UPDATED March 2, 2023
At Blue Cross and Blue Shield of Nebraska (BCBSNE), our top priorities are to ensure the health and safety of our customers and employees and provide quality service. We continue to follow the guidance of local and federal health officials regarding the impact of COVID-19.
End of Emergency Declarations
The federal government will end the COVID-19 national emergency and public health emergency on May 11, 2023. This means starting May 12, 2023, standard health plan provisions will apply with cost shares as applicable for COVID-19 testing, related services and vaccine administration.
Please see below for important updated information about benefits for COVID-19 vaccinations, testing and treatment, as well as benefits for telehealth services.
Coverage for COVID-19 vaccinations
COVID-19 vaccines authorized by the U.S. Food and Drug Administration are a safe, effective way to reduce your risk of severe illness. Vaccines are widely available, and BCBSNE encourages members to receive their shot(s).
To view the latest vaccine information, including:
- Approved vaccines
- Age groups that are eligible
- Booster shot eligibility
- Dose requirements
- And more
Visit the CDC’s website.
Administration of the COVID-19 vaccine is covered at 100% through May 11, 2023. Vaccines are considered preventive services under your health plan. Starting May 12, 2023:
- Vaccines administered by an in-network health care provider or pharmacy will be covered at 100%.
- Cost shares will apply as applicable if you receive the vaccine from an out-of-network provider. Note: There is no vaccine coverage from an out-of-network pharmacy.
Grandfathered plans may not cover vaccines at 100%, even from an in-network provider. Please refer to your health plan documents for specific benefit coverage.
Coverage for COVID-19 testing
BCBSNE is continuing to waive member cost-sharing for medically appropriate in-network COVID-19 testing and related services through May 11, 2023. This means members will pay nothing for medically appropriate in-network testing and related services in a telehealth session, doctor’s office, urgent care facility or emergency room.
This waiver of cost shares applies to all fully insured and self-funded groups and individual health plan members, along with those who receive their insurance through our Medicare Supplement and Medicare Advantage plans. Please note that starting May 12, 2023, cost shares will apply as applicable.
Medically appropriate COVID-19 tests must be ordered by a doctor or health care provider for the purpose of diagnosing COVID-19. This includes COVID-19 drive-through test sites or home test kits purchased with an order from a doctor.
Typically, the most appropriate test is the single component rapid (antigen) or PCR test, which tests only for COVID-19. Avoid having multiple or unnecessary tests, including large panel tests. Many conditions are tested for in large panel tests, only one of which is COVID-19. These may not be covered under your health plan, and you could be responsible for the entire fee (which could be up to $1,000).
Over-the-counter COVID-19 testing
Test kits that do not require a doctor’s order or a lab to read the results are considered over-the-counter (OTC). There is a $0 cost share for up to eight individual OTC COVID-19 tests per member per 30 days for tests purchased from Jan. 15, 2022, through May 11, 2023. Starting May 12, 2023, standard plan provisions will apply for OTC COVID-19 tests (please note: most health plans exclude coverage for OTC tests). This applies to all fully insured and self-funded groups that use BCBSNE’s pharmacy benefits manager, Prime Therapeutics, as well as individual health plan members. Federal Employee Program (FEP) members: Please visit FEPBlue.org for purchase instructions. People with Medicare should reference the Centers for Medicare and Medicaid Services (CMS) for information on obtaining OTC COVID-19 tests.
All FDA-approved OTC COVID-19 tests are eligible for reimbursement when purchased during the Jan. 15, 2022, to May 11, 2023, timeframe. View the list of eligible tests here. Tests purchased prior to Jan. 15, 2022, are not eligible for reimbursement.
Our pharmacy benefits manager, Prime Therapeutics, has established a preferred network of pharmacies to support members in obtaining at-home tests without member cost share. This network includes approximately 65,000 pharmacies nationwide. These preferred pharmacies can bill OTC COVID-19 tests directly to your insurance, resulting in no cost to you.*
Tests purchased from a non-preferred pharmacy, online retailer or retail store can be submitted for reimbursement through the pharmacy paper claims process for OTC COVID-19 tests. These claims will be reimbursed up to $12 per individual OTC COVID-19 test. Reimbursement includes tax and shipping, if any, as long as the tax and shipping can be readily identified on the receipt. For example, a box that includes two tests would be reimbursed at a maximum of $24 (including tax and shipping). If a large pack of tests is purchased for multiple members, a claim form is required for each member, and they may use the same receipt.
COVID-19 testing for public surveillance or employment purposes is not covered. This includes testing for work, school, travel and other public surveillance reasons, unless reimbursement becomes required by law.
*Some pharmacies may not be able to bill your insurance directly for OTC COVID-19 tests. Members should check with their pharmacy on its policies regarding OTC COVID-19 tests. If pharmacies are not able to support direct billing, please keep your receipt and use the pharmacy paper claims process for OTC COVID-19 tests to request reimbursement.
Coverage for coronavirus treatment
As of Jan. 1, 2021, BCBSNE began applying member cost shares to treatment of COVID-19. Self-funded groups that were covering treatment of COVID-19 without member cost shares could extend that coverage past Dec. 31, 2020. Employees of self-funded groups should check with their employer to find out about their cost shares.
Coverage for telehealth visits related to diagnosing COVID-19
Member cost shares will continue to be waived through May 11, 2023, for all in-network telehealth visits directly related to diagnosing COVID-19. Starting May 12, 2023, cost shares for in-network telehealth visits directly related to diagnosing COVID-19 will apply.
We encourage you to reach out to your primary care provider to learn about their telehealth capabilities. You can also register to use services provided by BCBSNE’s preferred telehealth provider, Amwell. To do so, please follow the instructions found on NebraskaBlue.com/Telehealth.