|April 1, 2020|
|*Special Enrollment Period and Resources for Group Members Losing Coverage|
At Blue Cross and Blue Shield of Illinois (BCBSIL), we are committed to standing with our customers and members in this changing environment. As part of that commitment, we want to let you know about some of the options that may be available to you and several different ways we can help group members who may need coverage support due to COVID-19.
What you need to know: Review details for eligibility requirements, special enrollment period, other coverage options and additional resources.
|BCBSIL Waiving Prior Authorization for Transfers to Post-acute Facilities|
BCBSIL is waiving prior authorization requirements for transfers to in-network, medically necessary alternative post-acute facilities until April 30, 2020.
What this means: We will no longer require prior authorization to transfer our members from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals and skilled nursing facilities.
This will help promote availability of acute care capacity for COVID-19 patients during this public health emergency. It also allows our members to continue to access medically necessary care.
If the transfer is for a behavioral health facility, it will require prior authorization.
More details available: Learn which members this applies to, criteria for transfers and timing.
|*BCBSIL Responds to COVID-19: Further Expanding Telehealth to All In-network Providers|
BCBSIL launched an expanded telehealth program on March 11, 2020, in quick response to the COVID-19 crisis in order to provide greater access and to help remove potential barriers to medical services for our members.
What’s new? On March 19, Illinois Governor J.B. Pritzker issued an Executive Order expanding telehealth services across the state. In collaboration with state efforts, BCBSIL has expanded in-network telehealth benefits for all state-regulated, fully insured members. This expansion will remain in effect until the Governor lifts his proclamation of Illinois as a disaster area . It is important to note that employer group telehealth benefits may differ by plan.
Effective March 19, 2020, BCBSIL began providing benefits to fully insured members for health care services provided by in-network and out-of-network providers for all medically necessary covered services and treatments (consistent with the terms of the member’s benefit plan).
More information: Review other important details and the types of providers that telehealth may include.
|Beware of COVID-19 Medicare Scams and What Members Should DoAccording to the Federal Communications Commission, criminals are using COVID-19 as an opportunity to steal identities and commit Medicare fraud.|
Why it matters: In some cases, scammers might tell Medicare beneficiaries that they’ll send them a COVID-19 test, masks or other items in exchange for their Medicare number or personal information. Members should be wary of unsolicited requests for their Medicare number or other personal information.
Review and share these recommendations and safety tips with your clients.
BlueCross BlueShield of IL Member Letter
To our Valued Customers,
The health, safety and well-being of our employees, members, customers — and the communities we serve — are a priority.
As the situation with COVID-19 evolves, our entire team is ready and standing by to support you and your employees.
We know you are actively requesting more information, information you need to make decisions, and to share with your employees. For all of us, what we know about COVID-19 is changing day-to-day. We are responding to rapid changes and will communicate to you what is known and what we’re doing.
Promoting health, safety and care.
Nothing is more important than you and your employees’ health and safety. We’ll share information with you about how we’re working to support and protect those vulnerable to COVID-19.
We’re available whenever and wherever you are.
We’ve implemented our business continuity plan, which means a large number of our employees are working remotely. We don’t expect any disruption in service. Our Customer Service team is ready to help you, your employees, and providers on the phone and online.
You can also check bcbsil.com/covid-19 for updates or contact your account executive with additional questions about our own preparedness planning and how it impacts the services we provide to you.
Actions we are taking.
The following information may vary based on what type of health coverage your employees have. We are working on coverage decisions based on the COVID-19 relief package the President signed on March 18 and will continue to keep you updated as we move forward.
In addition to the federal guidelines, we are aware that State Governors and regulators are releasing their own guidance. We will continue to merge those sets of State direction and guidance, update our approach to employer benefit plans, and release those resulting business impacts to you through several channels. These are not necessarily permanent changes and Blue Cross and Blue Shield of Illinois (BCBSIL) will continue to evaluate the appropriate timeframe for extending these temporary changes due to
(Note: Coverage may be different for members under certain employer self-funded health plans, depending on the decisions each employer makes about COVID-19 coverage.)
