COVID-19 Updates - Group Members

Coverage:  The claim will be covered in any of the following circumstances:

- prescribed testing from a doctor

- contact testing

- medical facility admission testing

If there is no indication of the above and the claim is related to non-diagnostic testing as a prerequisite for work, school or entry into country, the claim will not be covered.

Cost-sharing:  Enrolled GeoBlue/BCBS Global members enrolled can expect:

- Coverage, with no cost-share, for diagnostic testing for COVID-19, consistent with U.S. Centers for Disease Control (CDC) guidelines. In accordance with the Public Health Emergency period expiration, starting October 20, 2021, existing plan rules apply where there may be cost sharing for a COVID-19 test. Please consult your Certificate of Coverage for more information on coverage and benefits.

 

Medically necessary treatment for COVID-19 is covered as an illness under your policy. Please see the above FAQ response regarding testing coverage considerations.   

We will waive:

- Cost share for care once COVID-19 diagnosis is confirmed. This waiver will apply to claims incurred through December 31, 2020. Starting January 1, 2021, existing plan rules apply where there may be cost sharing. Please consult your Certificate of Coverage for more information on coverage and benefits.

- Prior authorizations for tests and covered services related to COVID-19, consistent with CDC guidelines.

The above actions apply to all plans with medical benefits underwritten by 4 Ever Life Insurance Company or 4 Ever Life International Limited.

When facilities require COVID-19 testing as a general condition of admission and/or prior to any surgical procedure, this will be covered. The normal in-patient cost share under the policy continues to apply to the underlying admission or procedure. Please refer to your Certificate of Coverage for more information on coverage and benefits.

As a rule, our plans do not cover non-medical administrative fees, therefore these fees would not be covered.

 

If the vaccine is administered in the U.S. and your GeoBlue plan covers preventive treatment in the U.S.

The cost of the COVID-19 vaccine is covered by the U.S. government under the CARES Act regardless of whether or not your policy includes an immunization/vaccination benefit. The pharmacy or provider, where you have the vaccine administered, will be reimbursed under the CARES Act. You are not responsible for any cost share for the vaccination itself.   

If there is an administration charge in addition to the cost of the vaccine, you will need to check your certificate of insurance or benefit summary to see if your policy includes an immunization or vaccination benefit. If yes, GeoBlue will cover 100% up to the CMS* published fee:

Vaccination(s) administered prior to March 15, 2021: CMS regulated administration fees:

- Single dose vaccine: up to $28.39 for a single dose vaccine;

- Double dose vaccine: up to $45.33 ($16.94 + $28.39 for both doses).

Vaccination(s) administered on or after March 15, 2021: CMS regulated administration fees:

- Single dose vaccine: up to $40;

- Double dose vaccine: up to $40 per dose 

If your plan does not include an immunization/vaccination benefit, then you are responsible for any administration costs charged separate from the cost of the vaccine.

 

If the vaccine is administered outside the U.S.

You should check your certificate of insurance or benefit summary to determine if your policy includes coverage for immunizations or vaccinations. Based on the country where the vaccination is administered, the government may or may not fund the cost. GeoBlue will not reimburse any claims for the cost of the vaccination in locations where the government funds the cost. GeoBlue will pay eligible non-government paid vaccination costs based on reasonable charges based on your plan immunization/vaccination benefit (member cost share and limits may apply). Additionally, if the administration fee is a separate charge, GeoBlue will pay that fee at 100% using the CMS* fee as the maximum amount:

Vaccination(s) administered prior to March 15, 2021: CMS regulated administration fees:

- Single dose vaccine: up to $28.39 for a single dose vaccine;

- Double dose vaccine: or up to $45.33 ($16.94 + $28.39 for both doses).

Vaccination(s) administered on or after March 15, 2021: CMS regulated administration fees:

- Single dose vaccine: up to $40;

- Double dose vaccine: up to $40 per dose 

The COVID-19 vaccine and any associated fee(s) are NOT covered on policies that do not have an immunization or vaccination benefit.

 

*The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS) in the US.  GeoBlue will consider administration fees for the COVID-19 vaccine based on reasonable cost using CMS published fees when the plan includes an immunization/vaccination benefit.

