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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 your employees are eligible, we urge them to say yes to the vaccine, for their own health as well as that of their friends and family.

COVID-19 Vaccine Myths

As COVID-19 vaccine administration expands, we are aware of myths spreading on social media and elsewhere about the vaccine. We believe it’s important to address any misinformation so your employees can understand the safety and efficacy of available vaccines and make informed decisions.

Below are some resources to help clear up these myths.

Emergency financial assistance is available to small businesses

For employers with less than 500 employees: If COVID-19 is causing financial difficulties for your business, financial relief loans are currently being offered to assist you in maintaining employees and keeping your business operating.

In some cases, you may need to provide your current payroll expenses. Use our eBilling tool to access your payment history.

Erie County COVID Impact Loan Program

The Regional Development Corporation, part of the Erie County Industrial Development Agency, is offering disaster relief assistance for qualified small businesses (under 50 employees).

The cost of the test and treatment is fully covered for our members

We understand that our members may be concerned about their access to care during this time. 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.

Managing Premium Invoices and Payments

BlueCross BlueShield offers a quick and easy way to manage your health plan and pay your premiums. By logging into your employer account, you can manage invoices, schedule convenient automatic payments, and track payment history.

Set Up An Online Account

Complete the HIPAA Employer Authorization Form. The completion of this form is required to access the online portal. Once HIPAA Authorization form is received, you can log in to your account to handle tasks such as, pay an invoice, complete an enrollment or termination request.

Stress Management

myStrength by Livongo®

During this stressful time, myStrength by our partner Livongo is here for you. Learn ways to manage extreme stress, get tips for parenting during challenging times, and find support to help you take care of your emotional health. Available through the end of June.

Frequently Asked Questions (FAQs)

BlueCross BlueShield 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 employers and members have access to the care and information they need.

Vaccination Coverage

Will my employees 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
  • BlueCross BlueShield fully-insured commercial, and Medicare members will not have to pay a cost-share for the COVID-19 vaccines that are authorized through an emergency use authorization (EUA) and recommended by the Advisory Committee on Immunization Practices (ACIP)
    • Please note: If a member receives the vaccine at their PCP office, other services performed at the same appointment will be covered in accordance with your health plan benefits

Will there be any plan costs for the vaccine?

  • Yes, while the federal government will cover the cost of the vaccine, providers can charge an administrative fee.  (CMS has indicated the following allowances – https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment)
    • We expect similar allowances for commercial and ASO business
  • Express Scripts has also implemented a $20 administration fee per COVID vaccination dose

As a self-funded plan, can I apply a member cost share for the administrative fees?

  • Federal guidance indicates that any non-grandfathered commercial or ASO employer group must cover the vaccination administration cost at $0 in-network and out-of-network under preventive benefits
  • BlueCross BlueShield is strongly encouraging all self-funded grandfathered plans to cover the cost-share for their members. For alternative arrangements, groups should contact their Account Executive

Is the vaccine safe?

  • The Food and Drug Administration (FDA) and the Advisory Committee on Immunization Practices (ACIP) carefully review all safety data from clinical trials before authorizing or recommending a vaccine for emergency use only when the expected benefits outweigh potential risks
  • 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 vaccine, visit cdc.gov

When can my employees get vaccinated?

  • We are supporting the federal, state and county distribution plans for the vaccine
  • The CDC has said the goal is for everyone to be able to easily get a COVID-19 vaccine as soon as large quantities are available; however, not everyone will be able to get vaccinated right away
  • The first people to receive the vaccine will be nursing home residents and staff and high-risk hospital workers followed by:
    • Long term care residents
    • EMS workers
    • Essential workers
    • General population
  • Staff at every NYS hospital will have access to the vaccine by a hospital that has the storage capacity
  • While specific distribution plans are still in development, we encourage members to prepare for a COVID-19 vaccine by consulting with their primary care provider

How many doses are needed for the vaccine?

  • Both mRNA vaccines (Pfizer-BioNTech and Moderna) require two shots
    • The first shot starts building protection, but a second dose is required a few weeks later to get the most protection the vaccine can offer
  • The J&J/Janssen vaccine requires one shot

How do my employees sign up for the vaccine?

  • Your employees can check if they are eligible to receive the vaccine by visiting the Am I Eligible website
  • Appointments at New York State-run vaccine sites can be made 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 pharmacies, hospitals and through local health departments. We advise individuals to contact their county health department or nearest pharmacy or health care facility to check availability and schedule a vaccine appointment
  • After your employees schedule a vaccine appointment, they can visit here to review the next steps to getting their vaccine, including what documentation they will need to bring

Do my employees need to bring their insurance cards to their vaccine appointments?

