Premera Blue Cross Response to COVID-19

  • Premera Blue Cross is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak.

    Updates as of May 11, 2023

    The federal Public Health Emergency (PHE) ends on May 11, 2023. See PHE section for details.

    For general questions about COVID-19:
    Washington State Department of Health
    Centers for Disease Control and Prevention

    If you have health plan questions not covered in these resources, call our customer service team at the number on the back of the member ID card, or your assigned account manager.

    We’ll be updating the following FAQ as additional information is available.

    COVID-19 Key Dates

    COVID-19 Coverage
    See related section for more information about health plan coverage.    		 End Date
    Cost share waivers for FDA-approved COVID-19 diagnostic testing other virus/respiratory testing tied to a COVID-19 diagnosis (federal Families First Act and Washington State OIC mandate) May 11, 2023*
    Antibody tests covered when done in an inpatient setting; late illness onset, or outpatient inflammatory syndrome in children.  May 11, 2023.
    Allowance for zero deductible/cost sharing for telehealth visits for HSA accounts. December 31, 2024.
    Medicare Advantage members: cost shares waived for the healthcare provider visit and FDA-authorized COVID-19 diagnostic test for members who meet criteria for testing (CMS guidance) May 11, 2023

    Ending the Public Health Emergency (PHE) for COVID-19

    Is the public health emergency (PHE) for COVID-19 ending? Yes. On January 30, 2023, the Biden administration announced that the PHE for COVID-19 is ending on May 11, 2023. This gives the government and others impacted 90 days to wind down current mandates set under the PHE.
    What is a public health emergency? With the declaration of a public health emergency, the federal government is allowed to access funding to prevent, prepare for, and respond to a disease emergency. It waives certain requirements and allows for new mandates to be established in response to the emergency.
    What does the end of the public health emergency mean? The end of the PHE means that most of the mandates under the current PHE for COVID-19 end on May 11, 2023. This could result in a loss of coverage for some people, or increased costs associated with COVID-19 for others.
    Will I have to pay for COVID-19 vaccines and boosters now? COVID-19 vaccinations will be at no cost for people with preventive care benefits after May 11, 2023.
    What about the cost of vaccines? While vaccinations will continue to be free for most members, the cost to insurers (and self-funded employers) will increase. Under the PHE, only the cost of administering the vaccine was allowed to be billed. This was typically around $25 per shot. With the end of the PHE, the federal government will no longer buy COVID-19 vaccines. The cost of the vaccines will now revert to commercial prices, which could range from $82 to $130 per dose. This cost would be borne by self-funded employer groups and health insurers.
    Will the cost of COVID-19 treatments continue to be at no cost? Those with private insurance have not been charged for monoclonal antibody treatment since they were prepaid by the federal government, though patients may be charged for the office visit or administration of the treatment. But that is not tied to the public health emergency, and the free treatments will be available until the federal supply is exhausted. The government has already run out of some of the treatments so those with private insurance may already be picking up some of the cost. We don’t know what the commercial price will be for monoclonal antibody treatments.
    Can I still get free at-home COVID-19 tests? Under the PHE, people could get up to 8 at-home COVID-19 tests per month. That ends on May 11, 2023, meaning any at-home tests after that time will be at cost for the member.
    I'm a self-funded employer. What can I expect? The end of the PHE means that the federal government is no longer purchasing COVID-19 vaccines for the public. Monoclonal antibody treatment supply, also purchased by the federal government, is running low. That means that public, or commercial, pricing will now apply for vaccines and treatments. We don’t yet know the actual commercial price but have seen reports indicating a cost between $82 to $130 per shot. We don’t yet know of any commercial pricing for treatments.

    COVID-19 vaccines

    Note: We’re updating our vaccine FAQs as information becomes available. Information about vaccines and distribution will continue to evolve.

  • New bivalent bivalent vaccines are available from Moderna and Pfizer. Bivalent boosters target both the original COVID-19 virus but also the newer Omicron related variants.

    To be eligible, you must have received your first full dose before receiving an additional dose. The Pfizer bivalent vaccine is available for those 6 months and older. The Moderna bivalent vaccine is available for those 6 months and older.

