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 September 20, 2023

    There are new COVID vaccines available. Find out more, including where to get your vaccine, below.

    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.

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

    The public health emergency (PHE) for COVID-19 ended. On January 30, 2023, the Biden administration announced that the PHE for COVID-19 is ending on May 11, 2023. The end of the PHE means that most of the mandates under the current PHE for COVID-19 ended on May 11, 2023.
    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. 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? Treatment for COVID continue to be covered and cost shares may apply.
    Can I still get free at-home COVID-19 tests? Free at home tests are no longer covered by Premera. However, the federal government will begin providing free tests to consumers on September 25, 2023. Visit Covidtests.gov to order your free kits.
    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 or treatments. We don’t yet know the actual commercial price but have seen reports indicating a cost between $82 to $130 per shot.

    COVID-19 vaccines

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

  • On Tuesday, September 12, the US Centers for Disease Control and Prevention approved two mRNA vaccines, from Pfizer and Moderna, for those 6 months and older. The updated Novavax vaccine is still under review, but the current formulation of the Novavax COVID vaccine is still available.

    The recommendations include:

    - at least one dose of an updated mRNA vaccine against Covid-19 vaccine this year for those ages 5 and up.

    - for those 6 months through 4 years, who may be getting their vaccines for the first time, two doses of a Moderna vaccine and three doses of a Pfizer Covid-19 vaccine, with at least one of the doses being an updated 2023 shot are recommended.

    - for people who are moderately or severely immunocompromised should have had at least three doses of Covid-19 vaccine, with at least one of those doses being an updated shot. They also have the option to get an additional updated vaccine later in the year.

    Under the terms of the Affordable Care Act, people with commercial health insurance plans through the government or their employer can receive vaccines at no cost.

    The original Novavax vaccine is still available for those 12 years and it doesn’t use the same mRNA base as Pfizer and Moderna.

    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. 

  • 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.

  • COVID-19 treatment 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. 

     

    Treatment costs are still covered as a medical expense. Cost shares may apply.

    The federal government will begin offering free COVID test kits beginning September 25, 2023. Visit Covidtests.gov to order your free kits.

    Over-the-counter COVID-19 home test kits may be covered under your health savings plan. Check your benefits to determine if you are covered.