  • Some locations may require your employees to provide their BlueCross BlueShield member ID cards and/or their red, white and blue Medicare Health Insurance ID cards
  • While requirements vary by location, we encourage members to bring these documents and contact Customer Service if they need new member ID cards
  • Your employees can also access their ID cards by logging into their member account at bcbswny.com

Can a COVID-19 vaccine make my employees 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?

  • The authorized vaccines are very 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

Do my employees need to get vaccinated if they have 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

Once my employees get vaccinated, should they continue to wear a mask and physically distance?

  • Yes, even after being vaccinated, your employees should continue following safety guidelines – wear a mask, frequently wash their hands, and stay six feet away from others
  • Distribution will take time and the vaccines’ effectiveness against infection, spread, and new strains continue to be monitored
  • For more information about wearing masks after vaccination, click here

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

Can my employees choose the vaccine they want?

  • Most likely no. We encourage your employees to get the first authorized vaccine available.
  • Getting everyone vaccinated as quickly as possible is the best way to protect against emerging virus variants

Cost Shares and Claim Processing

Is COVID-19 antibody testing covered for my employees?

  • Yes. In accordance with guidelines issued by the New York State Department of Health (NYSDOH), antibody testing will be covered at a $0 cost-share for in- and out-of-network services rendered.
    • Applies to claims dated April 10, 2020 through April 21, 2021
    • Coverage pertains to medically-appropriate testing only with a prescribed doctor's order
  • Employees should consult with their doctor to determine if they meet medically-appropriate testing guidelines
  • This coverage applies to all fully-insured and self-funded Commercial members
  • Employees should follow the recommendation of their doctor regarding the appropriateness and/or location of testing
    • A telehealth consultation with their primary care doctor is encouraged
  • Employees have the option to conduct a telehealth visit with Doctor on Demand as well
    • Quest Diagnostics remains our preferred network laboratory
    • Urgent care facilities and hospitals are offering access to antibody testing, but employees should defer to their doctor’s recommendation

If I require COVID-19 antibody testing for my employees to return to work or continue working, would health insurance cover the cost?

  • No. Occupational testing for COVID-19 antibodies is not a covered health care benefit

Do my employees have to go to a specific lab to get antibody testing?

  • After consulting first with their primary care provider, if the doctor feels it’s appropriate, they will determine where they can go for testing
    • Quest Diagnostics remains our preferred network laboratory

Is COVID-19 diagnostic testing covered for my employees?

  • Yes, BlueCross BlueShield will waive the cost-share for COVID-19 diagnostic tests for members who meet the NYS Department of Health guidelines for testing and is prescribed by your doctor through April 21, 2021
  • Any testing done without a doctor’s prescription, and that does not meet the NYS Department of Health guidelines is not covered
  • Broad public health testing to identify individuals who may have been exposed, or surveillance testing for employment purposes are also excluded from coverage
  • This includes any Commercial, Individual, and Medicare Advantage members

If I require COVID-19 diagnostic testing for my employees to return to work or continue working, would health insurance cover the cost?

  • No. Occupational testing for COVID-19 is not a covered health care benefit

When did the $0 member cost share mandate go into effect?

  • For COVID-19 testing and office visit, urgent care, ER and telehealth visit for the purpose of testing, the  New York State mandate went into effect on March 13 and the Federal mandate went into effect on March 18

What is the claim processing start date for COVID-19 testing?

  • Claims will be processed for services dating back to February 4, 2020
  • This is date that CMS approved the initial two codes; A third code was approved on March 13

What is the claim processing start date for $0 member cost share for COVID-19 office visit, urgent care, ER or telehealth visits for the purpose of testing?

  • Office, urgent care and ER visit claims will be processed for services dating back to March 1
  • We will apply the $0 member cost-share for treatment with the designated diagnosis codes

If my employees test positive for the coronavirus, will their treatment be covered?

  • Yes. Effective April 1, 2020 through June 30, 2021 we are waiving all copays, coinsurance and deductibles (including deductibles on HSA plans) for COVID-19 treatment received by fully-insured Commercial members

What is the claim processing start date for $0 member cost share for COVID-19 treatment?

  • Treatment claims will be processed for services dating back to April 1, 2020
  • The member cost share waiver applies to medically necessary inpatient, outpatient or office visit costs with a COVID-19 diagnosis 
    • We will apply the $0 member cost-share for treatment with the designated diagnosis codes
  • This coverage applies to all fully insured Commercial and Medicare Advantage members
    • Self-funded employers have the option to expand this coverage for their plans

 

What is the claim processing start date for $0 member cost share for all Telehealth services?

