Over-the-Counter (OTC) Test Reimbursement: To view the latest information on OTC COVID-19 tests, CLICK HERE.
As we work together to contain the COVID-19 (Coronavirus) pandemic, we want our members to have access to the latest information. We are closely following the situation and will update this site regularly.
We're here to help you
Vaccine coverage: let’s stick together
We believe the FDA authorized COVID-19 vaccines are safe, effective and our best tool to contain the pandemic. That’s why we are supporting federal, state and local vaccination distribution efforts by ensuring the vaccine will be covered at no cost to our members. When you are eligible, we urge you to say yes to the vaccine, for your own health as well as that of your friends and family.
Telehealth: you have $0 options
If you feel sick, stay home and call your doctor. In many cases, your doctor can provide a virtual visit and provide a diagnosis via phone or video conversation. We strongly recommend members use this benefit as the first step to consulting with a doctor.
Testing and treatment: fully covered for our members
Be assured, we will cover the full cost of COVID-19 diagnostic tests as prescribed by doctors. We will also cover the full cost of COVID-19 treatment regardless of where the care is provided in the United States. We are not requiring prior authorizations for testing, and all costs for participating doctors, telemedicine, urgent care, and emergency room visits for diagnostic testing related to COVID-19 have been waived.
An Important Message from our Chief Medical Officer, Thomas Schenk, M.D.
Frequently Asked Questions (FAQs)
Highmark Blue Cross Blue Shield of Western New York is closely monitoring the COVID-19 (Coronavirus) situation. The health and well-being of our members is our top priority, and we remain committed to ensuring our members and customers have access to the care and information they need.
Will I have to pay to get the vaccine?
- The first quantity of doses for the vaccine have been paid for in advance by the federal government
- Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) fully-insured commercial and Medicare Advantage members will receive FDA-authorized COVID-19 vaccines free of charge
- Please note: If you get the vaccine at your PCP office, any other services performed at the same appointment will be covered in accordance with your health plan benefits
Are the vaccines safe?
- Yes, the vaccines have been safe and effective in clinical trials and since being rolled out to the general population
- Please note: The FDA and CDC have reported a small number of cases of a rare and serious blood clotting disorder called thrombosis with thrombocytopenia syndrome (TTS), which involves blood clots with low platelets seen mostly in women under age 50, that is associated with the administration of the J&J/Janssen vaccine
- After a brief pause and further review, the FDA and CDC have determined the J&J/Janssen vaccine can continue to be administered
- The CDC recommends that women under 50, who may be at an increased risk for this rare but serious adverse reaction to the J&J/Janssen vaccine, be aware of this effect and know there are other vaccine options available (Pfizer-BioNTech or Moderna) where this risk has not been seen
- The FDA and CDC will continue to monitor the safety of COVID-19 vaccines, to make sure even very rare side effects are identified
- For more information on the safety of the vaccines, visit cdc.gov
Who is eligible for a COVID-19 vaccination?
- We are supporting the federal, state and county distribution plans for the vaccine
- The CDC recommends everyone ages 5 and older get a COVID-19 vaccine to help protect against COVID-19
- Currently, the Pfizer-BioNTech COVID-19 vaccine is the only COVID-19 vaccine available to children ages 5 through 17 years old
- For adults ages 18 years and older, the CDC advises getting one of the mRNA COVID-19 vaccines (Pfizer-BioNTech or Moderna) in most situations. We encourage you to talk with your doctor or provider about which COVID-19 vaccine is right for you
|4 years and younger||No||No||No|
|5-11 years old||Yes||No||No|
|12-17 years old||Yes||No||No|
|18 years and older||Yes||Yes||Yes|
How many doses are needed for the vaccines?
