The information below was provided by our friends at the NC Community Health Center Association:
We know this is a particularly busy time for you and your [organization] as you work to keep your communities safe amid the COVID-19 outbreak. We wanted to share updates from the four Marketplace insurers re: their COVID-19 related coverage. Please note we are sharing what we know at this time, and there may be additional updates from the insurers that are not listed here. Links to each insurer’s coronavirus info page is included below.
- Blue Cross Blue Shield of NC
- Coronavirus updates from BCBSNC
- Visits to doctors that previously required a face-to-face encounter can be performed virtually. These virtual visits must be medically necessary and meet qualifying criteria. These virtual visits will be paid at parity with office visits so long as they meet these criteria.
- BCBSNC will waive early medication refill limits on 30-day prescription maintenance medications (for example heart, diabetes, cancer, blood pressure). This will allow BCBSNC members to have a one-month supply on hand.
- Testing for COVID-19 will not need prior approval.
- BCBSNC members will have zero out-of-pocket expenses for the COVID-19 test. BCBSNC will cover the cost of the COVID-19 test whether or not the BCBSNC member has met their deductible.
- BCBSNC members diagnosed with COVID-19 will not need prior approval for medically necessary services.
- These updates went into effect on March 6, 2020 and will remain in effect for 30 days. BCBSNC will then re-evaluate.
- Coronavirus updates from Cigna
- Cigna will waive co-pays, co-insurance, and deductibles for COVID-19 testing.
- Telehealth options are available for Cigna members. Members can visit mycigna.com and select “Connect Now” to access telehealth options.
- Bright Health
- Coronavirus announcement from Bright Health
- Bright Health members whose care providers have ordered testing will have COVID-19 diagnostic tests covered as preventive care at no cost to the member.
- Bright Health members can have their next prescription refilled on an as-needed basis. Members should contact their pharmacist and ask the pharmacist to request approval for early refills through the company’s pharmacy help line.
- Coronavirus updates from Ambetter
- Co-payments, co-insurance, and deductibles will be waived for medically necessary COVID-19 diagnostic testing and/or medical screening services, when ordered and/or referred by a licensed health care provider.
- Prior authorization, prior certification, prior notification and/or step therapy protocols will not be required for medically necessary COVID-19 diagnostic testing and medical screening services, when ordered and/or referred by a licensed health care provider.
- Any medically necessary treatment related to COVID-19 will be considered a covered benefit, consistent with benefit coverage provisions. General plan cost-sharing requirements will apply for medically necessary treatment related services.
- Ambetter members will be able to refill prescriptions prior to the refill date.
Please encourage consumers/patients to call their provider if they are experiencing symptoms, rather than show up at their provider’s office. Also, please share steps that consumers/patients can take to prevent the spread of COVID-19.