For example, one box containing two tests counts as two tests. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Costco, Wal-Mart, Amazon), please attach itemized register receipts to the back of this form. All rights reserved. Most PDF readers are a free download. Visit the CDC website for the most up-to-date testing guidance. In Virginia, CareFirst BlueCross BlueShield, CareFirst MedPlus, and CareFirst Diversified Benefits are the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). this.start=function(){var t=this;"complete"!==document.readyState?window.addEventListener?window.addEventListener("load",function(){t.go()},!1):window.attachEvent&&window.attachEvent("onload",function(){t.go()}):t.go()};}; The Centers for Disease Control and Prevention (CDC) provides guidelines for who should get a diagnostic test and when based on your current health, your vaccination status, and your history of infection. You can download the claim form hereor call the number on the back of your member ID card to receive one by mail. 0 To be eligible for reimbursement, the purchased over-the-counter at-home COVID-19 tests: must be purchased on or after January 15, 2022 must be for personal diagnostic use used to identify the potential COVID-19 infection not be used for employment purposes not used for surveillance testing Wu3B= e&gZ-h'BR$djC?Wn>2esFdUb'$K6Q hbbd```b``)n`"EV`U`*8*I2&?tq&e@$E&">I0DjE0!c`) $L*H-`l)`l3Oz's&30t%S! [& Provide an itemized receipt that clearly shows that your purchase was for a COVID-19 test. Diagnostic tests are performed if you are experiencing COVID-19 symptoms or have been recently exposed. Health Benefits Election Form (SF 2809 Form) To enroll, reenroll, or to elect not to enroll in the FEHB Program, or to change, cancel or suspend your FEHB enrollment please complete and file this form. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Centers for Disease Control and Prevention website: Test for Current Infection (accessed January 2022): cdc.gov. You can also log in to the SydneySM Health mobile app, go to Claims, and choose Submit a Claim. this.go=function(){if(this.check()){var a=document.createElement("script");a.type="text/javascript";a.src=g;document.body&&document.body.appendChild(a)}}; To view this file, you may need to install a PDF reader program. For more information about coverage of over-the-counter tests, view our frequently asked questions. Health plans are offered by Blue Shield of California. cRequired for employment purposes. Some testing locations may not be in your health plans network, particularly if they arent part of a medical group or facility. The site may also contain non-Medicare related information. 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Over-the-counter COVID-19 tests will not be covered by your medical or pharmacy benefits after the end of the public health emergency. qO;,lH Most PDF readers are a free download. hb``g``````pD8 D8: I=3011\o`;!A ;\/0fpi$ ([!x Member Discounts Take advantage of member-only discounts on health-related products and services. Please mail completed form with copy of purchase receipt(s) to: Blue Shield of California P.O. Through May 31, all BCBS companiesincluding the BCBS Federal Employee Program (FEP)are: It is important that our members feel safe and secure during these unprecedented times, said Scott P. Serota, current president and CEO of the Blue Cross Blue Shield Association. Worlds Most Ethical Companies and Ethisphere names and marks are registered trademarks of Ethisphere LLC. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online. 2Some pharmacies may not be able to process claims for OTC tests at the pharmacy counter. b&HXR Use our. Call your doctor. The protection of your privacy will be governed by the privacy policy of that site. this.check=function(){var a=this.get(f);if(a)a=a.split(":");else if(100!=e)"v"==h&&(e=Math.random()>=e/100?0:100),a=[h,e,0],this.set(f,a.join(":"));else return!0;var c=a[1];if(100==c)return!0;switch(a[0]){case "v":return!1;case "r":return c=a[2]%Math.floor(100/c),a[2]++,this.set(f,a.join(":")),!c}return!0}; If you have any questions, please contact customer service at the phone number on your Blue Shield member ID card. If you paid for a COVID-19 test and think you might qualify for reimbursement, read the COVID-19 Testing Member Reimbursement Form (PDF) to find out more. Pumj(jlG_E>;j+/ %%EOF If you have an Anthem Medicaid or Medicare plan, you will need to visit your member website for information on how your health plan covers COVID-19 testing. P/* ldF76Y*\v|*-9?S % In this case, you should fill out three claim forms one for each member. You will still have access to vaccines . Then, complete and submit the online form. W006259 COVID-19 Testing Member Reimbursement Form - Non-Medicare Advantage Please use this form to request reimbursement for COVID-19 tests you have paid for out of your own pocket. Mail-in claim forms