- Both mRNA vaccines (Pfizer-BioNTech and Moderna) require two shots
- At this time, the CDC and FDA recommend a third dose of both mRNA vaccines (Pfizer-BioNTech and Moderna) for individuals who are moderately to severely immunocompromised at least 28 days after the second dose to provide increased protection against emerging new variants
- The J&J/Janssen vaccine requires one shot to be considered fully vaccinated
- For more information on COVID-19 vaccinations, please visit the CDC website, or speak to your provider about COVID-19 immunization
- Children and adolescents ages 12 years and older receive the same dosage of Pfizer-BioNTech COVID-19 vaccine as adults
- Children ages 5 through 11 receive one-third of the adult dose of the Pfizer-BioNTech COVID-19 vaccine
- Your child will need a second shot of the Pfizer-BioNTech COVID-19 vaccine three weeks after their first shot
- For more information on COVID-19 vaccines for children and adolescents, please visit the CDC website, or speak with your child’s pediatrician
How do I sign up for the vaccine?
- Appointments at New York State-run vaccine sites can be made on the Am I Eligible website or by calling the New York State COVID-19 Vaccination Hotline at 1-833-NYS-4-VAX (1-833-697-4829)
- Vaccines are also available at physicians’ offices, pharmacies, hospitals and through local health departments.
- Check vaccines.gov for other availability in your area
- If you live in Erie County, you can also review additional vaccine information and locations by visiting the Erie County Department of Health (ECDOH) website here
- After you schedule your vaccine appointment, click here to review the next steps to getting your vaccine, including what documentation you will need to bring
Do I need to bring my insurance card to my vaccine appointment?
- Some locations may require you to provide your Highmark BCBSWNY member ID card and/or your red, white and blue Medicare Health Insurance ID card
- While requirements vary by location, we encourage members to bring these documents and contact Customer Service if you need a new member ID card
- Your ID card can also be accessed by logging into your member account at bcbswny.com
Can a COVID-19 vaccine make me sick with COVID?
- No, none of the authorized vaccines contain the live virus that causes COVID-19, so you cannot get sick from the vaccine
- The vaccines teach our immune system to recognize and fight the virus that causes COVID-19
- While this process can cause temporary symptoms such as a sore arm, mild fever, or body ache, these are normal signs that your body is building immunity against the virus
Are the vaccines effective?
- Yes, data from millions of individuals show the authorized vaccines are safe and effective
- In clinical trials involving more than 70,000 individuals, the mRNA vaccines had an efficacy rate around 95%
- The J&J/Janssen vaccine was found to be 85% effective in preventing severe disease and 100% effective in preventing death, 28 days after vaccination
- This means that in most cases, the vaccines were shown to prevent COVID-19 or decrease its severity
- For more information about vaccine development and approval, read this article from the FDA: Vaccine Development 101
Are the vaccines safe for people of color?
- People of color represented 42% of Pfizer’s global clinical trials participants and 37% of Moderna’s participants
- The J&J/Janssen US vaccine study included more than 30% of individuals who identified as people of color, and percentages were much higher in some of the other countries where studies were conducted
- All these vaccines were created intentionally for a diverse worldwide population
- CDC data has shown that people of color have been disproportionately impacted by COVID-19; therefore, it is encouraging to see people of color well represented in these vaccine trials
Do I need to get vaccinated if I've already had COVID-19?
- Yes, people who have been sick with COVID-19 still need to get vaccinated
- Currently, experts do not know how long immunity lasts after a COVID-19 infection
- There are severe health risks associated with COVID-19 and re-infection is possible
Can the vaccines cause infertility?
- The CDC recommends that everyone 12 years and older get a COVID-19 vaccine including people who are pregnant, trying to get pregnant, might get pregnant in the future or are currently breastfeeding
- There is no evidence that any of the COVID-19 vaccines cause fertility problems in men or women
- There is also no evidence that the antibodies formed from COVID-19 vaccines cause pregnancy problems
- Click here to review additional CDC recommendations on COVID-19 and pregnancy and fertility
If I have allergies, should I get the vaccine?
