Coverage and support
We remain committed to ensuring our members have access to COVID related care, and that care remains as affordable as possible.
Vaccines
The COVID-19 vaccine is available at no cost to all members when administered by an in-network provider.
Testing and treatment
COVID-19 testing and treatment are covered based on your individual health plan. Members should login to Blue Connect℠ or call the number on the back of their member ID card to learn more about testing and treatment coverage.
Telehealth
Telehealth services for behavioral health, primary care and outpatient visits are covered under our current telehealth policy.
COVID-19 vaccines: what you need to know
According to the North Carolina Department of Health and Human Services (NCDHHS), vaccines are proven to help prevent COVID-19 and are effective in preventing hospitalization and death. Vaccines are based on years of research and are safe and effective. They are an important tool to help stop the spread of COVID, and we encourage everyone, age 6 months and older, to get vaccinated.
COVID vaccines that are FDA approved, including for emergency use authorization (EUA), are covered at 100% when members receive the COVID-19 vaccine at an in-network provider.
If members receive the COVID vaccine at an out-of-network provider, they may be responsible for the cost of the vaccine and / or vaccine administration based on their individual preventive care benefits.1
Visit myspot.nc.gov for the most up-to-date information about COVID-19 vaccines and boosters.
Getting tested
COVID-19 tests that are administered by a provider, consistent with Centers for Disease Control (CDC) guidance and cleared, approved or given EUA by the Food and Drug Administration (FDA) are covered based on each individual’s insurance plan, and members may be responsible for a portion of their costs1 to include copayments, coinsurance and deductible amounts.
- Commercial members can purchase over-the-counter (OTC) COVID-19 tests with their health flexible spending arrangements (health FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), or Archer medical savings accounts (Archer MSAs).
- Eligible Medicare Advantage members may use an OTC card to purchase OTC COVID-19 tests.
- Medicaid will continue to cover the cost of all FDA-approved COVID-19 tests, including home tests, with no member cost-share for Healthy Blue members through September 30, 2024.
COVID-19 testing resources
Receiving treatment
COVID-19 treatments are covered based on each individual’s insurance plan.1 Members may be responsible for a portion of their treatment costs, including copayments, coinsurance and deductible amounts.
According to the NCDHHS, anyone who has symptoms of or has been exposed to COVID-19 should get tested as soon as possible.
Find out where you can get treatment by visiting the North Carolina Health and Human Services website.
To find COVID-19 medications, go to the Department of Health and Human Services’ medication location tool.
For up-to-date information on COVID-19 treatment, the CDC is the best resource.
Frequently asked questions
Up-to-date information and resources for our members can be found at:
- North Carolina Department of Health and Human Services (NCDHHS)
- COVID-19 Testing and Treatment
- COVID-19 Vaccines
Testing
- Find a COVID-19 Test in North Carolina
- Centers for Disease Control (CDC) Testing for COVID-19
- At-Home Testing Information (Spanish)
Vaccines
- Find a COVID-19 Vaccine in North Carolina
- COVID-19 Vaccines Beyond North Carolina
- Centers for Disease Control (CDC) Vaccine Guidance
- Food and Drug Administration (FDA) Vaccine Information
Treatment
If members receive COVID-19-related services, including testing, treatment or the vaccine, at an out-of-network provider, they may be responsible for the cost of the treatment, test, vaccine and/or administration based on their individual benefits.
When the federal vaccine supply runs out, vaccine providers may begin billing patients for any amount not covered by their health plan.
If members have specific questions about coverage, we encourage them to contact Customer Service through Blue Connect℠ or by using the number on the back of their insurance card.
Effective May 12, 2023, Blue Cross NC and ASO groups will cover both the cost of the vaccine and vaccine administration at 100% when members receive the COVID-19 vaccine at an in-network provider as part of our preventive care services.
If members receive the COVID-19 vaccine at an out-of-network provider, they may be responsible for the cost of the vaccine and/or vaccine administration based on their individual preventative care benefits.
The federal government has invested in a large supply of COVID-19 vaccines and will continue to cover the cost of the COVID-19 vaccine until that supply is exhausted.
COVID-19 vaccines given at pharmacies are covered for Blue Cross NC members, as part of our preventive care services, and reimbursement will be determined based on whether the provider is in-network or out-of-network.
Effective May 12, 2023, COVID-19 tests administered by a provider that are consistent with CDC guidance and has been cleared, approved or given emergency use authorization (EUA) by the FDA are covered based on each individual’s insurance plan, and members may be responsible for a portion of their costs to include copayments, coinsurance and deductible amounts.
For more information on testing and how to find a COVID-19 test, visit NC Department of Health and Human Services.
Effective May 12, 2023, members will be responsible for the cost of over the counter (OTC) COVID-19 tests and can pay or be reimbursed under health flexible spending arrangements (health FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), or Archer medical savings accounts (Archer MSAs) because the cost to diagnose COVID-19 is an eligible medical expense for tax purposes.
Eligible Medicare Advantage members may use an OTC card to purchase OTC COVID-19 tests.
Medicaid will continue to cover the cost of all FDA-approved COVID-19 tests, including home tests, with no member cost-share for Healthy Blue® members through September 30, 2024.
Commercial members can purchase over-the-counter (OTC) tests with their health flexible spending arrangements (health FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), or Archer medical savings accounts (Archer MSAs).
COVID-19 tests do not need prior approval. That means your doctor doesn’t need to ask us for approval before you’re tested for COVID-19.
COVID-19 treatments are covered based on each individual’s insurance plan, and members may be responsible for a portion of their treatment costs to include copayments, coinsurance and deductible amounts.
Blue Cross NC Medicare Advantage members will continue to be covered under the Part B preventive vaccine benefit when receiving monoclonal antibodies until the end of the calendar year that the EUA declaration ends. Blue Cross NC Medicare Advantage members will be responsible for cost sharing when receiving treatment at an out-of-network facility, as specified under the plan benefit, beginning on June 10, 2023. COVID-19 treatment is covered with no cost-sharing for Healthy Blue® members through September 30, 2024.
Blue Cross NC is currently covering telehealth services for behavioral health, primary care and outpatient visits, which accounted for more than 97% of telehealth claims received during the last two years.
The policy applies to all Blue Cross NC fully insured and administrative services only (ASO) plans, including the State Health Plan. It does not apply to Blue Cross NC members receiving care from out-of-state providers. Members who do not have a commercial plan can find more information about their telehealth coverage below.
- Medicare Advantage members should review their evidence of coverage.
- Healthy Blue members have certain telehealth visits covered at parity under Medicaid benefits determined by the state.
- Federal Employee Program members can find details in their Service Benefit Plan Brochure.
Point of Blue
See the latest information on COVID-19 vaccines, treatments and more in the Point of Blue blog.
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Disclosures:
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If members receive COVID-19-related services, including the vaccine, testing or treatment, at an out-of-network provider, providers may balance bill patients for any amount not covered by their health plan.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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