allow you to submit a claim for multiple members with one form. Nondiscrimination Notice and Foreign Language Assistance, Summary of Preventive and Contraceptive Services, must be purchased on or after January 15, 2022, used to identify the potential COVID-19 infection, will be self-administered with results that can be self-read, will not be resold, given or supplied to persons other than family members covered under the same policy, The purchase receipt documenting the date of purchase and price, UPC** cut-out from the over-the-counter COVID-19 test packaging, Signed, completed attestation confirming and acknowledging that the purchased over-the-counter at-home COVID-19 test meets eligibility guidelines. this.get=function(a){for(var a=a+"=",c=document.cookie.split(";"),b=0,e=c.length;bOver-the-Counter Tests | CareFirst BlueCross BlueShield To access your member services, please visit your BCBS company. -60kWX6Ejr,@)wQGte^>2WUViq zn=`8REgLh`EsF53&5oc027R9 Thats a big step toward stopping the spread of the virus. If you have any questions about your reimbursement claim submission, call . endstream endobj 461 0 obj <>/ProcSet[/PDF]>>>>stream You may need to visit a doctor or hospital while traveling in another state. Centers for Disease Control and Prevention (CDC), Coronavirus, World Health Organization (WHO), Coronavirus, Keep Your Children 5 and Older Safe With a COVID-19 Vaccine, How to Manage Back-to-the-Workplace Anxiety, Anthem has a limited number of at-home diagnostic test kits available for certain members to order online. Find out if the testing provider is in your health plans network. endstream endobj 465 0 obj <>/ProcSet[/PDF]>>>>stream Coronavirus (COVID-19) Updates | bcbsm.com If you do not have an itemized receipt, you must send us the barcode (UPC code) from your test(s) packaging. O=>WNW% PO Box 272540 If you think you may have the virus or have been exposed to someone who has it: Not all testing sites are the same. Log in to blueshieldca.com (Engagement Point users at engagementpoint.com) Choose "Claims" Select "File a claim" endstream endobj 460 0 obj <>/ProcSet[/PDF]>>>>stream Waiving all prior authorization requirements for COVID-19 testing and related covered services. COVID-19 Test Kits Available Through the Federal Government COVID-19 test kits are available through the Federal Government . Register Now. This new site may be offered by a vendor or an independent third party. 2. Li@ c;8tH$0Neh,````1A88Co&) W e#f`lF|kQN2qC,`j` ` ;v Find your BCBS company. 454 0 obj <> endobj The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Box 272540, Chico, CA 95927-2540 Questions? Youll go to a page that explains the form and has a link to download it. Your frequently asked questions about COVID19 - IBX Newsroom This page may have documents that cant be read by screen reader software. this.check=function(){var a=this.get(f);if(a)a=a.split(":");else if(100!=e)"v"==h&&(e=Math.random()>=e/100?0:100),a=[h,e,0],this.set(f,a.join(":"));else return!0;var c=a[1];if(100==c)return!0;switch(a[0]){case "v":return!1;case "r":return c=a[2]%Math.floor(100/c),a[2]++,this.set(f,a.join(":")),!c}return!0}; bxx,| Check out the changes and updates to our plan in 2023. However, you must include all required information requested in the form. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. To receive reimbursement for over-the-counter/at-home tests with a receipt dated May 11, 2023 or prior, members with Independence Blue Cross prescription drug coverage should submit documentation through ibx.com. endstream endobj 470 0 obj <>/Subtype/Form/Type/XObject>>stream Lets say you made a one-time purchase of up to 24 tests for three members. Commercial members may receive reimbursement for up to eight over-the-counter COVID-19 at-home tests per covered individual in the household per 30-days without a healthcare provider order or clinical assessment. Buying tests to store them for a potential need isn't good for the community or public health. You can use these claim forms to ask us for reimbursement. 1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue . Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. See below.). If any information is missing from the invoice, contact the provider. With a BCBSTX health plan, you have access to care for COVID-19 related health issues. We have a nationwide network of providers that participate with Blue Cross Blue Shield of Michigan. window.CE_READY = function () { CE2.listen(window, 'click', function(evt) { 2023 Blue Cross Blue Shield Association. Individuals attempting unauthorized access will be prosecuted. To be eligible for reimbursement, the purchased over-the-counter at-home COVID-19 tests: Members must complete a claim form to be reimbursed for over-the-counter COVID-19 testing. Blue Shield and Blue Shield Promise cover these types of tests: 1Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. H0148_22_003_C_020822. We