Only visit the ER or call 911 if youre experiencing life-threatening symptoms. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Youll go to a page that explains the form and has a link to download it. To access your member services, please visit your BCBS company. endstream endobj 461 0 obj <>/ProcSet[/PDF]>>>>stream If you do not have an itemized receipt, you must send us the barcode (UPC code) from your test (s) packaging. Your member ID card is your key to using your medical plan benefits. 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.). follow the latest CDC guidance for isolation. Pickup cannot happen via drive-thru and tests will not be shipped. California Physicians' Service DBA Blue Shield of California 1999-2023. 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. Some testing locations may not be in your health plans network, particularly if they arent part of a medical group or facility. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. To print and mail your claim, download theclaim form (PDF). How Your Benefits Work COVID-19 vaccination coverage after the Public Health Emergency Coverage for COVID-19 testing COVID-19 treatment If you have Medicaid, you can go to https://mss.empireblue.com/ny/home.html for information about your plan. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. In addition, some sites may require you to agree to their terms of use and privacy policy. Most PDF readers are a free download. 454 0 obj <> endobj Li@ c;8tH$0Neh,````1A88Co&) W e#f`lF|kQN2qC,`j` ` ;v People may also access free or affordably priced testing in the community. endstream endobj 464 0 obj <>/ProcSet[/PDF]>>>>stream To submit a claim online, log in to, or register forMy Account, click My Documents, then Forms and select Over-the-Counter COVID-19 Test Online Claim to get started. The protection of your privacy will be governed by the privacy policy of that site. %%EOF To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. COVID-19 Test Kits Available Through the Federal Government COVID-19 test kits are available through the Federal Government . You can also include multiple receipts with one form. 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. For example, you have to see an out-of-network doctor that doesnt accept your insurance. You are leaving this website/app ("site"). The site may also contain non-Medicare related information. If you dont have a primary care doctor, we can help you find one. (function(){var g=function(e,h,f,g){ The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. As the COVID-19 pandemic continues, testing is an important way to limit the spread of the disease. 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. ro?gu?"t6Vr K?K@n}r`TyEycB". Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. 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. For example, one box containing two tests counts as two tests. P/* ldF76Y*\v|*-9?S % See below.). To qualify: . Once you reach the limit of eight tests per member per calendar month, we will not reimburse claims for additional tests. PO Box 272540 Some testing locations may not be in your health plans network. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. 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. endstream endobj 14 0 obj <>>> endobj 15 0 obj <. More than 140 million Americans have received a dose of the COVID-19 vaccine. If a test is sold in a package of two, that is considered two tests, and you'll be reimbursed $24. You can submit any number of receipts on a single claim form. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. at-home COVID-19 Test Reimbursement Claim form found here. Blue Cross Blue Shield of Michigan PPO: 1-800-762-2382 Blue Care Network HMO: 1-800-482-5982 Medicare Plus Blue PPO: 1-888-803-4960 BCN Advantage HMO and HMO-POS: 1-800-431-1059 Or, learn more about all the mental health options available to you. Please call OptumRx customer service toll-free at (855) 828-9834 (TTY:711) or see the COVID-19 test kit FAQ under "Which tests are covered" for the most up to date list of covered tests. Check the state-by-state list of Blue Cross Blue Shield companies to get started. a|VOXHXT:B4 Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 2023 Blue Cross Blue Shield Association. (For example, you can buy 4 boxes that include 2 over-the-counter COVID-19 tests.). Please mail completed form with copy of purchase receipt(s) to: Blue Shield of California P.O. FEP will cover up to eight (8) over-the-counter COVID-19 tests per member on a contract per calendar month. State and Federal Privacy laws prohibit unauthorized access to Member's private information. testing after you received an initial COVID-19 test. In addition, some sites may require you to agree to their terms of use and privacy policy. This page may have documents that cant be read by screen reader software. Your health plan covers FDA-authorized COVID-19diagnostic testingat no cost until the end of the public health emergency on May 11, 2023. 