Premera Blue Cross Response to COVID-19

We're here to help support you in keeping our communities safe during the COVID-19 outbreak. We’ll be sending out frequent communications, posting updated information on our websites, and providing links to expert resources for employers, producers, and members.

Premera is extending the 30-day premium grace period to 60 days for our fully insured groups. We’ve also implemented a grace period for OptiFlex monthly funding rates, and ASC Admin Fee only. This grace period extension is in effect until further notice.

This extended grace period is in place to ensure your employees are receiving the care and medications they need during this critical time. Grace period information can be found in your group contract. 

Note: This is a “premium grace period," not a “claims grace period.” This guards against cancellation. Premera will hold medical, dental and vision claims during the unpaid premium period though members will continue to show as eligible in the system. This will also allow members to get their prescriptions filled. 

There are restrictions that generally do not allow carriers to offer premium discounts or waivers to employers. 

Starting March 25, Premera is expanding its telehealth network to include 98point6 and Doctor on Demand. This gives members greater access and addresses the increased demand related to COVID-19. This expanded network is available until June 30, 2020, with the potential to extend the duration based on business and epidemiological considerations.

Who’s eligible for this benefit?

This benefit will apply to members of insured groups, individual, grandfathered, non-grandfathered, associations and OptiFlex. Self-funded plans have the option to participate.

Who's not eligible: Shared admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, Medicare Advantage, and self-funded plans that opt out.

Fully insured plans will be loaded and available on March 25, 2020. Self-funded plans who opt in will be loaded and available by end of day March 26, 2020.

What’s the cost of these new providers to the member? 

Telehealth cost shares will be waived for all in-network providers.  If a telehealth provider charges you a copay, deductible, or coinsurance for telehealth services through June 30, Premera will reimburse you when the claim is processed.

Are brick and mortar in-network offices covered?

Yes. All in-network providers who offer telehealth options are covered under this expansion.

When should I use telehealth services and what can they help me with?

If you’re feeling ill with non-COVID-19 symptoms, you can contact a telehealth provider. Telehealth providers can answer questions, diagnose, and treat acute and chronic illness for non-COVID-19 related symptoms. They can also fulfill necessary prescriptions or order lab tests at local facilities.  

98point6 is a text-based telehealth option available 24/7. Members can connect with a primary care physician right from their phone when it’s most convenient to them. Learn more about 98point6.

Doctor on Demand is an all-in-one technology and services platform enabling next-generation care. This telehealth option connects you with medical professionals through video communications. Learn more about Doctor on Demand.

98point6 uses a flat file through SFTP

Teladoc and Doctor on Demand use the 270/271 process.

Eligibility for fully insured groups were put in place on March 25 and on March 26 for self-funded groups who opted in.

This doesn't apply to shared admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, Medicare Advantage, and self-funded plans who opt out.

Our current leave of absence (LOA) allowance for large and small group standard contracts is up to 90 days. For self-insured and OptiFlex groups, we'll allow them to waive the LOA and actively at work requirements through the end of the COVID-19 crisis. 

No. This could impact a group’s health plan eligibility for all employees and require a full open enrollment period and the plan year to restart. Some employees who waived enrollment may be eligible for individual plans on the state or federal exchanges.

Premera processes eligibility based on information provided by the employer. As long as the employee remains on the eligibility file, they will remain covered. 

Premera processes eligibility based on information provided by the employer. As long as the employee remains on the eligibility file, they will remain covered. 

We're waiving any re-rating rules for all groups (insured, OptiFlex, and self-funded). Groups who fall under an eligibility threshold will be able to maintain their rates through the end of their plan year.

Our standard rules remain which allow for reinstatement during the same plan year without experiencing a waiting period or losing their out-of-pocket accumulators.  For groups whose plan year ends before June 30, we will treat them as if they were coming back within the same plan year.

Premera doesn’t have decision making authority on Continuation of Coverage rules. This is state regulated. Anytime someone experiences a job loss, they may be eligible for individual plans on the state or federal exchanges.

Premera processes eligibility based on information provided by the employer. As long as the employee remains on the eligibility file, they will remain covered.

The minimum aggregate deductible will be applied as defined in the group’s stop loss contract.

All Premera employees are working remotely until further notice. Currently all business processes and functions are operating normally, and we don’t anticipate any changes to our ability to meet our usual standards.

If the situation changes, we’ll be in direct contact to let you know what options are available.

