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.

We replicated our existing reimbursement process to offer the simplest, most convenient way to reimburse each member for up to eight eligible OTC at-home COVID-19 tests per month.

We implemented fraud and abuse prevention measures at the start. These include requiring the original receipt for the test and the original UPC code cut from the test kit box to be submitted to us with the reimbursement request. This allows us to be sure test kits aren’t being returned and that they’re less likely to be resold.

The federal government gave us just five days to put a process in place. We replicated our existing reimbursement process to offer the simplest, most convenient way for members to request reimbursement that also helps keep costs down. Members can find reimbursement details here.

Unfortunately, no. If the PBM manages the process, it manages all reimbursement activity, including processing out-of-network OTC at-home COVID-19 tests. BlueCross will not process claims through the medical benefit for in- or out-of-network reimbursement if the PBM is managing this process.

We believe the process we’ve created is in the best interests of our members and group customers. Because the federal government gave us just five days to put a process in place, we replicated our existing reimbursement process to offer the simplest, most convenient way for everyone involved that keeps the costs down. We will reimburse members the cost of eligible OTC at-home COVID-19 tests. Members can find reimbursement details here.

No. For the time being, we’re opting to use our existing reimbursement process. It’s a process we’ve used for many years that’s proved successful. Under this process, we’ll reimburse members the cost of eligible OTC at-home COVID-19 tests. Members simply download and complete our reimbursement form, attach the requested documentation, and mail it to us. You and your employees can find complete details here.

Every home in the United States is eligible to order four free at-home COVID-19 tests here. If members choose to purchase tests on their own, we’ll reimburse them for 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.

Yes, we always monitor claims we process for waste, fraud and abuse.

Here’s a list of FDA-approved, -authorized or -cleared tests. We’ll reimburse members for up to eight eligible OTC at-home COVID-19 tests per month.

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.

We don’t have a date for how long the federally purchased vaccines will be distributed. We’ll keep you updated as we learn more.

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 5 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 is currently the only vaccine that can be administered to children at this time.

You can also find answers to many of your vaccine questions through the CDC.

More information can be found here.

Yes.

We currently have no plans to offer drive-through COVID vaccine clinics. Major retail chains and clinics have begun offering vaccinations on a wide scale. For a list of vaccine locations, check with your local health department or visit VaccineFinder.org.

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.