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
Blue Cross Blue Shield 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.
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.
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 employers and members have access to the care and information they need.
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
- Blue Cross Blue Shield 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
- Blue Cross Blue Shield 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
- At this time the CDC and FDA have recommended a third dose of either the Pfizer-BioNTech or Moderna mRNA vaccines for moderately to severely immunocompromised patients at least 28 days after the initial two-dose series
- The CDC does not currently recommend a third dose of the mRNA vaccines for non-immunocompromised patients
- Visit the CDC for information on how to discuss an additional dose of an mRNA COVID-19 vaccine for your immunocompromised patients
- The following individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine are eligible for a booster shot at least 6 months after their initial series:
- 65 years and older
- Age 18+ who live in long-term care settings
- Age 18+ who have underlying medical conditions
- Age 18+ who work or live in high-risk settings
- Individuals aged 18 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
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 Blue Cross Blue Shield 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
Premiums and Invoicing
Enrollment and Eligibility
Will there be enrollment and eligibility flexibility during this state of emergency?
- Yes, Blue Cross Blue Shield 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?
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
- Members can call us directly at 1-800-888-5407
- 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:
- 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
- You provide us promptly with a clear written description on your Company letterhead of your extended plan eligibility terms
- 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?
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?
- Blue Cross Blue Shield 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
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
- Visit DoctorOnDemand.com to get started
- 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?
- Connecting with others in a meaningful way is important to physical and mental health, especially during the pandemic. Making connections may look different while social distancing, but there are tools available to help
- Your employees can visit the resources below for tips on how to overcome loneliness during the pandemic:
- Your employees can try a virtual activity that allows them to be part of a community. As Blue Cross Blue Shield members, your employees can stream free workout classes every day through Virtual Fitness at Canalside.
- Your employees may also have access to mental health counselors and psychiatrists with telemedicine through Doctor on Demand® with no out-of-pocket costs. Visit our website to learn more.
What resources are available to manage stress caused by COVID-19?
- The COVID-19 pandemic can bring about new stressors, especially for essential workers and those with chronic diseases or mental health conditions
- Your employees can use the resources below for tips on handling stress:
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?
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
An Important Message from our Chief Medical Officer, Thomas Schenk, M.D.
Prescription Drug Coverage: What You Need to Know
Use your 90-day mail order benefit
Refill or renew current prescriptions at retail pharmacies when 25% remains
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.