In response to the potential growth of COVID-19 cases, the Washington Health Benefit Exchange announced a limited-time, special enrollment period for qualified individuals who are not insured. Enrollment runs through April 8, 2020, and allows uninsured individuals 30 days to enroll in coverage through Washington Healthplanfinder.  Individuals can enroll through April 8 by calling the Customer Support Center from 7:30 a.m. to 5:30 p.m., Monday through Friday at 855-923-4633; TTY: 855-627-9604, or by contacting a local certified broker or navigator. Individuals who select a plan by April 8 will have coverage starting April 1, 2020. Read the full press release.

The new Families First Coronavirus Response Act requires all group health plans to provide coverage for diagnostic testing, including FDA-approved COVID-19 diagnostic testing products, items, and services related to testing during an office, telehealth, urgent care center or emergency room visit. We have removed the group waivers that were previously in place to comply with this mandate. As additional guidance is issued, a business decision may be made to allow opt-outs of additional criteria.

For commercial, Medicare Supplement, and self-funded or OptiFlex groups who opted in: We're waiving cost shares for members requiring FDA-approved testing for COVID-19. Per the new WA OIC requirements, we’re also waiving in-network copays and deductibles for other virus/respiratory testing tied to a COVID-19 diagnosis. This applies to testing and the related provider visit. All other treatments and services including hospitalizations will be subject to the usual benefits and cost shares. We’ll continue to evaluate guidance and the scope of COVID-19 and adjust as needed.

For Medicare Advantage members: We’re waiving all cost shares for the healthcare provider visit and FDA-authorized COVID-19 testing for members who meet CDC criteria for testing. All other treatments and services including hospitalization are subject to the usual benefits and cost shares.

No. On March 20, the FDA released an alert to consumers warning of "unauthorized fraudulent COVID-19 test kits," which specifically noted that "the FDA has not authorized any test that is available to purchase for testing yourself at home for COVID-19.” Premera doesn’t cover experimental or investigational services.

Yes. Drive-through testing for COVID-19 is covered and cost shares will be waived as they are for in-clinic testing.

Yes. Premera-contracted providers are able to 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. 

For Medicare Advantage members: CMS has loosened guidelines around telehealth services during the COVID-19 Public Health Emergency. Starting March 6, 2020, Premera will cover telehealth visits for Medicare Advantage members billed by any healthcare facility at the same cost shares as an in-clinic visit. The previous requirement for services to be provided in certain types of originating sites and locations has been waived for the duration of the COVID-19 Public Health Emergency.

Virtual care will likely play a critical role as cases continue to rise. Our telehealth vendors are working with network providers on virtual care preparations. This should help alleviate the burden placed on emergency rooms and minimize spread via communal exposure. 

No, telehealth providers don’t issue disability certifications, as they can’t definitively diagnose COVID-19, only likely symptomatology and possible exposure. Current policies limiting excuse notes to 72-hours will not be enforced in situations where COVID-19 guidance recommends isolation for 14 days.

Some telehealth providers have also temporarily waived their refill policy prohibiting the refill of chronic medications beyond twice in a calendar year. Providers will consider clinical appropriateness, patient safety and professional judgement.

Yes. Premera offers Talkspace for all our members. This is an online, virtual behavioral health provider resource. Many local mental health providers are also offering telehealth services. You should check with their provider first, or they can go directly to Talkspace. 

As long as the member is still eligible and has the Blue Cross Blue Shield Global Core program (formerly known as BlueCard Worldwide®) they should be covered outside the United States. Members should look for the suitcase logo on their ID card and can call the number on the back of their card to be connected for services out of the country.

With Global Core, Premera applies the benefits and coverage determination and approves payment. BCBS Core works with the provider in other countries to set up guarantee of payments. Members must call the number on the back of the card to set up a guarantee of payment.

You can access proof of coverage from your Premera.com account. Your online benefit booklet has proof of coverage that can be printed and used for your travel.

We’re urging all members to take precautions to protect themselves and avoid spreading disease to others. Additionally, we ask members to stay informed on the most current information from public health organizations including the CDC, the State Department of Health in Washington, and the World Health Organization (WHO). 

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

We urge members to stay informed on the most current information on COVID-19 symptoms available from public health organizations including the CDC and WHO.

Current indications are that COVID-19 symptoms are similar to flu symptoms which may then progress to cause shortness of breath. Check the Washington State Department of Health website for more information on symptoms, how it spreads, and how to stay healthy.

The WA State Department of Health has the following advice: Individuals at risk of severe illness should stay at home avoiding gatherings or other situations of potential exposures, including travel, church attendance, social events with 10 or more people and cancel elective and non-urgent procedures. The most prudent course of action at this time is to avoid potential exposures, particularly for individuals at risk for more serious complications from the virus due to age or co-morbid conditions.

We encourage members to call their providers if they suspect they’ve been exposed to COVID-19 or if they’re experiencing flu-like symptoms. If you do go to the doctor, make sure to call first so they can prepare for your arrival.