 

If the vaccine is administered in the U.S.

 

The cost of the COVID-19 booster is covered by the U.S. government regardless of whether your policy includes coverage for immunizations/vaccinations. The pharmacy or provider, where you have the vaccine administered, will be reimbursed. You are not responsible for any cost share for the booster itself.

 

If there is an administration charge in addition to the cost of the booster, you will need to check your certificate of insurance or benefit summary to see if your policy includes coverage for an immunizations or vaccinations. If yes, GeoBlue will cover 100% up to the CMS* published fee. Please refer to the below guidelines:

- For Pfizer administered after 9/22/2021 or for Moderna & Janssen after 10/20/2021 for these populations:

- 65 years of age or older

- 18-64 years old at high risk of severe COVID-19

- 18-64 years old with frequent institutional or occupational exposure to SARS-CoV-2

- For any type of booster for anyone 18 years of age or older, after 11/20/2021

- The booster type does not need to match the original treatment type

- Single dose CMS published fee = $40

 

 

If the vaccine is administered outside the U.S.

You should check your certificate of insurance or benefit summary to determine if your policy includes coverage for immunizations or vaccinations. Based on the country where the vaccination is administered, the government may or may not fund the cost. GeoBlue will not reimburse any claims for the cost of the vaccination in locations where the government funds the cost. GeoBlue will pay reasonable charges for eligible non-government paid vaccination costs according to your plan immunization/vaccination benefit (member cost share and limits may apply). Additionally, if the administration fee is a separate charge, GeoBlue will pay that fee at 100% using the CMS* fee as the maximum amount. Please refer to the below guidelines:

 

- For Pfizer administered after 9/22/2021 or for Moderna & Janssen after 10/20/2021 for these populations:

- 65 years of age or older

- 18-64 years old at high risk of severe COVID-19

- 18-64 years old with frequent institutional or occupational exposure to SARS-CoV-2

- For any type of booster for anyone 18 years of age or older, after 11/20/2021

- The booster type does not need to match the original treatment type

- Single dose CMS published fee = $40

 

 

*The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS) in the US.  GeoBlue will consider administration fees for the COVID-19 vaccine based on reasonable cost using CMS published fees when the plan includes an immunization/vaccination benefit.

COVID-19 requirements vary worldwide. We highly recommend you review the host country’s COVID-19 requirements before you travel to or within that country. Costs associated with a mandatory quarantine, when not medically necessary, are not covered under your plan. For example, if you test positive for COVID-19 but are asymptomatic and forced to quarantine in a hospital, those hospital charges will not be covered by your plan as these costs are not considered medically necessary.

Members covered under the following are eligible to receive OTC tests under this regulation:

- A corporate employer group expat policy

- A student health insurance plan issued to New York schools and certain schools in California

This regulation does not apply to members covered under an individual or business traveler plan, individual expat plan or other student and individual plans underwritten by 4 Ever Life International, Limited, Bermuda. Members may want to contact their primary health insurance carrier regarding OTC testing coverage.

The regulation mandates that insurance carriers cover FDA-authorized at-home diagnostic tests available over the counter, purchased on or after 1/15/2022.

Each covered individual (policyholder and any dependents) will be covered for up to eight (8) OTC tests per 30-day period, plus any additional test ordered by an attending healthcare professional.

As an example, it’s eight tests per 30-day period (not calendar month) for each covered individual on the policy. If a box contains two tests, then six tests remain for reimbursement for that covered individual in the 30-day period. Any claims for reimbursement must be submitted per covered individual (under each member ID).

FDA-authorized, self-administered tests are covered under the regulation, regardless of whether they are ordered by a healthcare professional. As a rule, if you can take and read the results of the test on your own at home and it is FDA-authorized, it is covered under the new regulation. Tests that must be processed by a lab or administered by a healthcare professional (for example, PCR tests) are not covered, unless they are ordered by a healthcare professional for diagnostic purposes.

We encourage everyone to follow the latest CDC guidelines for testing, which can be found here.

No, you will not be responsible for any cost-sharing or contribution.

Yes, if you obtain an FDA-authorized OTC test outside the U.S. on or after 1/15/2022 you can submit a claim for reimbursement.

