Over-the-counter COVID-19 tests
As part of our commitment to protect the health, safety, and well-being of our members and their communities, we recognize that access to COVID-19 testing is one tool in the fight against this virus.
One way to get tests is through a federal program offering free at-home COVID-19 tests. Every household in the U.S. is eligible to receive eight free at-home COVID-19 tests.
Health plan coverage
Effective January 15, 2022, we will begin to cover certain FDA-approved over-the counter (OTC) COVID-19 diagnostic tests--up to eight OTC at-home tests per covered individual per 30-day period. Please note that most tests are packaged with multiple tests per package. This coverage is per test, not per package.
We will continue to cover the cost of OTC tests through the end of the national Public Health Emergency (PHE).
Our over-the-counter COVID-19 test FAQ provides more details on this coverage.
COVID-19 vaccines and boosters
- Safety measures like COVID-19 vaccines are making a difference in the fight against the pandemic. People who get a vaccine are at lower risk of serious illness and hospitalization.
- Three COVID-19 vaccine types are now available nationally from Pfizer-BioNTech, Moderna, and Johnson & Johnson. Please check our COVID-19 vaccine FAQ for up-to-date information.
- We’re covering the COVID-19 vaccine from each manufacturer at no cost to members. Vaccines are available for adults and for children ages five and up. If you haven’t received your shot yet, consider getting it — to protect yourself and your loved ones as the virus continues to circulate.
- Find out the benefits of getting a vaccine from the Centers for Disease Control and Prevention (CDC). Use this map to find COVID-19 vaccines near you.
Temporary coverage changes
During the national Public Health Emergency (PHE), currently scheduled to end July 15, 2022, declared by the U.S. Secretary of Health and Human Services, Capital Blue Cross health plans will cover the cost of a COVID-19 diagnostic test without applying member cost share (such as deductibles, copays, and coinsurance) if performed as a result of an individualized clinical assessment, such as a test ordered by a provider or when a provider refers you for a test. We recommend you use MyCare Finder to find an in-network provider that accepts your plan’s benefits. Please keep in mind that member cost share might apply after the end of the PHE.
Under most circumstances and unless deemed medically necessary by a healthcare provider, testing for employment purposes is not covered.
Over-the-counter COVID-19 tests
See the over-the-counter COVID-19 tests for details on this coverage change.
In accordance with statutory guidance, we are waiving the member costs of the provider visit that results in a COVID-19 test, whether in an office, emergency room, urgent care center, or telehealth visit during the PHE, currently scheduled to end July 15, 2022. That means you are not responsible for paying the copay, coinsurance, or deductible for this specific visit while the federal public health emergency is in effect.
Claims and appeals
In many cases, members have extra time to file a claim or an appeal during the PHE. If you are a member who gets your insurance through your employer or through an individual/family policy, a new temporary rule gives you extra time to file claims and appeals while the COVID-19 related PHE remains in effect. For example, most members have up to 180 days to file an appeal from the date of an adverse benefit decision, such as a claim denial. The temporary rule currently gives you up to one additional year to file an appeal, so you have the normal 180 days plus one additional year. However, please keep in mind that the temporary rule will end 60 days after the PHE ends, and our normal deadlines will go back into effect at that time. If your insurance is from a state or local governmental plan, you may not be eligible for extra time since the new temporary rule does not apply to those plans.
For an out-of-network visit to a doctor for a COVID-19 screening, or lab testing as a result of the screening appointment, keep in mind that Capital Blue Cross does not have a contract with out-of-network providers. That means we cannot limit their ability to charge you for amounts beyond what Capital Blue Cross pays the provider. The provider may bill you to collect the difference, which is known as balance billing.
Telehealth and teledentistry
Members may use telehealth to connect remotely by video with in-network providers for services covered under their health plan. Members may also connect with providers by phone, and we temporarily expanded the types of providers whose services are covered through telehealth.
Our VirtualCare benefit offers a convenient and effective way for members to get care, including behavioral health services and nutrition counseling. VirtualCare doctors can diagnose common illnesses and send prescriptions straight to your pharmacy. VirtualCare is covered by most Capital Blue Cross health plans.
To check on your coverage, refer to your Certificate of Coverage or call the Member Services number on the back of your ID card (TTY:711) for assistance.
For members with Capital Blue Cross Dental coverage, in-network teledentistry consultations are covered by your plan. If you'd prefer to have a teledentistry visit, contact your dentist's office to see if teledentistry visits are available.
How to stay safe
- The best way to stay safe and healthy is to get vaccinated and stay up to date on your COVID-19 vaccines.
- Visit CDC's website for additional measures the CDC recommends to protect yourself and others.
- Thank you for your tireless, selfless effort to care for us, our members, our loved ones, and our communities. We know you are tired. We thank you for fighting on. Access our Provider portal for the most up-to-date information on COVID-19 provider information.