- The CDC recommends that people who have had severe or immediate allergic reactions to any ingredient in the vaccines, or who have had a severe or immediate allergic reaction to the first mRNA vaccine dose, should not get vaccinated
- Polyethylene glycol (PEG) is an ingredient in the mRNA vaccines and polysorbate is an ingredient in the J&J/Janssen vaccine
- If you are allergic to PEG, the CDC recommends that you should not get an mRNA vaccine and ask your doctor if you should get the J&J/Janssen vaccine
- If you are allergic to polysorbate, the CDC recommends that you should not get the J&J/Janssen vaccine and ask your doctor if you should get an mRNA vaccine
- People with a history of severe allergic reactions not related to vaccines or injectable medications (including food, pet, venom, oral medication, environmental, or latex allergies) should get the vaccine
- Vaccine allergies are very uncommon
Were the vaccines developed too quickly?
A number of factors helped bring safe and effective vaccines to market quickly:
- The messenger RNA (mRNA) technology used in the Pfizer-BioNTech and Moderna vaccines, as well as the technology used by J&J/Janssen, has been studied for years
- The pandemic resulted in guaranteed investment from governments and heightened urgency, making clinical trials easier to complete than any other previous vaccine
- Widespread COVID-19 infection made it easy to confirm that the vaccine worked on trial participants
Are the vaccines effective against the newest variants of the virus?
- Getting the recommended doses of either approved vaccine is the best way to protect against the emerging virus variants
- According to the CDC, studies so far suggest that antibodies generated through the authorized vaccines recognize these variants
Will the mRNA vaccines change my DNA?
- No, COVID-19 Messenger RNA (mRNA) vaccines do not alter or interact with our DNA in any way
- These vaccines teach our cells how to make a protein that triggers an immune response
- The mRNA from the COVID-19 vaccine never enters the nucleus of the cell, which is where our DNA is kept, so the mRNA cannot affect or interact with our DNA in any way
Can I choose the vaccine I want?
- In most situations, the CDC recommends getting a Pfizer-BioNTech or Moderna COVID-19 vaccine over the J&J/Janssen COVID-19 vaccine for primary and booster vaccination due to the risk of serious adverse events; however the J&J/Janssen vaccine may be considered in some situations
- If you’re unsure about which vaccine is right for you, we encourage you to talk to your doctor or provider
- To see which locations are offering what type of vaccine closest to you, you can visit the Am I Eligible website or vaccines.gov
- Getting everyone vaccinated as quickly as possible is the best way to protect against emerging virus variants
What should I do if I received the J&J/Janssen vaccine?
- If you have received the J&J/Janssen vaccine and experience symptoms of a rare blood clotting disorder within 3 weeks of getting vaccinated, you should contact your health care provider immediately
- According to the CDC, symptoms may include:
- Severe or persistent headaches or blurred vision
- Shortness of breath
- Chest pain
- Leg swelling
- Persistent abdominal pain
- Easy bruising or tiny blood spots under the skin beyond the injection site
Are the vaccines safe for pregnant people?
- Yes, the CDC recommends that everyone ages 5 years and older get a COVID-19 vaccine including people who are pregnant, trying to get pregnant, might get pregnant in the future or are currently breastfeeding
- The CDC advises that pregnant and recently pregnant people are at an increased risk of developing severe illness or hospitalization if diagnosed with COVID-19
- Getting a vaccine offers the most protection against severe illness
- Click here for more information about COVID-19 vaccines for pregnant and breastfeeding individuals
- Please note: The CDC recommends that women under 50, who may be at an increased risk of a rare and serious blood clotting disorder called thrombosis with thrombocytopenia syndrome (TTS), which involves blood clots with low platelets associated with the administration of the J&J/Janssen vaccine, be aware of this adverse effect and know there are other vaccine options available (Pfizer-BioNTech or Moderna) where this risk has not been seen
If I am eligible for a COVID-19 booster shot, will my plan cover it?
- Yes, you will not have to pay a copay to receive any dose of the COVID-19 vaccines
Do I need to wait to get my flu vaccine if I got/am planning to get the COVID-19 vaccine?