- COVID TESTING: Currently, BCBSIL members won’t pay copays, deductibles or coinsurance for testing to diagnose COVID-19 or for testing-related visits with in-network providers, whether the visit is at the provider’s office, urgent care, the emergency room or by telehealth. Their doctor doesn’t have to ask us for the authorization to test for COVID-19.
Non-COVID-19 doctor’s visits, along with other non-COVID-19 related tests and services (like hospitalization and ER services), are covered, consistent with your benefit plan. This means your employees may have a copay, coinsurance or deductible for visits or other services, depending on the terms of their benefit plan. To the extent State laws require coverage of COVID- 19-related treatment or additional items and services, we will follow those State requirements.
- PRESCRIPTION REFILLS: We have temporarily lifted restrictions on getting early fills of prescription drugs for members. That fill will be for the same quantity as the last prescription filled. Your employees can contact their pharmacy directly to ask for an early fill. They have approval to provide an early fill on most medications. (Note: These prescription fill rules may differ for employees covered through self-funded plans.)
Your employees can also use 90-day supply benefits for covered non- specialty medications at select retail pharmacies or home delivery (mail order). They can log into Prime Therapeutics’ website or call the number on their member ID card.
Please note: The above early fill information applies to members with BCBSIL pharmacy benefits administered by Prime Therapeutics. Also, all safety measures, prior authorization reviews, as well as prescribing and dispensing laws, still apply.
TELEHEALTH (Virtual Visits): Currently, members of BCBSIL State- regulated, fully insured plans can access telehealth benefits for covered services. These benefits provide access to care while reducing risk of exposure to COVID-19 or other viruses. These telehealth benefits are not specific to the treatment of COVID-19.
For a short time, BCBSIL will end cost-sharing for
medically necessary, covered medical and behavioral health services with
in-network providers delivered through telemedicine. Those benefits may differ
for self-insured groups and based on applicable state laws and mandates.
Between now and April 30, BCBSIL will continue to consider whether to extend the timeframe of this temporary cost-sharing change.
Depending on your group benefits, your employees may have access to:
- Telehealth visits (including behavioral health) covered as a regular office visit in accordance with benefit plan terms for in-network providers who offer the service through two-way, live interactive telephone or digital video consultations or other methods allowed by applicable State laws and regulations. Some members may also have access to out-of-network telehealth providers.
- Bilingual 24/7 Nurseline. Employees who think they’ve been exposed to COVID-19 can call the 24/7 Nurseline. The 24/7 Nurseline can help them identify some options if they’re sick. Nurses are available at 1- 800-581-0368, 24 hours a day, seven days a week.
- Virtual Visits benefit*. Provided by BCBSIL and powered by MDLIVE, the doctor is in 24/7/365. Employees can consult a board-certified doctor for non-emergency situations by phone, mobile app or online video. Virtual Visits doctors can even send e-prescriptions to their local pharmacy.
Areas we continue to assess:
We understand your requests to ease the impact of COVID-19 on your workforce. We are evaluating requests that seek clarity around topics such as:
- Payment grace periods
- Employment requirements and health plan eligibility guidelines
- Requests for extensions on your renewal decisions and/or open enrollment decisions from your employees
- And other ways to support you in making decisions to help your business and your employees
As we work through these and other decisions please continue to work closely with your Account Executive, as they are your direct source and will provide immediate updates on any changes that may impact your benefit choices.
We thank you for being a Valued Customer.
*Virtual Visits and telehealth may not be available on all plans. Virtual Visits and telehealth are subject to the terms and conditions of your benefit plan, including benefits, limitations, and exclusions. Non- emergency medical service in Montana and New Mexico is limited to interactive online video. Non- emergency medical service in Arkansas and Idaho is limited to interactive online video for initial consultation. Other State law limitations and rules may apply.
MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Illinois. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services.