Does my plan cover COVID-19 screening and testing?
During the federal public health emergency, Blue Shield will continue to 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).
- 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.
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.
For any new treatments received after February 28, 2021, standard out-of-pocket costs will apply based on your plan’s benefits.
This applies to the following plan types:
- Plans purchased through Blue Shield of California directly
- Plans purchased through Covered California
- Medicare Supplement plans
- Fully-insured employer-sponsored plans
- Self-insured and flex-funded employer-sponsored plans where the plan sponsor has elected to pay for copays, coinsurance, and deductibles for COVID-19 treatment (These plans are not required to cover these costs)
To find out which plan you have, if your employer is continuing to cover treatment costs, or to ask other questions, call the Member Services number on your member ID card. For details about your out-of-pocket costs for treatment, please check your plan policy or Evidence of Coverage.
If I paid out of pocket for COVID-19 treatment that was received between March 1, 2020, and February 28, 2021, what do I need to do?
First, call Member Services at the 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, Member Services 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 also have access to Teladoc, Heal™, or NurseHelp 24/7℠ 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.* Login to find out what options are available to you.
Doctors within your plan’s network may have virtual visits available.
Varies by plan. Standard office visit copay may apply.
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.
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 Evidence of Coverage or plan documents for information regarding standard out-of-pocket costs for your plan. You can also log in to your online account or call Member Services at the number on your ID card to learn what benefits your plan covers.
What if I seek care from an out-of-network provider for COVID-19? Will it be covered?
In the case of a medical emergency, care provided by network and out-of-network providers will be covered for all plans.
Outside of an emergency situation, you should seek care from 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 network and out-of-network copays, coinsurance, and deductibles for COVID-19 covered treatment benefits during this time.
However, it’s important to note that out-of-network providers may charge more than the covered benefit amount. In that case, you may be responsible for paying the difference.
For HMO plans that do not have an out-of-network benefit, there is no coverage for non-emergency COVID-19 treatment received from out-of-network providers.
Also, since out-of-network treatments are not a covered benefit, the cost-sharing waiver for copayments, coinsurance, and deductibles would not apply in these situations. Therefore, you will be responsible for paying all costs.
Be sure to seek non-emergency care from in-network providers if you have an HMO plan.
What if I need to refill my prescriptions?
If you are worried you might run out of prescribed medications, Blue Shield of California allows early refills on your prescriptions as long as there are refills available. This applies to all members with pharmacy benefits through Blue Shield.
If you have specific questions about the medicine you take, call the Member Services 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.
Most members can order a 90-day supply of maintenance medications through our mail service pharmacy, CVS Caremark®, with no delivery fee. To review your pharmacy benefits, log in to your online account and call your doctor to switch to a 90-day prescription.
How can I continue seeing my mental health care provider?
If you are currently seeing a mental healthcare provider, you can continue to see 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 new 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.