- You can get a COVID-19 vaccine and flu vaccine at the same time and do not need to wait to get one or the other
Will I still be considered fully vaccinated if I don’t get a booster shot?
- Yes, according to the CDC you are still considered to be “fully vaccinated” two weeks after a second dose of the Pfizer-BioNTech or Moderna vaccines or two weeks after a single dose of the J&J/Janssen vaccine
- Click here to review additional CDC vaccine information
Am I eligible for a booster shot?
- Individuals 12 years and older who received a Pfizer-BioNTech COVID-19 vaccine are eligible for a booster shot at least 5 months after their initial series
- Individuals 18 years and older who received a Moderna COVID-19 vaccine are eligible for a booster shot at least 5 months after their initial series
- Individuals 18 years and older who received a J&J/Janssen COVID-19 vaccine are eligible for a booster shot at least 2 months after their initial series
- CDC recommendations advise that eligible individuals may choose which booster to receive even if it is different from their initial series
- For more information please visit the CDC or NYSDOH pages on COVID-19 vaccine booster doses
Should I get the COVID-19 antibody test?
- COVID-19 antibody testing tells individuals who may have had symptoms if they were infected 1-3 weeks prior; scientists do not know yet if antibodies protect from reinfection and/or how long immunity might last
- Please note: testing for COVID-19 antibodies is a blood test and should not be confused with the COVID-19 diagnostic test which is a swab test
- We are aware that some local urgent care and other facilities are offering direct access to antibody testing and we strongly encourage you to speak with your primary care provider before having this performed
- If you suspect you had symptoms of COVID-19 and are fully recovered, your doctor or provider will determine if you should get tested
- The CDC has stated the antibody test is not 100% accurate and should not be used to determine if someone can return to work or participate in group gatherings; mass testing should be used for research purposes only
Is COVID-19 antibody testing covered by my plan?
- Yes, Highmark BCBSWNY members will not pay to receive an antibody test that was performed by a licensed or authorized health provider between April 10, 2020 and April 16, 2022
- Consult with your provider to determine if you should get tested
- Highmark BCBSWNY will continue to evolve our testing policy based on science and will cover medically-appropriate, provider-ordered testing at no cost to our members
If I have not had symptoms or been diagnosed with COVID-19 and I do not have an order from my provider, but my employer requires testing for me to return to work or continue working, would my health insurance cover the cost?
- No, occupational testing for COVID-19 antibodies is not a covered health care benefit; generally, your employer would cover these expenses as a work-related cost
- You should contact your employer for more information about getting tested
- You can make an appointment to get employer-required testing at one of the New York State testing sites by calling the New York State Department of Health at 1-888-364-3065 or contacting your county health department
Do I have to go to a specific lab to get antibody testing?
- After consulting first with your primary care provider, if your provider feels it’s appropriate, they will determine where you can go for testing; however, Quest Diagnostics remains our first preferred network lab
What is the over-the-counter test reimbursement mandate?
- On January 10, 2022, the federal government announced new guidance that individuals can seek reimbursement from their health insurer when they purchase over-the-counter (OTC) COVID-19 tests on or after January 15, 2022 through April 16, 2022
What does my plan cover under the over-the-counter test reimbursement mandate?
- FDA-approved, over-the-counter (OTC), at-home COVID-19 diagnostic tests are eligible for reimbursement
- According to federal guidelines, you can receive 8 FDA-approved, OTC at-home tests per household member per month (Example: a family of 4 can receive 32 tests per month)
- Please note: Tests may be sold individually or with more than one test per package; federal guidelines allow 8 tests to be reimbursed per individual per month regardless of how they are packaged and sold
Who is eligible for over-the-counter test reimbursement?
