COVID-19 Coverage for Members

Vaccines and Boosters | Tests and Testing Sites | Medical Care Options | Mental Health Services | About COVID-19 Costs | Prescription Coverage

Your health is always our priority. Your Blue Cross and Blue Shield of Texas (BCBSTX) health plan gives you benefits that allow you access to the care you need during the COVID-19 pandemic.

With a BCBSTX health plan, you have access to care for COVID-19 related health issues. Use the doctors, labs and facilities in your BCBSTX health plan’s provider network for:

• Vaccines and boosters
• Tests to diagnose COVID-19. This includes over-the-counter, at-home testing beginning Jan. 15
• COVID-19 testing-related doctor’s visits
• COVID-19 treatment

COVID-19 Vaccines and Boosters

With a BCBSTX health plan, you have access to any FDA-approved COVID-19 vaccines and boosters, often at no cost to you. Talk with your doctor if you have any questions about the vaccines. Find out where to go to get vaccinated.

While most plans cover COVID-19 vaccines at no cost, some self-funded groups do not cover preventive services, including COVID-19 vaccines. If you are unsure what your plan covers, contact your company’s benefits administrator or call BCBSTX Customer Service at the number listed on your member ID card.

Testing and Testing Sites

Getting Tested

If you think you may have the virus or have been exposed to someone who has it:

• Call your doctor right away. Your doctor can order a COVID-19 diagnostic test and coordinate your testing at an in-network lab. 
• If you don’t have a primary care doctor, we can help you find one. Call us at the Customer Service number listed on your BCBSTX member ID card.
• Find an in-network doctor by logging in to Blue Access for Members^SM or downloading the BCBSTX app¹ to use our Provider Finder^®.

Testing sites:

Not all testing sites are the same. To make sure the associated costs for getting diagnostic tests are covered by your BCBSTX plan:

• Find out if the testing provider is in your health plan’s network. Some testing locations may not be in your health plan’s network, particularly if they aren’t part of a medical group or facility.
• Ask your doctor to refer you to an in-network testing site. Some labs and hospitals may not provide testing without a doctor’s order.
• Find out if the testing site is charging a separate/additional fee to give you the test, and exercise caution if visiting a non-State regulated or out-of-network “pop-up” testing site which may not have the same standards or billing practices as an in-network provider with your health plan. 

At-home testing:

• If you have employer coverage, or an individual or family plan, we will be covering FDA-authorized over-the-counter COVID-19 tests for diagnosing COVID-19 through your BCBSTX/Prime Therapeutics^® pharmacy benefits. If you use a pharmacy in Prime’s network, you should not have to submit a separate claim for reimbursement. We will cover FDA-authorized over-the-counter diagnostic tests purchased on or after January 15, You will be reimbursed up to $12 per test, up to 8 tests every 30 days per person. (For example, you can purchase 4 boxes that include 2 over-the-counter COVID-19 tests.)
• Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered.
• You can also request free OTC tests through the federal government’s site. These tests do not count toward the 8 tests per covered member every 30 days under your BCBSTX coverage.
• If you aren’t sure if a test kit is FDA-authorized, ask your pharmacist for help.
• If an in-network pharmacy can’t submit your claim electronically, you can submit a claim for reimbursement.
• If you don’t have pharmacy benefits with BCBSTX/Prime, please contact your health plan administrator for more information.
• Take your test to the pharmacy counter to pay for your test. 
• Medicare: Over-the-counter diagnostic tests are not covered at this time. COVID-19 tests ordered by a health care professional continue to be covered at no cost under your medical benefits. 

Medical Care Options

If you think you’ve been exposed to COVID-19, you may want to get tested even if you don’t have symptoms.

To start, call your doctor’s office. Your doctor will help guide your care.

Your doctor’s office may provide testing services, or they can refer you to an in-network testing site.

If you test positive for COVID-19, follow up with your doctor’s office so they can plan next steps.

