Employer, Family & Individual Plan Members

Last Updated on April 18, 2024

Your Health Plan

Yes, if you’re a commercial member and your provider offers this service. We’ll support telehealth visits with providers in our networks who offer this service for members who get their coverage through their employers or get it on their own for themselves and family. This includes visits with your primary care physician, specialists, behavioral health providers, ABA providers, and physical, speech and occupational therapists. This visit will cost you the same as a face-to-face visit with your provider, so any copay or cost-share you would normally have will still apply. If you have this kind of visit with a provider out of your network, they may bill you for the difference between their visit charge and our payment to them.

As of February 2024, the CDC has updated its COVID-19 isolation guidelines to align with recommendations for flu and other respiratory illnesses. If you test positive for COVID-19, you should isolate and/or stay home while experiencing symptoms and return to work or school once you’re feeling better and have been without a fever for at least 24 hours without the use of a fever-reducing medication. Even after returning to work or school, the CDC still recommends exercising caution for at least five days, which includes:

Wearing masks around vulnerable or immunocompromised people
Opening windows to increase fresh air flow

Visit the CDC’s Respiratory Virus Guidance for more information.

We’ll cover FDA-approved or emergency-authorized COVID-19 antibody tests that a network provider orders during an appointment, including during a telehealth appointment, under your health plan’s standard benefits for lab testing. Your share of the costs will depend on the network status of the lab that performs the test and whether your plan includes a copay, deductible/coinsurance, or no out-of-pocket costs for lab testing or if you have a health plan without out-of-network benefits.

Yes. If you’re diagnosed with COVID-19, we’ll cover medically necessary in-network provider treatment at your normal cost share. If you use a provider who’s not in our network, we’ll cover treatment under your out-of-network benefits. That means those providers may bill you for the balance owed after BlueCross pays its allowed amount and you pay your out-of-network deductible and cost share. Marketplace plans don’t include out-of-network coverage except for emergency care. In a true emergency, please go to the nearest emergency room.

Yes. If your provider gives you FDA-approved or emergency-authorized COVID-19 treatments in the hospital or while at their office to help with the symptoms of COVID-19, we’ll cover those at your normal cost share. Any covered prescription drugs your doctor recommends for at-home symptom treatment will have your normal copay or cost share. Over-the-counter medication isn’t covered by most plans. But you may be able to use funds from an FSA or HSA to cover costs of OTC medications.

COVID-19 tests don’t require prior authorization, but some treatments and hospital stays do. If you’re seeing an in-network provider, they usually ask for prior authorization on your behalf. But if you get care from an out-of-network provider, please contact us to see if prior authorization will be required, or to let us help you find care from in-network providers. Marketplace plans don’t include out-of-network coverage except for emergency care. In a true emergency, please go to the nearest emergency room.

Throughout much of the pandemic, we’ve allowed early refills on many prescriptions. On Sept. 1, 2021, we reverted to our standard refill timeline if your pharmacy benefits are covered through BlueCross. However, you can get 90-day fills for many medications to treat chronic conditions. Your plan may also have mail-order benefits if you don’t want to go out to a pharmacy to get your medications.

You usually have one year plus three months to file a claim from the date of service, and 180 days to file an appeal from the date of a benefit decision, like a claim denial. A new rule implemented during the COVID national emergency allowed members to “pause” the deadline during the outbreak period and start counting again once it expired.

Unless you placed a one-year pause that hasn’t yet expired on your claim deadline prior to the public health emergency ending on May 11, 2023, you will have the normal amount of time to file a claim.

COVID-19 and Fraud

Unfortunately, some people are using the threat of coronavirus to defraud others, especially our senior population.

Moms and Babies

Pregnant women are considered to have an increased risk for COVID-19 complications. Women with higher-risk pregnancies may be more at risk. Continue your prenatal appointments so your provider can manage any symptoms you may have.

However, looking at past viruses, like the flu and SARS, the Centers for Disease Control and Prevention warns that pregnant women who contract COVID-19 could be more likely to have severe respiratory problems, like pneumonia. This is because pregnant women already have increased heart rates and diminished lung capacity.

According to the Centers for Disease Control and Prevention, you may have a higher risk of miscarriage or premature delivery if you contract COVID-19.

It’s not clear yet whether cases of newborns with COVID-19 are born infected, or are becoming infected after birth. It’s likely that if you’re infected with COVID-19, your baby will be placed in isolation after birth to prevent the disease from passing from you to them.

Some BlueCross members may have benefits for a home birth with a certified nurse midwife. Home births are recommended only for low-risk pregnancies, and you must have a detailed birthing plan that includes a hospital and doctor, in case of complications. If you’re unsure if your plan covers home births, call us at the Member Services number on the back of your Member ID card.

It’s important to note that licensed and accredited hospitals and birth centers are still safe places to deliver your baby. If you’ve already chosen your delivery provider, talk with them about your concerns to ensure you’re making the right birth choice for you and your family.

No. Even under normal circumstances, NICU babies are at higher risk of getting sick because of their compromised immune systems. The NICU generally recommends that you not take babies in public for at least three months. This includes church and grocery stores. With COVID-19 health risk, taking your baby out in public is even more risky. The best advice is to keep your baby at home and protect them from exposure to all possible viruses, including COVID-19.