- Highmark Blue Cross Blue Shield of Western New York fully-insured commercial, self-insured ASO, and Federal Employee Plan (FEP) members are eligible to receive OTC test reimbursement
- At this time, Highmark BCBSWNY Medicare Advantage members are not eligible for reimbursement. The Biden Administration did not include Medicare as part of the federal mandate, noting that Medicare will not cover OTC at-home COVID-19 tests
- Highmark BCBSWNY Medicare Advantage members can still access COVID-19 testing at no-cost when performed by a licensed or authorized health care provider through April 16, 2022
How do I get reimbursed for over-the-counter tests?
- You must complete the Subscriber Claim Form (Non-Medicare) located on our member forms page to receive reimbursement for over-the-counter COVID-19 tests
- Please note: A Subscriber Claim Form must be submitted for each individual Highmark BCBSWNY member; tests for multiple members cannot be combined on one claim form submission
- Click here to access the form and be sure to include the following in your submission:
- A copy of your receipt
- The barcode or UPC (universal product code) label from your test kit packaging
- Please note: By submitting a manual claim for OTC COVID-19 test reimbursement, you are attesting that the test was purchased for personal use and not for occupational, employer-required testing, and will not be reimbursed by another source or used for resale
Should I get tested for the coronavirus?
- COVID-19 diagnostic testing tells individuals who are symptomatic or came in contact with a symptomatic individual but are asymptomatic, if they have a current infection, or very recent infection
- Please note: diagnostic testing for COVID-19 is a swab test and should not be confused with the COVID-19 antibody test which is a blood test
- If you suspect you have symptoms of the coronavirus, please call your provider or connect with them through telemedicine if they offer it
- Your provider will determine whether you need additional testing and care and, if needed, will make a specific recommendation on where to go
What if I don’t have a doctor?
- If you do not have a primary care physician, you might consider scheduling a visit with our telemedicine partner, Doctor on Demand® by Included Health
- They will determine whether you need additional testing and care and, if needed, will make a specific recommendation on where to go
- You can also call the customer service number listed on the back of your member ID card if you need help finding a provider near you
Is the coronavirus diagnostic test covered with my health plan?
- Yes, Highmark BCBSWNY members will not have to pay for COVID-19 diagnostic tests through April 16, 2022
- Exclusions to this coverage include testing for the following:
- Public surveillance testing
- Testing required to attend large gatherings and events (i.e. sports games, concerts, weddings, etc.)
- Testing required to return or continue going to work or school
- Testing required for national or international travel, including Canada
- If you were identified as being potentially positive for COVID-19 as part of pool-testing for occupational or education-required testing, we will waive the cost-share for the secondary, individual test; however, the initial pool-test is not considered to be a covered health care benefit
- This includes any Commercial, individual, and Medicare Advantage members
- For information on Medicaid coverage, please visit mybcbswny.com/wny-members/coronavirus.html
What is a COVID-19 rapid diagnostic test and is it covered by my plan?
- A COVID-19 rapid test is one type of diagnostic test that gives results within minutes of testing a sample
- We will continue to waive the cost-share for COVID-19 diagnostic testing, this includes rapid testing
If I have no symptoms or a provider's order, but my employer, or New York State, requires diagnostic testing for me to return to work or continue working, would my health insurance cover the cost?
- No, occupational testing for COVID-19 is not a covered health care benefit; generally, employers would cover these expenses as a work-related cost
- You should contact your employer for more information about getting tested
- You can get make an appointment to get employer-required testing at one of the New York State testing sites by calling the New York State Department of Health at 1-888-364-3065 or contacting your county health department or visit the online search tool at coronavirus.health.ny.gov/find-test-site-near-you
If my/my child’s school district/university requires diagnostic testing to return to school, would my health insurance cover the cost?
- No, school-required diagnostic testing for COVID-19 is considered occupational testing and is not a covered health care benefit
- You can make an appointment to get school-required testing at one of the New York State testing sites by calling the New York State Department of Health at 1-888-364-3065 or contacting your county health department or visit the online search tool at coronavirus.health.ny.gov/find-test-site-near-you
Will the visit also be covered by my health plan if I think I have the coronavirus?