You should also call your doctor if you start having symptoms of COVID-19. Your doctor can determine what you have, even if it isn’t COVID-19, so that you get the care you need.

Telehealth is a convenient way to get medical care without leaving home. Your doctor may offer virtual visits by phone or video chat, or you can use another telehealth provider covered by your health plan.

Telehealth benefits may differ based on your plan. Call the Customer Service number listed on your BCBSTX member ID card if you have questions about your coverage.

Our Bilingual 24/7 Nurseline² is also here to discuss any health concerns and can guide you if you think you’ve been exposed to COVID-19 or have symptoms. Nurses are available 24 hours a day, 7 days a week.

• Call: 1-800-581-0368

Seek emergency medical care immediately if you have:

• Trouble breathing
• Persistent pain or pressure in the chest
• Confusion
• Inability or difficulty waking or staying awake
• Bluish lips or face

For those times when you can’t get in to see a doctor and it’s not an emergency, you can visit an in-network urgent care center. They offer primary care services like your doctor, and the wait time can be much shorter than an ER visit. They can let you know if you need to go to a hospital.

Mental Health Services

Coping with the stress and anxiety of COVID-19 can be overwhelming. Remember to take care of your mental health. Your health plan covers mental health services, including counseling.

• If you need help, call your primary care doctor. They may be able to see you without you having to leave home, using telehealth. Or they may refer you to someone who specializes in mental health counseling and treatment.
• Many BCBSTX health plans include 24/7 phone access to licensed mental health care specialists as part of the mental health coverage. The number may be listed on your member ID card, or you can call Customer Service to find out if you have this benefit.

About COVID-19 Costs

Your BCBSTX health plan covers a lot of the costs of COVID-19 testing, the vaccine, boosters and treatment.

For most plans*:

• Vaccines are covered at no cost.
• If you have employer coverage, or an individual or family plan, we will cover FDA-authorized over-the-counter diagnostic tests purchased beginning Jan. 15 through your BCBSTX/Prime pharmacy benefits. Coverage includes up to 8 tests every 30 days per person. If you aren’t sure if a test kit is FDA-authorized, ask your pharmacist for help. If you don’t have pharmacy benefits with BCBSTX/Prime, please contact your health plan administrator for more information.
• Lab tests to diagnose COVID-19 are covered at no cost. (However, tests for things like return to work or school, travel and recreational event requirements may not be covered.)
  
• Testing-related visits are covered at no cost to you if you see a primary care provider in your health plan’s network, either in person or using telehealth.
• Treatment for COVID-19 is covered by your health plan, meaning copays, deductibles and cost-sharing will be applied as outlined in your benefits. If you are treated by a provider not in your health plan’s network, or for which you were not referred by your HMO Primary Care Physician, you may be responsible for all of your treatment costs except in the case of an emergency.

If you are unsure what your plan covers, contact your company’s benefits administrator or call BCBSTX Customer Service at the number listed on your member ID card.

Remember to use your BCBSTX member ID card for your doctor’s visit and testing to help with the reimbursement process.

Prescription Coverage

It’s important that you have your medicine on hand when you need it. Make sure you keep your refills current and reach out to your doctor before the last refill runs out. Your plan also may include the option to get up to a 3-month supply of certain drugs.

Many drug stores may offer delivery options. If part of your plan, you can also sign up online or call the number on your BCBSTX member ID card for mail-order delivery of 90-day supplies with the home delivery program³.

Talk with your doctor or pharmacist about your options. Remember, your care is always between you and your doctor.

¹To download the app, text BCBSTXAPP to 33633 or search for BCBSTX in the Apple App Store or Google Play. Message and data rates may apply.

²The 24/7 Bilingual Nurseline may not be available with all plans. Check your benefits booklet for details.

*Grandfathered plans may not cover the cost of vaccines, including the COVID-19 vaccine.

If you are unsure what your plan covers, call BCBSTX Customer Service at the number listed on your member ID card.

³Blue 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.