    Two other vaccines are available: Novavax for those 12 years and up and Janssen for those 18 and up. These do not use the same mRNA base as Pfizer and Moderna.

    Janssen COVID-19 vaccine is only recommended for certain individuals. Read the CDC information about appropriate use of the Janssen vaccine.

    Currently unknown. Some scientists think eventually people may get regular COVID-19 shots like annual flu vaccinations. But researchers will need to study how long protection from the current boosters lasts.

    The CDC, and many medical practitioners, are strongly recommending everyone get a flu shot this year. With the flu almost non-existent last year due to the stay-at-home orders, masking and handwashing, many are expecting this flu season to come back strongly. According to the CDC, it is safe to get both your COVID-19 vaccine and the flu vaccine at the same time.

    Both are contagious respiratory illnesses, but there are differences. The CDC has detailed information on the differences in signs and symptoms. An easy-to-read graph is also available.

  • Frequently asked questions about COVID-19 and health plan coverage

    Group eligibility and premiums questions

  • On April 28, 2020, the U.S. Department of Labor's (DOL) Employee Benefits Security

    Administration (EBSA) and the Internal Revenue Service (IRS) issued a rule and guidance, the EBSA Disaster Relief Notice 2020-01, which extended certain health care benefit deadlines.

    The EBSA Relief notice of 2020-01 extended FSA claim submission periods under the public health emergency. With the end of the PHE on May 11, 2023, the claim submission period will end. Per the notice, there is an outbreak period of 60 days after the end of the PHE. On July 11, 2023, FSA claims submissions will revert back to a plan's determined "disregarded period." In most cases, a plan's "disregarded period" is 90 days. This is the timeframe that a member may submit FSA claims after the end of the plan year. Check your benefit plan for your specific "disregarded period."

    The U.S. Department of Labor (DOL) along with the Internal Revenue Service (IRS) issued a joint final rule extending specific deadlines affecting COBRA continuation coverage and payments, special enrollment periods, claims for benefits, appeals of denied claims, and external review of certain claims.

    With the end of the COVID PHE on May 11, 2023, we are required to allow a run-out period of 60 days. These timeframe extensions will now end on July 10, 2023.

  • Virtual care benefits

  • Yes. Premera-contracted providers can provide telehealth services to the extent allowed by their licensure. Members can check with their current provider office to see if they offer telehealth services.

    Cost share waivers for telehealth visits ended December 31, 2020.

  • COVID-19 benefits and testing

  • The new drugs for treating COVID-19 are currently covered under our policy as Emergency Use Authorized (EUA) drugs may be accepted per Premera policy 05.01.549: Off-label Use of Drugs and Biologic Agents.
    Note: These drugs are covered under mandate and the public health emergency (PHE) and could change.

    While Premera may not cover this drug in certain circumstances, it is not restricted at this time when acquired through government distribution systems.

    Because these drugs are approved only through EUA, our stance on this drug could change based on FDA PHE changes, FDA approval status, or additional data as it becomes available.

    Test-to-treat antivirals began distribution by HHS on March 7, 2022. Oral antivirals may only be provided when prescribed by a qualified healthcare provider. Only pharmacies with in-store clinics are eligible for distributing these medications. Get more information and to find a test-to-treat location. 

     

    Cost share waivers for all COVID-19 treatment (both inpatient and outpatient) ended on June 30, 2021.

    Treatment costs are still covered as a medical expense.

    The rules implemented on January 10, 2022, requiring coverage of over-the-counter home COVID test kits will end on May 11, 2023. Test kits purchased prior to May 11, 2023, online or through a network pharmacy will be covered. Kits purchased after May 11, 2023, will no longer be covered.

    The mandate requiring cost share waivers for COVID testing will end on May 11, 2023. After May 11, 2023, all lab tests for COVID will revert to standard plan benefits, which may include cost shares.

    Premera will reimburse for antibody tests that are for the purpose of supporting a COVID-19 diagnosis as part of the treatment or management of a patient’s medical condition. Member cost shares may apply. We will not cover antibody tests that are for other purposes, such as back-to-work testing. We believe that this approach meets applicable federal law and regulations governing coverage for COVID-19 testing.

    Over the counter home test kits will be covered through May 11, 2023. Test kits purchased after May 11, 2023, will not be covered.