  • New York State Mandate to provide all telehealth at $0 member cost-share was effective March 17, 2020
  • Telehealth claims will be processed for services dating back to March 17, 2020
  • At this time, the $0 cost-share for telehealth services for fully insured Commercial and Medicare Advantage members will end on March 5, 2021
    • Self-funded employers have the option to expand this coverage for their plans
  • An employee’s physician may offer telehealth — they should contact them directly for more information
  • If they don’t, the cost-share for telemedicine visits through Doctor on Demand® is also temporarily waived

 

If my employees received mental health services in-person or through telehealth and they are not considered essential workers, will it be covered?

  • Effective May 2, 2020, we are temporarily waiving any cost-share (excluding HSA-qualified plans) for all fully-insured Commercial members for outpatient, in-office and telehealth mental health services performed by an in-network provider through March 26, 2021
    • After March 26, 2021, in-office and outpatient services will be subject to your regular cost-share
    • Cost-shares for telehealth mental health services received after March 26, 2021 will continue to be waived through April 4, 2021
    • Self-funded employers have the option to expand this coverage for their plans

What is a COVID-19 rapid diagnostic test and is it covered for my employees?

  • 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 that is medically necessary and ordered by a provider. This includes rapid testing

If my employees have telehealth visits with their providers for something other than COVID-19, will it be covered?

Premiums and Invoicing

How can I receive and pay my premium invoices if I can’t access my mail?

  • You can pay online by logging into our secure employer portal
    • You can pay any amount toward your balance until further notice
  • Premium invoices are available for viewing, download, and payment
    • If you do not already have access to our online tools, you will need to download HIPAA Form 2(I) from our website and return the completed form to your account executive via email
    • Your account executive will contact you with your login information
  • If you do not have the ability to pay online, you can mail your payment – with your group number listed on the check
    • Payment Processing Center
      PO Box 644366
      Pittsburgh, PA 15264-4362 

Will there be premium invoice payment due date flexibility during this state of emergency (e.g. grace period)?

  •  Employers that are adversely impacted by COVID-19 who are unable to make premium payments on time should contact their Account Executive to discuss potential solutions

If I have to lay off some of my employees will pre-paid premiums be refunded?

  • If you maintain group coverage, your overpayment will be applied to your next month’s premium invoice
  • If you are terminating all employee coverage, you will receive a refund of any overpayment once the termination is processed

Are premium invoices still being mailed?

  • Yes, there is no disruption in mailing of invoices  
  • Additionally, all invoices are located within our secure employer portal 

Enrollment and Eligibility

Will there be enrollment and eligibility flexibility during this state of emergency?

  • Yes, BlueCross BlueShield will extend the 30-day enrollment guideline until further notice.
  • Eligibility transactions can be updated in a timely and automated manner via BlueConnect, our online enrollment tool.

Does the enrollment flexibility allow for special enrollments during this state of emergency?

  • Special enrollment is associated with a qualifying event, as outlined in our Group Benefit Administrator Manual

    • Examples of qualifying events would include newborns, loss of spousal coverage, etc. 

    • These qualifying events allow for changes in coverage in eligibility

    • Employees who waived coverage during the open enrollment period without a qualifying event cannot be added to the plan

      • We can connect these employees with our consumer market account executives to explore alternative coverage options

      • Members can call us directly at 1-800-888-5407

Will you accept emails for eligibility transactions?

  • No, we cannot accept emails to request eligibility transactions
  • We encourage you to use our BlueConnect tool or complete an application.
  • Applications can be downloaded from our website, and employee signature is not required.
    • Until further notice, we will not be requiring back up paperwork for items like domestic partner enrollment, adoption or disabled dependents
    • We will conduct an audit of transactions to obtain this information once the state of emergency is lifted

Plan and Coverage Options

Can I add a less expensive plan option?

  • Small groups can hold a one-time special open enrollment provided it’s available to all employees. 

    • NOTE:  If employees make a plan change mid-year, accumulators (such as deductibles and out of pocket maximums) would reset with their new plan 

      • Accumulators would also reset at their regular open enrollment period as well

  • Should you wish to hold such a special open enrollment please contact your Account Executive and/or broker

  • Large groups are subject to underwriting guidelines and review, and as such should contact their Account Executive and/or broker with questions 

What other options are available for coverage for members no longer on my group plan?

  •  We will support your employees, by connecting them with our consumer market benefit consultants to explore alternative coverage options

Can I maintain group coverage if my business has closed permanently?

