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 (including Teladoc)
- In a doctor’s office
- At an urgent care center
- 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.
What if I need treatment for COVID-19?
There are no prior approvals needed for COVID-19 treatment. Blue Shield will waive copays, coinsurance, and deductibles for COVID-19 treatments received between March 1 – December 31, 2020. 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, call the customer service number on your member ID card.
If I paid out of pocket for COVID-19 treatment that took place between March 1 and December 31, 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?
If you have a fever, cough, feel short of breath, or are experiencing other symptoms of COVID-19 as identified by the CDC, we suggest using a virtual care option such as Teladoc, NurseHelp 24/7SM, or the Nurse Advice Line before seeking in-person care. You can also check to see if your primary care physician is offering telehealth services. This will help reduce the risk of spreading the virus. If your doctor or nurse recommends testing for COVID-19, they can tell you where to go to get tested.
Not all plans have access to these services.
Talk to board-certified doctors 24/7 by phone or video.
(800) 835-2362 [TTY: 711]
Varies by plan, see details below.*
NurseHelp 24/7 or
Nurse Advice Line
Get health advice 24/7 from a registered nurse over the phone.
Call (877) 304-0504.
Teladoc access and out of pocket costs vary by plan.*
For these plans, members have $0 copays for all visits always*:
- Trio HMO plans
- Tandem PPO plans
- Medicare Supplement Plan G Extra
For these plans that include regular access to Teladoc with standard copays or coinsurance, members have $0 copays for all visits extended through December 31. After December 31, standard out-of-pocket costs will apply*:
- All other HMO plans (not Trio)
- All other PPO plans (not Tandem)
- High Deductible Health Plan (HDHP) plans
For self-insured employer-sponsored plans that include Teladoc access, out-of-pocket costs varies by plan. * Please note that not all self-insured employer-sponsored plans include access to Teladoc.
These plans were granted temporary access to Teladoc through December 31 with $0 copays through temporary access period:
- IFP Grandfathered plans
- All other Medicare Supplement plans (not plan G Extra)
Heal provides on-demand house calls in select zip codes. During the coronavirus (COVID-19) pandemic, all initial Heal appointments will 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.
PPO and Trio HMO plans include access to Heal. Heal will tell you about any costs associated with your visit upfront, so there are no surprises. If you have an Access+ HMO or Medicare Supplement plan, although Heal is not a covered benefit with your plan, you can still access their services, but will have to pay all costs out-of-pocket. See if Heal is available for you.
* Please refer to your Evidence of Coverage or plan documents for information regarding standard out-of-pocket costs for your plan. You can also call Member Services at the number on your ID card or log in to your online account to see 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 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.
What if I continue seeing my mental health care provider?
If you are currently seeing a mental health care 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.
Questions about medical or prescription coverage?
Call the number on your member ID card.