hand sanitizer can help when soap and water are unavailable.
Clean all frequently touched surfaces in your home, car and workspace.
Cover your coughs and sneezes, and immediately throw away the used tissues.
If someone in your house is sick or has symptoms, have them self-isolate away from others in the house. Call their provider for instructions on what to do next.