Does my plan cover COVID-19 screening and testing?

Yes. During the public health emergency, Blue Shield of California will waive out-of-pocket costs for copays, coinsurance, and deductibles for:

  • COVID-19 screenings or evaluations done:
    • Virtually using telehealth,
    • In a doctor’s office,
    • At an urgent care center, or
    • In a hospital, including emergency room (ER).
  • COVID-19 testing that’s ordered by a healthcare provider who is licensed to order these tests.

There are no prior approvals needed for COVID-19 screenings, evaluations, or testing.

View testing coverage

 

What if I need treatment for COVID-19?

There are no prior approvals needed to receive COVID-19 treatment. 

Blue Shield will waive copays, coinsurance, and deductibles for COVID-19 treatments received between March 1, 2020 – February 28, 2021. This includes hospital admissions for COVID-19 that began during this timeframe. 

Standard out-of-pocket costs will apply for any new treatments received after February 28, 2021. 

This applies to the following plan types:  

  • Medicare Advantage plans 
  • Medicare Supplement plans

If you have a Cal-MediConnect plan, visit our MediCal and Cal-MediConnect COVID-19 resources

To find out which plan you have, call the customer service number on your member ID card. 

 

What do I need to do if I paid out of pocket for COVID-19 treatment received between March 1, 2020, and February 28, 2021?

First, call the Customer Care number on your member ID card to see if your provider sent the claim directly to Blue Shield. If the claim has not been submitted by the provider directly, Customer Care will help you submit a claim along with an itemized statement for processing a reimbursement.

 

What virtual care options does my plan cover?

Contact your primary healthcare provider to find out if they have virtual visits available. Virtual visits are covered and standard office visit copays may apply based on your plan benefits. 

Some plans may have access to Teladoc, HealTM, or NurseHelp 24/7SM as alternative options for virtual care. These services can help you see if your symptoms may be related to COVID-19 or something else. However, they will not be able to order a COVID-19 test for you. 

Not all plans have access to these services. 

VIRTUAL CARE
Description
Out-of-Pocket Cost

Primary Doctor
Doctors within your plan’s network may have virtual visits available.
Varies by plan. Standard office visit copay may apply.

Teladoc®
Talk to board-certified doctors 24/7 by phone or video. 
(800) 835-2362 [TTY: 711]
Log in to find out your costs and if you have access.

Heal†
Heal offers virtual appointments and in select cities on-demand house calls. During the pandemic, Heal is offering virtual appointments by phone or video throughout California. House calls are limited to the service area only.†
Log in to find out your costs and if you have access.

NurseHelp 24/7 or
Nurse Advice Line
Get health advice 24/7 from a registered nurse over the phone.

Call (877) 304-0504.

$0. Log in to find out if you have access.

* Please refer to your Member Handbook/Evidence of Coverage or plan documents for information regarding access to these programs. You can also call Customer Care at the number on your ID card or log in to your online account to see what benefits your plan covers. 

† Blue Shield’s Medicare Advantage PPO plans also include Heal, which provide virtual visits and on-demand house calls in select ZIP codes. During the COVID-19 pandemic, initial Heal appointments may be via phone or video.  If your issues remain unresolved and you are not symptomatic or exposed to COVID-19 and are seeking care in a Heal covered ZIP code, your Heal doctor will schedule a house call.

Heal will tell you about any costs associated with your visit upfront, so there are no surprises. At this time, Heal is not available to Blue Shield Medicare Advantage HMO Plans, Medicare Supplement Plans, or Blue Shield Promise Cal MediConnect Plans.

Log in to get care

 

What if I seek care from a non-network provider for COVID-19? Will it be covered?

In the case of a medical emergency, care provided by in-network and out-of-network providers will be covered for all plans. 

Outside of an emergency situation, you should seek care from in-network providers to save money and make sure you don’t have to pay more out-of-pocket. 

If you have a plan with out-of-network covered benefits, Blue Shield will cover both in-network and out-of-network copays, coinsurance, and deductibles for COVID-19 covered benefits during this time. Medicare Supplement Plan members may see any provider accepting Medicare.

 

What if I need to refill my prescriptions?

If you are worried you might run out of prescribed medications, Blue Shield allows early refills on your prescriptions as long as there are refills available with your prescription. This is for all members with pharmacy benefits through Blue Shield. 

If you have specific questions about the medicine you take, call the Customer Care number on your member ID card.

To meet your needs and promote social distancing, many retail pharmacies are waiving fees for home delivery of prescriptions. Visit your pharmacy’s website or call your local pharmacy for more information. Also, if available, utilize the drive-thru window when picking up your prescriptions.

You can also fill a prescription for an extended days supply of maintenance medications at retail pharmacies in addition to our mail service pharmacy.

See Blue Shield Medicare Advantage pharmacy benefits.
See Cal Medi Connect pharmacy benefits.

 

How can I continue seeing my mental healthcare provider?

If you are currently seeing a mental healthcare provider, you can continue seeing that provider virtually, such as over the phone or by video. Your standard coverage and out-of-pocket costs apply.

If you would like to find a mental healthcare provider in your network, learn how to find one.

Questions about medical or prescription coverage?

Call the number on your member ID card.