U.S.: Update on COVID-19 cost-share changes
Recently, Blue Cross Blue Shield of Michigan (BCBSM) announced updates to the COVID-19 temporary benefit changes that were in place the past few months as BCBSM members navigated the pandemic.
Following is an overview of the updated COVID-19 cost-share provisions:
| Blue Cross Online Visits (telemedicine) | The temporary cost share waiver will end on June 30, 2020. Effective July 1, 2020, member cost sharing resumes. |
| COVID-19 tests and administering the tests | No change at this time. COVID-19 tests are fully covered for BCBSM members as long as the federal public health emergency mandate is in place. Tests are only covered if approved by the Food and Drug Administration (FDA) and ordered by a health care provider. |
| COVID-19
treatment |
The member cost share waiver for COVID-19 treatment has been extended to Dec. 31, 2020. |
As noted in the table above, the cost share waiver for COVID-19 treatment for all BCBSM members is extended through Dec. 31, 2020.
In addition, there is new process for COVID-19 treatment claims as of July 1, 2020. Here is what you need to know:
- If you are on a DENSO health care plan and you get treated for COVID-19, you will need to pay the cost share (copay, deductible, coinsurance) up front.
- That amount is added to your out-of-pocket maximum (OOPM) accumulation for the calendar year.
- BCBSM will post an Explanation of Benefit (EOB) statement to your member account at (bcbsm.com) and mail that EOB to your home. NOTE: The EOB will not reflect the reimbursement you’ll receive for COVID-19 treatment cost share expenses.
- All COVID-19 treatment claims meeting the member cost-sharing criteria, meaning you had a positive COVID-19 diagnosis, will go through a special check-writing process.
- Checks are handled outside of BCBSM’s claim system and will be issued once a month. That means that your account in BCBSM’s system will show that you paid the cost share, and it will not show that you were reimbursed for those costs.
- You will receive a letter from BCBSM before the EOB explaining why you will receive a reimbursement check.
- COVID-19 treatment claim checks will state “special payment” and will include “for COVID treatment cost share” on the check stub. The check will be accompanied by a letter with the following details:
- An explanation on why you are receiving a check. You should/can use the check to pay the cost-share amount to your health care provider. If you’ve already paid the health care provider, the check is reimbursement to you for the services billed.
- Claim summary information, which will be listed on the back of the letter.
These updates and samples of the pre-EOB letter and the EOB letter accompanying the check are available on the COVID-19 page on www.densobenefits.com (username: denso).