You can submit an eClaim via the Member Hub or mobile app or a paper claim following the instructions on the claim form. eClaim submissions are strongly encouraged. You are required to submit a copy of your receipt that shows the amount and the date purchased.

Members covered under a corporate employer group expat plan or a student health insurance plan issued to New York schools and certain schools in California (refer to question 1) can obtain testing kits at participating pharmacies with no upfront costs. To find out where you can obtain testing kits just by presenting your member ID card, visit the prescription benefits section of the GeoBlue Member Hub.  Please note, you need to purchase the OTC test at the pharmacy so they can process the claim accordingly. 

For out-of-pocket purchases on or after January 15, you can submit an eClaim via the Member Hub or mobile app or send us a paper claim. eClaim submissions are strongly encouraged.

No. You can receive OTC tests for diagnostic purposes, even if you do not currently have symptoms or suspected exposure. 

COVID-19 tests will play a crucial role in ending this public health crisis. We encourage everyone to follow the latest CDC guidelines and, when using at-home tests, follow the manufacturer instructions on appropriate use. 

Americans can now order free at-home COVID-19 tests. Orders for up to four tests per household can be placed using the website www.COVIDtests.gov. 

Yes! A safe and convenient option for accessing healthcare services is through our telemedicine service, Global TeleMD™, which is available at no additional cost to our members.

The Global TeleMD app provides remote access to a global network of licensed doctors by telephone or video without needing to leave your home or office. All Global TeleMD doctors in the region are briefed on the World Health Organization’s recommendations and are prepared to render remote consultations with patients around the world. Remote consultations via Global TeleMD are free and can be used as many times as you need.

The Global TeleMD app can be downloaded for free to your mobile device from the Apple App Store or Google Play. Once you download the app, you’ll need to create a profile, which is quick and easy. Please have your member ID card,  Certificate Number or Group Access Code available when creating your profile. You must be registered with GeoBlue to utilize the Global TeleMD service.

Anxiety, panic and stress are common emotions you may experience during an outbreak, such as the coronavirus. As a covered member, you have access to telephonic emotional support services provided by trained counsellors. You can access these services via the telehealth button in the GeoBlue mobile app and then "Talk to a Counselor" or by logging in to the member portals listed below.Our wellness portal also provides helpful links and resources including 10-minute meditation sessions, articles on how to cope with stress during a disease outbreak and other crisis support information.

- For BCBS Global Expat plan members, log into the Member Hub at www.geo-blue.com  and locate "Global EAP" in the "Wellness" section

- For those on education institution-sponsored plans, log into the Member Hub at www.geobluestudents.com and locate  Global Wellness Resources in the Wellness section 

In addition, we also offer timely and relevant online seminars. Now available on demand: Keep Calm and Carry on – Maintaining your composure amidst the pandemic panic. In this webinar you will learn:

- Strategies to tackle feelings of anxiety and stress

- Practical techniques for working from home

- Ways to address signs of panic in the workplace

- When to reach out for further help and support

To access, visit the Member Hub locations noted above and choose your preferred "country-language" to view this online seminar. Current languages available are:

- Global-English 

- US-English 

- Chinese-Mandarin

- France-Français

- Canada-Français

*Some plans do not include this service. Check your certificate of insurance or ask your HR or program administrator.

The CDC has published a geographic risk assessment for COVID-19 transmission by country along with travel health notices. The U.S. State Department has a COVID-19 traveler information resource page where additional information can be found.

GeoBlue has compiled a list of COVID-19 hotlines by country as a resource to help you get in contact with the local public health authorities. In many cases, the public health authorities are directing and managing access to testing and have oversight of the public health response to this pandemic. If you are unable to communicate with the operators of the hotlines due to a language barrier, please contact the Embassy or consular service in the country of your stay by hotline, email or via their accounts on social media for guidance. This information, compiled from open sources, is provided as a courtesy and is current as of when we compiled the data. We cannot provide any warranties about the accuracy and/or comprehensiveness of the data. This is provided for informational purposes only and cannot be substituted for official governmental data, or consultation with a licensed healthcare professional.

No. We presume the patient meets medical necessity for the test by virtue of it being prescribed by a physician or ordered by a governmental health authority.