ask everyone to respect and protect community health as the supply chain and our health and retail partners catch up with demand. a|VOXHXT:B4 D@3[0V PDF COVID-19 AT-HOME TEST REIMBURSEMENT FORM - Arizona COVID-19 Home Test Kits - For members | Blue Cross Blue Shield - BCBSRI By continuing to use this website, you consent to these cookies. // ]]>, // Coverage for COVID-19 testing | Blue Shield of CA BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Coronavirus (COVID-19) Updates | Blue Cross Blue Shield **The UPC (Universal Product Code) is the barcode and 12-digit-number that typically runs below it. testing after you received an initial COVID-19 test. 510 0 obj <>/Encrypt 455 0 R/Filter/FlateDecode/ID[]/Index[454 121]/Info 453 0 R/Length 185/Prev 186847/Root 456 0 R/Size 575/Type/XRef/W[1 3 1]>>stream Find out if the testing site is charging a separate/additional fee to give you the test, and exercise caution if visiting a non-State regulated or out-of-network pop-up testing site which may not have the same standards or billing practices as an in-network provider with your health plan. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. The number one priority for Blue Cross Blue Shield (BCBS) companiesespecially as the nation faces this unprecedented health crisisis getting their members across the country the care they need. Use the doctors, labs and facilities in your BCBSTX health plans provider network for: File is in portable document format (PDF). If you do not have an itemized receipt, you must send us the barcode (UPC code) from your test(s) packaging. Please enter the NDC or UPC number from the cash register receipt or test package. To file a claim for those out-of-network services, youll need to use the claim form from the state where you were treated. %%EOF According to the Centers for Disease Control (CDC) recommendations, if your over-the-counter test has a positive result, you should follow the latest CDC guidance for isolation, wear a well-fitted mask if you have contact with others and call your healthcare provider. Coverage of at-home COVID-19 tests | ERS - Texas Required documentation for this medical claim includes: The attestation included in our claims process ensures our members comply with the spirit of this policyto ensure tests are accessible and affordable for those who need them. If this happens, you can pay for the test and then submit a claim for reimbursement. File is in portable document format (PDF). Everyone qualifies. We are committed to making sure members get the care they need when they need it. All OTC at-home tests ordered by a healthcare provider are covered. We use cookies on this website to give you the best experience and measure website usage. // ]]>. All Rights Reserved. Using facts from the CDC, we hope to answer your questions and arm you with the knowledge you and your children deserve so you can feel confident in your decision. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. The Blue Cross Blue Shield companies partner with state and federal agencies, as well as advocacy organizations, to report, investigate and reduce the incidence of healthcare fraud. Important Information About Medicare Plans. COVID-19 diagnostic tests will be covered at your regular benefit level after the end of the public health emergency. (function(){var g=function(e,h,f,g){ . Also, note that all American households can order free COVID-19 tests from the federal government. Log in to blueshieldca.com (Engagement Point users at, Enter that information as indicated. If you use a pharmacy in Primes network, you should not have to submit a separate claim when you buy the tests at the pharmacy counter. 1To download the BCBSTX app, text BCBSTXAPP to 33633 or search for BCBSTX in the Apple App Store or Google Play. Sometimes the form is called Member Application for Payment Consideration, which is the same as a claim form. You can also include multiple receipts with one form. 142 0 obj <>stream If you purchased an OTC at-home test at the direction of your health care provider, please use this form: If you purchased an OTC at-home test for any other reason, please use this form: Send a copy of all your receipt(s) with the form. try{(new g(100,"r","QSI_S_ZN_eQKLROMaB9E1yfz","https://zneqklromab9e1yfz-carefirst.siteintercept.qualtrics.com/SIE/?Q_ZID=ZN_eQKLROMaB9E1yfz&utm_source=Qualtrics")).start()}catch(i){}})(); Site Map|Feedback|Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org, COVID-19 Testing Member Reimbursement Form (PDF), Forms for Blue Cross Blue Shield of Michigan (PPO) members, Forms for Blue Care Network (HMO) members, Prescription drug claim forms (PPO and HMO). Check the state-by-state list of Blue Cross Blue Shield companies to get started. Your health plan covers FDA-authorized COVID-19diagnostic testingat no cost until the end of the public health emergency on May 11, 2023. Blue Shield of California PO Box 272540 Chico, CA 95927-2540 COVID-19 laboratory tests (PCR tests) If you paid out of pocket for a test that was sent to a laboratory, follow the steps below to file a reimbursement claim. Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices To find an in-network pharmacy, click here or download the fepblue app. Reimbursement is limited to OTC COVID-19 at-home tests authorized for emergency use by the Food and Drug Administration. For the Health of America. It must include the original receipt or a copy of the receipt for purchasing the tests. Over-the-counter COVID-19 tests will not be covered by your medical or pharmacy benefits after the end of the public health emergency. At home Covid test coverage - Blue Cross Blue Shield of Massachusetts If you have employer coverage, or an individual or family plan, you can get FDA-authorized, over-the-counter COVID-19 tests for diagnosing COVID-19 through your BCBSTX/Prime Therapeutics. PDF COVID-19 Testing Member Reimbursement Form Non-Medicare Advantage - BCBSM Your Blue Cross and Blue Shield of Texas (BCBSTX) health plan gives you access to the care you need during the COVID-19 pandemic. Reimbursement Claim Form for Over-the-Counter at-home COVID-19 Test BCBS COVID-19 Info - Benefits, Testing, and More - FEP Blue If you are covered by a group or individual and family health plan, you can get reimbursed for your purchase of FDA-authorized, at-home testing kits at $12 per test, or $24 for a box that includes two tests, for up to 8 tests per person every 30 days. For example, you have to see an out-of-network doctor that doesnt accept your insurance. OTC tests purchased at retail locations cost, on average, $12 for a single test and $24 for a double test kit. CVS Caremark is part of the CVS Health family of companies. If you have health coverage through a large employer, we recommend you contact your Benefits or HR Administrator to determine if your over-the-counter COVID-19 testing claim should be submitted to CareFirst as a medical claim or to your employers Pharmacy Benefit Manager as a pharmacy claim. A recent announcement from the federal government intends to increase access to COVID-19 testing. The Biden administration announced that it intends to end the COVID-19 national and public health emergency (PHE) declarations on May 11, 2023. F2g5 :s+Jc How to get reimbursed for COVID-19 tests | Blue Shield of CA In this case, you should fill out three claim forms one for each member. The process we've put in place empowers our members to buy and submit claims for tests purchased through online vendors and retail locations of their choosing. In addition, some sites may require you to agree to their terms of use and privacy policy. *CVS Caremark is an independent company that has been contracted to administer your pharmacy benefits for Blue Cross Blue Shield of Massachusetts. endstream endobj 14 0 obj <>>> endobj 15 0 obj <. All Rights Reserved. try{(new g(100,"r","QSI_S_ZN_7NEbFnBCgXhmlPT","https://zn7nebfnbcgxhmlpt-carefirst.siteintercept.qualtrics.com/SIE/?Q_ZID=ZN_7NEbFnBCgXhmlPT")).start()}catch(i){}})(); Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. ro?gu?"t6Vr K?K@n}r`TyEycB". In addition, some sites may require you to agree to their terms of use and privacy policy. Even though the Public Health Emergency is ending May 11, 2023, our commitment to helping you live your healthiest life will not change. f/4kg>/ProcSet[/PDF]>>>>stream Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Read Full Story Audience Communities PDF Medicare Advantage COVID-19 Testing Member Reimbursement Form - BCBSM California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. One option is Adobe Reader which has a built-in screen reader. If you have any questions about your over-the-counter test, you should call your healthcare provider or check out our FAQs. If you purchase at-home tests without an order from your healthcare provider, you can be reimbursed for up to eight individual tests per member, per month. endstream endobj 467 0 obj <>/ProcSet[/PDF]>>>>stream State and Federal Privacy laws prohibit unauthorized access to Member's private information. How can I resolve a problem with my PPO or HMO claim? Medicare Advantage members: You will need an order for an OTC at-home test from an authorized healthcare provider to get reimbursed at this time. You will be reimbursed up to $12 per test by submitting a claim. New User? If a test is sold in a package of two, that is considered two tests, and you'll be reimbursed $24. Coverage varies by plan type. . Blue Shield of California is an independent member of the Blue Shield Association A53064-FF . You do not need health insurance to receive your free tests. You can also include multiple receipts with one form. The California Department of Health Care Service (DHCS) will reimburse the cost of your at-home tests purchased from March 11, 2021, to January 31, 2022.