  • No. Employees will receive a termination notice listing enrollment options which include state-subsidized plans (e.g. Medicaid, Essential Health Plan) or direct pay plans
  • We will support your employees, by connecting them with our consumer market account benefit consultants to explore alternative coverage options
  • Employees are not eligible for COBRA coverage if the business has closed permanently

Employee Coverage Considerations

If my business has reduced hours or is temporarily shut down, resulting in temporary layoffs, can I keep my employees on my health plan?

  • It’s the employer’s responsibility to determine employee coverage status
  • If an employer continues to offer health plan coverage and the account is in good standing, employees will continue to have coverage under the period for which premium has been paid 
  • It is the responsibility of the employer to notify us of a termination of coverage

If I choose to subsidize COBRA coverage for my employees, whether at the current cost share arrangement or an alternative arrangement, how will that be handled?

  • We will continue to cover these individuals so long as full payment of the associated COBRA premium is received

Can I amend my new hire policies to allow for coverage immediately upon employees returning to work or on day 1 for new employees?

  • Employers can amend new hire policies at their discretion 

Self-Funded Plans Regarding Stop Loss

What impact will a reduction in employee hours due to COVID-19 restrictions on business operations have on a stop loss policy?

  • If you modify your plan’s eligibility rules to extend coverage in connection with the COVID-19 pandemic, stop-loss policy claims incurred during the extended coverage period will apply provided that the following conditions are met:

  1. The extended coverage is offered only to those individuals who were covered under the plan and whose hours of employment were impacted by the pandemic
  2.  You provide us promptly with a clear written description on your Company letterhead of your extended plan eligibility terms
  3. The extended coverage period does not extend beyond [x date], [x months after the person would have lost coverage under the plan without the eligibility extension], [the date that the public health emergency caused by the pandemic ends], etc.  Any additional conditions could be added (e.g. employee having to pay a share)

Testing and Treatment

Do my employees have to get preauthorization (prior approval) for the coronavirus test?

  • No, preauthorization is not required for COVID-19 testing

Where can my employees go to receive the test?

  •  If one of your employees suspects they have symptoms of COVID-19, they should call their provider or use the telemedicine (Doctor on Demand®) benefit
  • An employee’s provider will determine whether that employee needs additional testing and care and, if warranted, will make a specific recommendation on where to go

Can my employees 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 an employee suspects they have symptoms of COVID-19, they should call their provider or use the telemedicine (Doctor on Demand®) benefit
  • An employee’s provider will determine whether that employee needs additional testing and care and, if warranted, will make a specific recommendation on where to go 

What is telehealth/telemedicine and how do my employees access it if they think they have the coronavirus?

  • BlueCross BlueShield strongly recommends members use their existing telehealth benefit to connect with a provider when possible
  • Virtual visits are a safe and effective way for your employees to consult with a provider from their homes, either over the telephone or in a video chat 
  • That’s why we’re expanding coverage to telehealth and temporarily waiving any cost-share for medically necessary virtual visits with your employees’ physicians
    • Note: if your employee’s telehealth visit is with an out-of-network provider, they may be charged a cost-share according to their out-of-network benefits
  • Your employees’ physicians may offer telehealth. Your employees should contact them directly for more information
  • If physicians don’t offer telehealth, your employees’ cost-share for telemedicine visits through Doctor on Demand ® is also being temporarily waived
  • Your employees can download the Doctor on Demand app or visit our website for step-by-step instructions on how to set up a visit
    • Your employees should select either “Coronavirus (COVID-19) evaluation” or “Coronavirus (COVID-19) education” as a reason for their visit if they feel like they may have been exposed to the coronavirus and require testing

Mental Health

What can my employees do if they’re feeling overwhelmed or anxious?

  •  Your employees can 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 one of your employees already sees a counselor, the employee can ask if they offer telehealth; if they do, your employee can talk with them from their home
  • Your employees may also have access to mental health counselors and psychiatrists with telemedicine through Doctor on Demand® with no out-of-pocket costs
  • Your employees can 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 help my employees overcome loneliness caused by social distancing?

What resources are available to manage stress caused by COVID-19?

An Important Message from our Chief Medical Officer, Thomas Schenk, M.D.

Prescription Drug Coverage: What You Need to Know

Number 1 Icon

Use your 90-day mail order benefit

Number 2 Icon

Sign-up for mail order delivery

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Refill or renew current prescriptions at retail pharmacies when 25% remains

Stay Informed

We encourage all employers to login to their secure accounts to access information about billing, enrollment, termination and forms.  

Keep Your Employees Informed

The health and well-being of our members is our top priority. Stay up to date with information regarding COVID-19.

Need More Information?

Coronavirus (COVID-19) Assessment Tool