If you have symptoms like a cough, fever, or other respiratory problems, call your doctor first. Do not go to the emergency room. Emergency rooms need to be able to serve those with the most critical needs. If you have difficulty breathing, it doesn't mean you have COVID-19, but you should call 911 if it’s serious.

24-Hour NurseLine or other telehealth services may be included in your benefits and are also excellent resources if you’re concerned about your symptoms. Many providers offer telehealth services by phone or video chat. Ask your provider if they offer these services.

People with flu-like symptoms aren’t being tested for COVID-19 unless they meet certain criteria set by the CDC. The CDC criteria are set as a condition of the FDA-approved emergency use authorization, which allows new tests to be used in emergency situations on high-risk people only.

The criteria has widened to include people who are hospitalized with symptoms that are otherwise unexplained, in addition to testing people with travel history or a close contact with a known case. These criteria may evolve to include more people over time.

This information is not yet available. The CDC and state public health laboratories aren’t billing for COVID-19 tests. However, the U.S. Centers for Medicare and Medicaid Services created a billing code for the COVID-19 test, and a small number of labs have emergency authorization from the FDA for testing. It’s possible other approved labs may bill for this test, but billing may vary by approved lab or facility. There’s also a new diagnosis code for COVID-19. 

We don’t have a full list. Labs are still getting emergency authorization and awaiting test kit deliveries.

Given the nature of the COVID-19 outbreak, seeking in-person medical care, such as going directly to a lab, may lead to further spreading of the virus. Members should contact their doctor or a virtual care provider for guidance on testing.

Yes. We’ve adjusted our “refill too soon” policy for medications. This allows pharmacies to override refill too soon edits during a declared emergency at the pharmacy counter.

90-day refills:

• Most plans have access to mail-order prescriptions. Ask your provider about getting a 90-day supply.
• Medicare Advantage members: Use this mail-order form.
• Medicare Supplement members: If you have a separate Part D prescription drug plan, contact your Part D plan administrator for more info.

Note: Some prescriptions are not eligible for mail order. Check your plan benefits or contact customer service at the number on the back of your member ID card.

Some telehealth providers have also temporarily waived their refill policies prohibiting the refill of chronic medications beyond twice in a calendar year. Providers will consider clinical appropriateness, patient safety, and professional judgement.

Currently, controlled substances are not carved out. Pharmacies can override the refill too soon edit at the point of sale by entering a submission code. The dispensing pharmacist will review the need to override refill too soon rejections on controlled substances (such as opioids and benzodiazepines) by working with the prescriber. 

Yes. The Premera pharmacy network maintains rigorous safety standards for inventory and follows guidance from multiple regulatory agencies (including the FDA, CDC, and U.S. Preventive Services Task Force) to ensure drugs are approved by the FDA for the U.S. market. All drugs approved for use in the U.S. must meet FDA-manufacturing standards to assure quality and product label requirements.

We frequently see drug shortages in the U.S. based on manufacturer issues, raw product issues, etc. We may see new reported shortages based on the COVID-19 impact to Chinese manufacturers. Premera will respond to these shortages the same way we do today, by ensuring the following:

• The pharmacy team will check public and industry resources to identify new shortages that may impact our members.
• We’ll review medical policies to determine if adjustments are needed to ensure access to alternative medications (should we change our preferred drugs or update prior authorization criteria to account for shortages both short and long term).
• Our review processes already account for drug shortages. If a drug we require as first-line therapy is in short supply, we’ll waive this requirement based on market realities and approve coverage when preferred formulary alternatives are in short supply.

We’re also reviewing rejected claims to see if members are getting the medications they need. If we see any drug shortages, we’ll seek other options to meet member needs. We’ll continue to monitor the situation with our pharmacy partners, so members won’t run out of needed medications.

For members who are out of country: Standard Premera plans don’t cover medical evacuation or repatriation to those overseas who may become ill. 

For members within the U.S.: Plans cover ambulance transport for a medical emergency, when a person’s health is in serious danger and an ambulance is the only safe way to get to the closest medical facility equipped to treat their condition. Emergency transport is subject to the usual benefits and cost shares Transport from a hospital capable of treating the patient because the patient and/or the patient’s family prefer a specific hospital or physician isn’t considered medically necessary.

Currently, COVID-19 is treatable at many facilities. In the event a patient is transported to one of these facilities under the direction of the Department of Health and Human Services and is otherwise not covered, we'll review the situation to determine eligibility for benefits

If your child is covered under your health plan, they may be covered for illness while abroad. Call the BlueCard Worldwide Service Center at 800-810-BLUE (2583) to locate doctors, hospitals, or obtain medical assistance services when outside the country.