In a newborn, a fever of 100.4° F is considered high enough to seek medical treatment in the first two months of your child’s life. As always, double-check the environment to make sure your baby’s temperature is accurate. Wearing extra warm clothes or being bundled in blankets, as well as being in a very warm room or in a hot car, could make their temperature reading higher.

If you’re worried about your baby’s temperature, your safest bet is always to call your pediatrician for advice on next steps.

COVID-19 and Health Accounts

If your employer allows qualifying event election changes, you can update your status if there is a change in the child-care provider. For example, if the provider is no longer providing the care, like when a summer day camp cancels or care is no longer needed, you can reduce or stop the election. Temporary regulations designed to provide COVID relief also allow employers the option to allow mid-year changes for any reason in 2021. Please check with your employer about specific rules about election changes for your plan.

Your Health

The CDC has a coronavirus self-checker on its website that helps you quickly understand which symptoms to watch out for and how to get help. The virus has a wide range of symptoms that include fever, cough, shortness of breath or trouble breathing, chills, repeated shaking with chills, fatigue, muscle pain, headache, sore throat, diarrhea, congestion or runny nose, and new loss of taste or smell.

The first step is to stay home and separate yourself from other people or animals as much as possible. That’ll help keep germs from spreading until you can get tested and advice from a doctor.

Next, check with your county health department to schedule at a free testing site or call your primary care provider. If your doctor thinks you need to be tested, they can give you instructions for where to go for testing if their office doesn’t offer it. Many pharmacies and urgent care centers offer testing.

Other than for testing, please stay at home, wear a mask and isolate yourself from others in your home, if possible.

If you’re up to date with vaccination or had confirmed COVID-19 within the past 90 days:

Wear a high-quality mask or respirator (e.g., N95) as soon as you find out you were exposed and any time you are around others inside your home or indoors in public.
You don’t need to stay home unless you develop symptoms.
Get tested five days after exposure, even if you don’t get symptoms. Start counting from Day 1:
- Day 0 is the day of your last exposure to someone with COVID-19
- Day 1 is the first full day after your last exposure
Watch for symptoms for 10 days following your exposure.
If you develop symptoms, isolate immediately, get tested, stay home until you know your results, and wear a mask around others.

If you’re unvaccinated:

Wear a high-quality mask or respirator (e.g., N95) as soon as you find out you were exposed and any time you are around others inside your home or indoors in public. You don’t need to stay home unless you develop symptoms.
Get tested five days after exposure, even if you don’t get symptoms. Start counting from Day 1:
- Day 0 is the day of your last exposure to someone with COVID-19
- Day 1 is the first full day after your last exposure
Watch for symptoms for 10 days following exposure.
If you develop symptoms, isolate immediately, get tested, stay home until you know your results, and wear a mask around others.

The first step is to stay home and separate yourself from other people or animals as much as possible. That’ll help keep germs from spreading until you can get advice from a doctor.

Next, check with your county health department to schedule at a free testing site or call your primary care provider. If your doctor thinks you need to be tested, they can give you instructions on where to go for testing if their office doesn’t offer it. Many pharmacies and urgent care centers offer testing.

Other than for testing, please stay at home, wear a mask and isolate yourself from others in your home, if possible.

If you test positive, stay home for five days, and wear a mask if you have to be around others in your home. Day 1 of five is the first full day after you got symptoms or when you tested. Wear a mask around others until Day 10.

If you have symptoms:

You can end isolation after Day 5 if you haven’t had a fever for at least 24 hours – without using a fever-reducing medicine – and your symptoms are improving.

If you didn’t have symptoms:

You may end your isolation after Day 5 of a positive test.

If you had severe symptoms:

Isolate for 10 days. Talk to your doctor before ending isolation.

Yes. Providers are following some safety social distancing guidelines, so be sure to call their office before your appointment to know what extra safety steps they’ll want you to follow when you get there. You also should take some personal safety measures, including wearing a mask if you’re not fully vaccinated and making sure you don’t have a fever or any signs of COVID-19 before going in person. If you are vaccinated and do not have any symptoms, be sure to consult the level of risk in your area to see the CDC’s guidelines for mask-wearing. If you have any symptoms or have been exposed to someone with COVID-19, you’ll need to reschedule your appointment.

If you have health issues that put you at higher risk of COVID-19 complications or simply don’t feel comfortable going out in person, many providers are still offering telehealth appointments.

Protecting Yourself and Others

Getting a vaccine and booster are your best protection against COVID-19. Until you’re fully vaccinated, social distancing and wearing a mask are the best ways to protect yourself. Even if you’re vaccinated, the CDC recommends wearing a mask in many situations, depending on the level of risk in your area. Stay up to date on the latest mask guidelines here.

Wash your hands with soap and water frequently, especially if you’re out of your home. Hand sanitizer can help when soap and water are unavailable.

Clean all frequently touched surfaces in your home, car and workspace.

Cover your coughs and sneezes, and immediately throw away the used tissues.

If someone in your house is sick or has symptoms, have them self-isolate away from others in the house. Call their provider for instructions on what to do next.

BlueCross Working for You

No. We’re considered essential, so we’ll remain open. However, we have taken steps to help keep our employees well while ensuring our members see no lapse in service. In early 2020, we transitioned many of our customer service, care management, claims and billing employees to work from home. Since March 16, 2020, the majority of our workforce has been working full time from their homes to allow them to practice social distancing. We’ve not experienced any reduction in service to you, nor do we expect any.