Employer Q&A About Vaccines and Testing
Yes. As mandated by federal requirements, we’re reimbursing the cost of eligible OTC at-home COVID-19 tests purchased on or after Jan. 15, 2022, for our commercial members. This includes members in our group and individual on- and off-Marketplace plans.
Here’s a list of FDA-approved, -authorized or -cleared tests.
Members can find reimbursement details here. As well, every home in the United States is eligible to order four free at-home COVID-19 tests. Learn more: www.covidtests.gov.
Yes. Self-funded groups who have carved out pharmacy benefits may elect to work directly with their Pharmacy Benefit Manager (PBM) to allow their employees to purchase these OTC tests from the PBM’s retailer of choice without any out-of-pocket costs. If you prefer to use this option for your employees, please connect directly with your PBM and notify your BlueCross account executive of your intentions.
We don’t have access to information from your PBM. So, failing to let us know that this is your option could result in your paying for tests through both your medical and pharmacy benefits. That means your medical benefits would still reimburse for up to eight tests per member per month, as well as reimburse for the total cost of each eligible test.
At your request, we can implement an option where we’ll return any medical reimbursement request, asking the member to file it through your PBM to ensure the limit of eight is managed.
Yes, members can purchase tests from their employers’ on-site pharmacy for personal use and be reimbursed the cost of up to eight eligible OTC at-home COVID-19 tests per month. Here’s a list of FDA-approved, -authorized or -cleared tests. Members can find reimbursement details here.
As well, every home in the United States is eligible to order four free at-home COVID-19 tests. Learn more: www.covidtests.gov.
Yes, we’ll cover COVID-19 vaccines authorized for emergency use and approved by the FDA*. Currently, the federal government is purchasing vaccine doses. Providers are not allowed to charge an individual or a plan for the vaccine when it’s provided by the federal government. Once the government stops supplying the vaccine, plans will be required to cover the cost as they do any other preventive service.
The CARES Act requires that group health plans (and individual health insurance plans) include coronavirus preventive services, including COVID-19 immunizations, as preventive services to be covered without member cost-share.
*Those under self-funded grandfathered plans that don’t have the Affordable Care Act 100% preventive coverage can speak to their account executive about how their plan will cover the vaccine and vaccine administration.
Yes. Plans must cover both the vaccine and the administration charge at 100%, just as they do other ACA preventive services*. While the vaccine cost will be covered by the federal government initially, plans will cover the administration cost.
*Those under self-funded grandfathered plans that don’t have the Affordable Care Act 100% preventive coverage can speak to their account executive about how their plan will cover the vaccine and vaccine administration.
All U.S. residents age 6 months or older are eligible for the vaccine. Your employees can check with their local health department or visit vaccines.gov to find vaccine locations. Currently, the Pfizer vaccine and Moderna vaccines are the only vaccines that can be administered to children.
You can also find answers to many of your vaccine questions through the CDC.
More information can be found here.
As an employer, you play a key role in preventing and slowing the spread of COVID-19 within your workplace. The CDC has many resources to help you, including guidance on:
- Implementing virtual health checks
- Office quarantine policies
- Mask requirements
- Testing and vaccines in the workplace
Check out their Guidance for Businesses and Employers to learn about these topics and many more.
Your employees can order four free at-home COVID-19 tests from the government starting Jan. 19, 2022, at COVIDtests.gov. The government will mail them directly to each household.
They can also contact their local health departments for free community testing locations, or buy OTC at-home tests from most retail pharmacies.
Yes. As mandated by federal requirements, we’re reimbursing the cost of eligible OTC at-home COVID-19 tests for our commercial members. This includes members in our group and individual on- and off-Marketplace plans.
Here’s a list of FDA-approved, -authorized or -cleared tests. Only the tests with “OTC” listed in the Attributes column are eligible for reimbursement if purchased on or after Jan. 15, 2022.
Currently, BlueCross is offering the reimbursement process. Members can find reimbursement details here.
Self-funded groups who have carved out pharmacy benefits may elect to work directly with their PBM to allow their employees to purchase these OTC tests from their retailer of choice without any out-of-pocket costs. If you prefer to use this option for your employees, please work with your BlueCross account executive to be sure reimbursements aren’t applied to your medical plan.