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. Just choose the form based on your group or plan and the service. Medicare Advantage members: Use the claims form for OTC at-home tests with a healthcare provider order. OTC tests, also known as self-tests, detect if you are currently infected with COVID-19. Purchase FDA-authorized OTC tests at a retail location and then submit a Health Benefits Claim Form, providing an itemized receipt that clearly shows that your purchase was for a COVID-19 OTC test to your local BCBS Plan. 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. this.get=function(a){for(var a=a+"=",c=document.cookie.split(";"),b=0,e=c.length;b/Subtype/Form/Type/XObject>>stream You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online. In the face of COVID-19, every question, answer and vaccination is important. (To submit a single form for multiple members and/or receipts, use a mail-in form instead. Costco, Wal-Mart, Amazon), please attach itemized register receipts to the back of this form. try{(new g(100,"r","QSI_S_ZN_7NEbFnBCgXhmlPT","https://zn7nebfnbcgxhmlpt-carefirst.siteintercept.qualtrics.com/SIE/?Q_ZID=ZN_7NEbFnBCgXhmlPT")).start()}catch(i){}})(); 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 We provide health insurance in Michigan. Centers for Disease Control and Prevention website: Test for Current Infection (accessed January 2022): cdc.gov. COVID-19 diagnostic tests will be covered at your regular benefit level after the end of the public health emergency. That means members will pay nothing out-of-pocket to take care of their COVID-19-related health needs. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. O=>WNW% IMPORTANT CORONAVIRUS/COVID-19 ANTI-FRAUD MESSAGE TO CONSUMERS. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. this.set=function(a,c){var b="",b=new Date;b.setTime(b.getTime()+6048E5);b="; expires="+b.toGMTString();document.cookie=a+"="+c+b+"; path=/; "}; You may need to visit a doctor or hospital while traveling in another state. We are committed to making sure members get the care they need when they need it. 142 0 obj <>stream endstream endobj startxref You do not need health insurance to receive your free tests. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Online claim example 1: Lets say you made a one-time purchase of up to 24 tests for three members. But some are still hesitant to get the shot. 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. A nurse case manager with Blue Cross & Blue Shield of Rhode Island found that listening, without judgment, to one patients concerns made all the difference. Sometimes the form is called Member Application for Payment Consideration, which is the same as a claim form. Blue Shield of California is an independent member of the Blue Shield Association A53064-FF . Then, complete and submit the online form. Check your symptoms and risk for COVID-19 The CDC has a prevention tool you can use. Even if you have medical, vision, dental or prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, there may be occasions when you have to pay for services yourself. To be reimbursed for a COVID home test kit purchased at any pharmacy or retailer (e.g. s&jPDed To view this file, you may need to install a PDF reader program. Over-the-counter COVID-19 tests will not be covered by your medical or pharmacy benefits after the end of the public health emergency. 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. this.set=function(a,c){var b="",b=new Date;b.setTime(b.getTime()+6048E5);b="; expires="+b.toGMTString();document.cookie=a+"="+c+b+"; path=/; "}; Starting February 1, 2022, Medi-Cal members should obtain OTC at-home tests through pharmacies enrolled as Medi-Cal providers. Lets say you made a one-time purchase of up to 24 tests for three members. Additional details about at-home COVID-19 testing can be found on the Blue Cross Blue Shield website. Medicare Advantage COVID-19 Testing Member Reimbursement Form Important Information About Medicare Plans. If you are a Medicare Advantage, Medigap, Medicaid or Dual Eligible Special Needs Plan member, please call the number on the back of your member ID card for benefit information. // ]]>, // >>/EncryptMetadata false/Filter/Standard/Length 128/O(a;uY[7y\\ Y)/P -1036/R 4/StmF/StdCF/StrF/StdCF/U(6Tn= )/V 4>> endobj 456 0 obj <>>> endobj 457 0 obj <> endobj 458 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/StructParents 10/Tabs/W/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 459 0 obj <>/ProcSet[/PDF]>>>>stream 2023 copyright Anthem Insurance Companies, Inc. Stay informed by checking these resources for up-to-date information about COVID-19, especially if youre thinking about traveling. And if you use a pharmacy in Prime's network and check out at the pharmacy counter, you shouldn't have to pay upfront or submit a claim . For more information about coverage of over-the-counter tests, view our frequently asked questions. Wu3B= e&gZ-h'BR$djC?Wn>2esFdUb'$K6Q 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

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