COVID-19 coverage facts for employers

The effects of COVID-19 continue to make an impact on public health nationwide. Check out this resource for general information about COVID-19 coverage for your employees.

Please contact your account executive or producer with questions.

Benefits and coverage

Vaccines

COVID-19 vaccines are covered by all Capital Blue Cross health plans that include preventive care services.

Effective September 12, 2023, the federal government transitioned COVID-19 vaccines to the commercial market. This means that the cost of COVID-19 vaccines is now paid by health plans, including by self-funded groups that cover preventive services.

Our flu, COVID-19, and RSV vaccine FAQ offers more details about what your employees should know about preventive vaccines.

COVID-19 test coverage

Diagnostic tests

Diagnostic tests will be covered according to the plan’s benefit design. Any applicable member cost share will apply. Standard payment guidelines for OON network providers apply.

Provider visits that result in COVID-19 testing

Office, urgent care, or emergency room visits are covered with applicable member cost share according to the member’s benefit plan.

Over-the-counter (OTC) tests

OTC tests through the medical or pharmacy benefit are not covered.

Inpatient treatment for COVID-19

A member’s cost share for in-network and out-of-network inpatient COVID-19 treatment currently applies based on their benefit plan design.

Oral antiviral and monoclonal antibody treatment

Our medical policies will delineate medical necessity of treatment related to COVID-19. Some services that were covered by regulation during the COVID-19 public health emergency (which ended on May 11, 2023) may not be considered medically necessary and may not meet coverage criteria.

Timeframes for claims and appeals

U.S. Department of Labor guidance issued in February 2021 requires health insurers to extend timeframes for the submission of claims or the submission of an appeal by members for one year from the date the company-stated deadline would have normally expired or 60 days after the COVID-19 public health emergency (PHE) ends (whichever occurs earlier). The PHE ended on May 11, 2023.

Beginning July 11, 2023, we restored the application of the pre-PHE timeframes for claims and appeals.

A claim or appeal submitted on or after July 11, 2023 must be within the number of days allowed for a claim or an appeal as specified in a member’s Benefits Booklet and on the back of any Explanation of Benefits (EOB) statements they receive.

Support for employees

Our experiences during the COVID-19 pandemic increased awareness about how important it is to have access to behavioral health support when needed.

Capital Blue Cross members can call the behavioral health number on their ID card (TTY: 711) for 24/7 support to answer questions about benefits, available services, and finding providers. They can also find more information about their benefits by logging into their secure account. Capital Blue Cross’ network of behavioral health providers includes:

  • Psychiatrists
  • Psychologists
  • Counselors
  • Marriage/family therapists
  • Clinical social workers
  • Alcohol/drug addiction counselors

Additional resources

It’s still essential to take steps to prevent COVID-19 and other illnesses. Visit our preventive healthcare services page for details on services that can keep members healthy and help them detect issues when they are most treatable.

For more guidance about COVID-19, check out these websites:

The information on this page is intended to provide general information for your reference. Capital Blue Cross does not provide medical advice. Please consult your legal and human resources counsel for information specific to your business. Capital Blue Cross does not assume any liability associated with your use of, or reliance on, any of the suggested guidance provided here.