- Yes, you will not be responsible for any out-of-pocket costs related to COVID-19 diagnostic testing, including the provider visit
- This includes any copays, co-insurance or payments towards your deductible that you would normally owe to your provider
Is the coronavirus test and visit covered if I have a High Deductible Health Plan (HDHP)/Health Savings Account (HSA)?
- Yes, costs related to COVID-19 diagnostic testing will be covered before the deductible for members with high deductible health plans and HSAs
Do I have to get preauthorization (prior approval) for the coronavirus test?
Where can I go to receive the test?
- If you suspect you have symptoms of COVID-19, please call your provider or use your telemedicine (Doctor on Demand® by Included Health) benefit
- Your provider will determine whether you need additional testing and care and, if warranted, will make a specific recommendation on where to go
Can I go to Quest Diagnostic to receive the test?
- Quest Diagnostics does not currently collect ACTIVE INFECTION coronavirus (COVID-19) testing in their Patient Service Centers
- If you suspect you have symptoms of COVID-19, please call your provider or connect with them through telemedicine if they offer it
- Your provider will determine whether you need additional testing and care and, if needed, will make a specific recommendation on where to go
How can I order free at-home COVID-19 tests?
- Every home in the U.S. is eligible to order 4 free at-home COVID-19 tests
- You do not need to pay to receive the tests
- Orders will ship within 7-12 days
- To order your free at-home COVID-19 tests, click here
- Please note: only one order per household can be placed
How can I get a longer supply of my prescription medication?
- We are committed to helping you access the medications you need during this time and are closely monitoring this evolving situation
- Currently, we are not aware of any medication shortages related to COVID-19 but will respond swiftly to any updates we may receive from the FDA and our pharmacy partners
- We encourage you to use your mail order benefit to obtain a 90-day supply of your prescription medication
- You can also refill or renew your prescription medication at retail pharmacies when 25% of your current prescription is remaining
- If you have an emergent need to refill your prescription earlier, your dispensing pharmacist may be able to request an emergency waiver
- Our goal is to ensure that our members can access medications when they need them by avoiding medication stockpiling
- If you have additional questions about your prescription, contact our pharmacy service team by calling the number on the back of your member ID card
How do I use my mail order benefit to obtain a 90-day supply of my prescription medication?
How can you ensure my prescriptions will continue to be available?
- Highmark BCBSWNY monitors guidance from the Federal Drug Administration (FDA), as well as guidance from local, state and federal government and health officials
- Currently, we have not received confirmation of any medication shortages related to COVID-19, but will respond swiftly to any updates we may receive from the FDA and our pharmacy partners
- Should Highmark BCBSWNY be alerted to a potential shortage of critical medications, we are prepared to:
- Work with our Pharmacy Benefits Manager, Express Scripts, to strengthen community pharmacists’ ability to provide early medications if needed; and
- Make benefit or formulary changes to make alternative medications available to our members
What can I do if I’m feeling overwhelmed or anxious?
- Visit the New York State Office of Mental Health’s guide for additional support and ideas on how to manage stress and anxiety related to Coronavirus (COVID-19)
- If you already see a counselor, ask if they offer telehealth; if they do, you can talk with them from your home
- You may also have access to mental health counselors and psychiatrists with telemedicine through Doctor on Demand® by Included Health with no out-of-pocket costs
- Visit DoctorOnDemand.com to get started
- Call us at 1-877-878-8785, option 2 or visit our Behavioral Health Care Management webpage for more information or to connect with a behavioral health care manager
What resources are available to manage stress caused by COVID-19?
- The COVID-19 pandemic can bring about new stressors, especially for children, teens, essential workers, and those with chronic diseases or mental health conditions
- Check out the resources below for tips on handling stress:
What is personal protective equipment (PPE) and why did I receive a charge for it at my provider/dental office?