GeoBlue’s position remains consistent in covering testing when medically necessary and as part of diagnosis and treatment. Specifically, GeoBlue will cover, at no cost sharing until 1/1/2021, COVID-19 anti-body testing when ordered by a doctor for diagnostic and treatment purposes, when used to diagnose a suspected case for which PCR (polymerise chain reaction) testing is negative or unavailable. Anti-body testing should not be ordered as a stand-alone test for diagnosis and treatment.

GeoBlue will not cover any COVID-19 testing (including anti-body testing) requested by non-medical personnel (members, employers, school programs, governmental agencies) for non-diagnostic treatment purposes. This includes, but is not limited to, testing for personal information or for return to work/school requirements.  Please consult your Certificate of Coverage for more information on co-pays, deductibles, coverage and benefits. 

Yes! A safe and convenient option for accessing healthcare services is our telemedicine service, Global TeleMD™, which is available at no additional cost to members of our BCBS Global Expat and educational institution-sponsored group plans.

We have also expanded access to Global TeleMD to Blue Cross Blue Shield Global Traveler members. Members must use their Group Access Code when they create a profile.  They must also use the same email address they used to register with the GeoBlue mobile app.  Please contact your GeoBlue representative to obtain the code for your travelers, if you are unsure.

The Global TeleMD app provides remote access to a global network of licensed doctors by telephone or video without members needing to leave their home or office. All Global TeleMD doctors in the region are briefed on the World Health Organization’s recommendations and are prepared to render remote consultations with patients around the world. Remote consultations via Global TeleMD are free and can be used as many times as members need.

BT plans have an extension of coverage provision which states the following:

Extension of Benefits: No benefits are payable for medical treatment benefits after the Policy Holder’s insurance terminates. However, if an Insured Person is in a Hospital on the date the insurance policy terminates, the Insurer will continue to pay the medical treatment benefits until the earlier of the date the confinement ends, the Trip Coverage Period ends, or 31 days after the date the insurance terminates.

Medical evacuation coverage and restrictions vary by product. If your plan provides coverage for medical evacuation, the medical evacuation would be covered under the following circumstances:

- Sudden accident or unforeseen* Illness that leads to a recommendation for medical evacuation by the local attending physician.

- Medical evacuation is medically necessary and subject to approval by our physicians in consultation with the attending physician

- Medical evacuation is advisable i.e. the patient is stable enough to travel, noting that evacuation is always to the nearest capable facility

- Evacuation is practically possible e.g. with due consideration of origin and destination government rules and restrictions, the availability of commercial air ambulance providers and a receiving facility.

*Unforeseen illness refers to a condition that was not pre-existing.

Transport of COVID-19 patients is possible via commercial air ambulance providers but the process is very slow and complex. It is important to keep in mind the limitations on receiving care as well as the various permissions required for permits. We will evaluate each case on its own facts and circumstances.

No. Our corporate group policies do not have any benefit provisions for covering the evacuation of healthy members due to the fear of or inconvenience posed by disease outbreak. The medical transport benefit in our policies requires the member to be seriously ill or injured and requiring a level of care not available in their present location.

Commercial air ambulance operators are reporting the ability to move COVID-19-infected patients, using specialized isolation equipment. For any covered member who is ill or injured and meets the criteria for medical evacuation we would work with transport vendors (air ambulance or commercial medical escort providers), receiving care providers and treating doctors to determine feasibility for transport. The facts and circumstances at the time of need will dictate what is possible, timeframe, and destination. For instance, any suspicion that the patient may have had exposure may affect options regarding timing, destination, routing, etc. Movements may also be affected by closed borders or government-imposed flight limitations.

PEND policy coverage, provided through our partner Crisis24/Drum Cussac, requires the underlying cause for a U.S. Department of State Level 4 Travel Advisory to be due to political, military, or natural disaster concerns. Medical conditions are not a covered peril. There are other triggering criteria that may be met in individual situations, such as a covered person being designated persona non grata by government authorities or being exposed to political or military conditions at the local level that do not cause the US Department of State to issue a Level 4 Travel Advisory. As such, we review each member’s situation individually, but the coronavirus outbreak itself generally does not meet the PEND criteria for evacuation coverage.