This page may have documents that can’t be read by screen reader software. For help with these documents, please call 1-800-975-6314.
Blue Cross and Blue Shield of Texas (BCBSTX) health plans cover medically necessary health benefits, including physician services, hospitalization and emergency services.
In addition, we have put in place working solutions to help our members get the care they need during these uncertain times.
With a BCBSTX health plan, our members have access to care for COVID-19 related health issues. Members can use doctors, labs and facilities in their BCBSTX health plan’s provider network for:
In response to the pandemic, BCBSTX made some temporary changes impacting coverage for various services. Some of these changes will end with the end of the public health emergency. Some may end sooner, depending on the member’s plan. To understand what is currently in effect, please view effective coverage dates.
With a BCBSTX health plan, members have access to COVID-19 vaccines at no cost to them. Members should talk with their doctors about when they should get vaccinated once available and discuss any questions they have about the vaccines.
While most plans cover COVID-19 vaccines at no cost, some self-funded groups do not cover preventive services, including COVID-19 vaccines. Members who are unsure what their plan covers should contact their company’s benefits administrator or call BCBSTX Customer Service at the number listed on their member ID card.
To make it easier for our members to get the care and treatment they need amid the COVID-19 outbreak, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance, related to testing for COVID-19.
The policy applies to members in these plans:
Cost-share waivers on telehealth or telemedicine services for fully insured group, retail, Medicare (not Part D) and Medicare Supplement plans ended on Dec. 31, 2020. That means copays, deductibles and coinsurance now apply.
Telehealth cost-share waivers for fully insured group, retail, Medicare (not Part D) and Medicare Supplement plans ended on Dec. 31, 2020. That means copays, deductibles and coinsurance now apply.
Self-funded customers have some choices about how we administer COVID-19 treatment coverage for their employees. Benefits for members of self-funded plans may vary. They should call BCBSTX Customer Service at the number listed on their member ID card for more information.
Members with pharmacy benefits through Prime Therapeutics®** are encouraged to keep refills current and ask for new prescriptions before the last refill runs out.
Many drug stores may offer delivery options. If part of plan benefits, members can sign up for mail-order delivery (up to a 90-day supply of covered non-specialty medications) with the home delivery program.
Members with Group Medicare Advantage and Group MedicareRx (PDP) plans can get 90-day fills through mail order.
For Transfers. Prior authorization from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals and skilled nursing facilities will not be required through Feb. 28, 2021. This will help promote availability of acute care capacity for COVID-19 patients during this public health emergency. It also allows our members to continue to access medically necessary care. Transfers to a behavioral health facility will still require prior authorization.
On Previously Approved Elective Surgeries, Procedures and Therapies. We extended approvals on existing prior authorizations for non-emergent elective surgeries, procedures, therapies and home visits, if the service was provided by Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1, 2020 and June 30, 2020.
Relaxed Eligibility Requirements
Employers can maintain employees who were enrolled as of March 20, 2020 through Sept. 30, 2020, regardless of the eligibility definition stated in their plan or the BPA. This includes reduced work hours, furlough, leave of absence or layoffs. This flexibility does not apply to those who are newly electing coverage via a special enrollment period.
*Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. Myprime.com is an online resource offered by Prime Therapeutics.