How Blue Cross Blue Shield of Wyoming is responding to the COVID-19 pandemic — and what you need to know
BCBSWY Continues to Support Access to COVID Vaccines
Sep 28, 2023 — BCBSWY works each day to help our members access the care they need. Congress requires the vast majority of private insurance plans to begin coverage of any COVID vaccine, including boosters, after the federal approval or authorization. BCBSWY has and will continue to support broad access to COVID vaccines and treatments, and we encourage everyone to speak to their providers and pharmacists about the updated COVID-19 booster vaccines.
May 11, 2023 — At Blue Cross Blue Shield of Wyoming (BCBSWY), our top priorities are to ensure our customers’ and employees’ health and safety and provide quality service. We continue to follow the guidance of local and federal health officials regarding the impact of COVID-19.
End of Emergency Declarations
The federal government will end the COVID-19 national and public health emergencies on May 11, 2023. Starting May 12, 2023, standard health plan provisions will apply with cost shares as applicable for COVID-19 testing, related services, and vaccine administration.
Please see below for important updated information about the benefits of COVID-19 vaccinations, testing, and treatment.
Coverage for COVID-19 vaccinations
Approved vaccines
COVID-19 vaccines authorized by the U.S. Food and Drug Administration are a safe, effective way to reduce your risk of severe illness. Vaccines are widely available, and BCBSWY encourages members to receive their shot(s).
To view the latest vaccine information, including:
- Approved vaccines
- Eligible age groups
- Booster shot eligibility
- Dose requirements
- And more
Visit the CDC’s website.
Starting May 12, 2023:
- Vaccines will be covered under preventive care. See your benefit booklet for cost share information.
Coverage for COVID-19 testing
BCBSWY is continuing to waive member cost-sharing for medically appropriate in-network COVID-19 testing and related services through May 11, 2023. Members will pay nothing for medically appropriate in-network testing and associated services in a doctor’s office, urgent care facility, or emergency room.
This waiver of cost shares applies to all groups and individual health plan members.
Medically appropriate COVID-19 tests must be ordered by a doctor or health care provider for the purpose of diagnosing COVID-19. This includes COVID-19 drive-through test sites or home test kits purchased with an order from a doctor.
Note: Unnecessary tests, including large panel tests, may not be covered under your group’s health plan. Members could be responsible for the entire fee, which could be up to $1,000.
Starting May 12, 2023:
- Cost shares will apply accordingly
Over-the-counter COVID-19 testing
Test kits that do not require a doctor’s order or a lab to read the results are considered over-the-counter (OTC). There is a $0 cost share for up to eight individual OTC COVID-19 tests per member per 30 days for tests purchased from Jan. 15, 2022, through May 11, 2023. Starting May 12, 2023, standard plan provisions will apply for OTC COVID-19 tests (please note: most health plans exclude coverage for OTC tests). This applies to all groups that use BCBSWY’s pharmacy benefits manager, Prime Therapeutics, and individual health plan members.
Federal Employee Program (FEP) members: Please visit FEPBlue.org for purchase instructions.
People with Medicare should reference the Centers for Medicare and Medicaid Services (CMS) for information on obtaining OTC COVID-19 tests.
All FDA-approved OTC COVID-19 tests are eligible for reimbursement when purchased from Jan. 15, 2022, to May 11, 2023. View the list of eligible tests here. Tests purchased before Jan. 15, 2022, do not qualify for reimbursement.
Our pharmacy benefits manager, Prime Therapeutics, has established a preferred network of pharmacies to support members in obtaining at-home tests without member cost share. This network includes approximately 65,000 pharmacies nationwide. These preferred pharmacies can bill OTC COVID-19 tests directly to your insurance, resulting in no cost to you.*
Tests purchased from a non-preferred pharmacy, online retailer, or retail store can be submitted for reimbursement through the pharmacy paper claims process for OTC COVID-19 tests. These claims will be reimbursed up to $12 per individual OTC COVID-19 test. Reimbursement includes tax and shipping, if any, as long as the tax and shipping can be readily identified on the receipt. For example, a box that includes two tests would be reimbursed at a maximum of $24 (including tax and shipping). If a large pack of tests is purchased for multiple members, a claim form is required for each member, and they may use the same receipt.
COVID-19 testing for public surveillance or employment purposes is not covered. This includes testing for work, school, travel, and other public surveillance reasons, unless reimbursement becomes required by law.
*Some pharmacies may be unable to bill your insurance directly for OTC COVID-19 tests. Members should check with their pharmacy on its policies regarding OTC COVID-19 tests. If pharmacies cannot support direct billing, please keep your receipt and use the pharmacy paper claims process for OTC COVID-19 tests to request reimbursement.
Coverage for coronavirus treatment
In our continued effort to reduce barriers to getting medical care to treat COVID-19, BCBSWY has extended our commitment to waive cost sharing and copayments for treatment and inpatient hospital admissions for the treatment of COVID-19, effective through December 31, 2021, for most members.
FEP Members
So that we can continue to serve you, please send us a secure message via your online account at FEPBlue.org.