- Personal protective equipment (PPE) refers to clothing and safety equipment to protect against injury or infection and can include medical gowns, masks, face shields, safety goggles, and gloves
- Some offices may be charging a fee for PPE due to COVID-19
- Please note: you should not be charged a fee for PPE
- If you have received a fee for PPE (sometimes referred to as an “infection control fee”), please contact us at the number on the back of your member ID card
Protect Yourself Against COVID-19 Scams
How can I report scams or price gouging?
- We are aware of reported scams and price gouging, specifically related to medical devices or insurance policies
- We encourage members to treat any COVID-19 phone calls, emails, social media, or text messages with extra caution
- If you are exposed to scams or price gouging, you can report them to the New York Attorney General’s Office or the Federal Complaint Center
- We also encourage you to contact us before purchasing unsolicited insurance policies or if you’re asked to change the terms of your current coverage
What can I do to protect myself against scams?
- Be cautious of unsolicited requests for your Medicare or Medicaid number
- Scammers are offering COVID-19 tests to Medicare beneficiaries in exchange for personal details, including Medicare information
- These services are unapproved and illegitimate
- Fraudsters are targeting beneficiaries in a number of ways, including telemarketing calls, social media platforms, and door-to-door visits
- The personal information they collect from you can be used to fraudulently bill federal health care programs and commit medical identity theft
- If Medicare or Medicaid denies the claim for an unapproved test, you could be responsible for the cost
- Be suspicious of any unexpected calls or visitors offering COVID-19 tests or supplies. If your personal information is compromised, it may be used in other fraud schemes
- Ignore offers or advertisements for COVID-19 testing or treatments on social media sites
- A doctor or other trusted health care provider should assess your condition and approve any requests for COVID-19 testing
Source: Office of Inspector General
COVID-19 and Pregnancy
These FAQs only apply to employer groups with over 20 eligible employees.
What is the COBRA subsidy provision under the American Rescue Plan Act?
- Under the law signed by President Biden, people on COBRA who lost their employer coverage due to involuntary termination of employment (e.g., layoff) or reduced hours are eligible to have their COBRA coverage fully paid from April 1, 2021 to September 30, 2021
Where can we find eligibility guidelines for COBRA subsidy?
Will groups have to send out a new notice to individual(s) currently on COBRA?
Will the subsidy be applicable to past months?
- No. The subsidy is only available from April 1, 2021 through September 30, 2021
Why are some people eligible for 18 months of COBRA while others are eligible for 36 months?
- The federal COBRA period is 18 months. New York State has extended COBRA provisions for up to 36 months. The eligibility period is dependent on your health plan
What if I paid my Direct Bill COBRA invoice for April? How will I be reimbursed?
- We will send you a refund for your April premium
Who is responsible for managing the COBRA members during the subsidy period?
- The employer group is responsible for managing all COBRA members during the subsidy period
Once I identify my members who are not eligible for the subsidy, can I move them back to the Direct Bill COBRA group?
- No. The employer group is responsible for managing all members during the subsidy period
Do COBRA enrollees have the opportunity to elect a different plan than what they had as active employees?
- COBRA enrollees can choose a different plan than the one they were enrolled in as long as the premium is the same or lower
What if I have a COBRA group? Will a COBRA subgroup be setup under the active group?
- No. You will continue to manage the COBRA group separately
What happens after September 30, 2021 for my COBRA enrollees?
- If your enrollee is still within their COBRA coverage period, they may choose to stay on their COBRA coverage by paying the full premium amount (plus any permissible administrative fee charged for their COBRA coverage). Or, they may choose another plan from us through New York State of Health
These FAQs only apply to employer groups with under 20 eligible employees.
For employer groups with under 20 eligible employees, who pays the COBRA premium for ARPA-eligible individuals?
- Highmark Blue Cross Blue Shield of Western New York will pay COBRA premiums for ARPA-eligible individuals in groups with under 20 eligible employees from April 1, 2021 to September 30, 2021.
Who will receive the ARPA tax credit for groups with under 20 eligible employees?
- Because Highmark Blue Cross Blue Shield of Western New York will pay COBRA premiums on behalf of eligible individuals within employer groups with under 20 employees, we will receive the tax credit.
For employer groups with under 20 eligible employees, what is the process for new eligible COBRA participants?
- When we receive a new COBRA application, we will check for an ARPA eligibility form
- If a completed form is included and the member is eligible, we will not bill premiums for that member and we will pay COBRA premiums on behalf of that member from April 1, 2021 to September 30, 2021
- If there is no form included, we will send the ARPA eligibility form to the member and they must complete and return it within 60 days
Will you continue to bill Direct Bill COBRA members until they submit ARPA eligibility forms?
- While we are waiting for eligibility forms to return, we will continue to bill Direct Bill Cobra participants. If Direct Bill COBRA participants provide us with a completed eligibility form and are ARPA eligible, we will refund them for any COBRA premiums they paid after April 1, 2021.
Where can employer groups or members send the ARPA eligibility form?
- The ARPA eligibility form should be completed and mailed to:
- Highmark Blue Cross Blue Shield of Western New York
Attn: Billing and Enrollment
PO Box 80
Buffalo, NY 14240-0080
- Highmark Blue Cross Blue Shield of Western New York
- The eligibility form can also be emailed to
Where can I find the eligibility form?
For employer groups with under 20 eligible employees, what is the process for existing COBRA participants?
- If a member is ARPA eligible and an employer has a COBRA subgroup, we will credit the employer group any COBRA premiums that were paid beginning April 1, 2021 to date
- If a member is ARPA eligible and an employer has a Direct Bill COBRA arrangement, that member will not be billed until September 30, 2021. Any eligible COBRA premiums the member paid beginning April 1, 2021 to date will be reimbursed to that member
Keeping the Home Safe
- Clean hands at the door and at regular intervals
- Create habits and reminders to avoid touching their face and cover coughs and sneezes
- Disinfect surfaces like doorknobs, tables, and handrails regularly
- Increase ventilation by opening windows or adjusting air conditioning
Households with vulnerable seniors or those with significant underlying conditions
Significant underlying conditions include heart, lung, kidney disease; diabetes; and conditions that suppress the immune system
- Have healthy people in the household conduct themselves as if they were a significant risk to the person with underlying conditions. For example, wash hands frequently before interacting with the person, such as by feeding or caring for the person
- If possible, provide a protected space for vulnerable household members
- Ensure all utensils and surfaces are cleaned regularly
Households with sick family members
- Give sick members their own room if possible, and keep the door closed
- Have only one family member care for them
- Consider providing additional protections or more intensive care for household members over 65 years old or with underlying conditions
Lifestyle & Wellness
Lifestyle & Wellness
Emotional well-being is important at every stage of life. When mental health difficulties arise for you or a loved one, you are not alone. We're here for you.
Feeling Stressed About Coronavirus (COVID-19)?
The outbreak of Coronavirus (COVID-19) may be stressful for people. Fear and anxiety about a virus can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.
Everyone reacts differently to stressful situations. How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.
Things you can do to support yourself:
- Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
- Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly and get plenty of sleep.
- Make time to unwind. Try to do some other activities you enjoy.
- Connect with others. Talk with people you trust about your concerns and how you are feeling.
Reduce stress in yourself and others
Sharing the facts about COVID-19 and understanding the actual risk to yourself and people you care about can make an outbreak less stressful.
When you share accurate information about COVID-19 you can help make people feel less stressed and allow you to connect with them.
New York State Office of Mental Health Emotional Support Line
The Emotional Support Line, 1-844-863-9314, provides free and confidential support, helping callers experiencing increased anxiety due to the coronavirus emergency. The Help Line is staffed by volunteers, including mental health professionals, who have received training in crisis counseling.
Our Customer Service Team is Here to Help
Call the number on the back of your ID card to speak to one of our team members.
We encourage all members to create their own account to receive updates about COVID-19, and access doctor, pharmacy and benefit information.