COVID-19 Update: Antibody Testing

The COVID-19 (coronavirus) public health emergency has resulted in changes to the delivery and coverage of health care, including new protocols, new tests and new treatments.

On June 23, 2020, new guidance was issued by the federal government that impacts how antibody (serological) tests are covered under the Families First Coronavirus Response Act (the FFCRA) as amended by the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act).

This federal guidance, supported by guidelines from the Centers for Disease Control and Prevention (CDC) and guidance from the Food and Drug Administration (FDA), clarifies how diagnostic testing for COVID-19 should be covered by health plans. We want you to know how Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) will cover antibody testing under your health plan.

Beginning with claims received on August 1, 2020, Horizon BCBSNJ will pay claims for COVID-19 antibody testing for members:

• Age 20 and under without member cost sharing and without requiring proof of an individualized clinical assessment from an eligible clinician, acting within the scope of their licensure.
• Age 21 and older without member cost sharing when evidence for an individualized clinical assessment to determine whether the test is medically appropriate for the individual in accordance with currently accepted standards of medical practice from an eligible clinician is provided.

These claims will be reimbursed without member cost sharing until at least 90 days after the end of the public health emergency and State of Emergency declared by Governor Murphy in Executive Order 103 of 2020.

Antibody testing claims for members age 21 and older who self-direct, or those lacking evidence for an individualized clinical assessment, will be denied.

Antibody testing claims received before August 1, 2020 will be paid without member cost sharing and without requiring proof of an individualized health assessment, as testing was done before the federal government released guidance for these claims.

Watch this video from the FDA about antibody testing.

For most members, if your doctor determines that you should be tested for COVID-19, your out-of-pocket costs for testing will be waived. The waiver of out-of-pocket costs for COVID-19 testing is in place now and will be for at least 90 days after the end of the public health emergency and State of Emergency, as declared by Governor Murphy.

Additionally, through December 31, 2020, unless extended, most members will not pay any cost share (copay, coinsurance, deductibles) for covered services related to inpatient or outpatient treatment when the primary diagnosis is COVID-19.

This information applies to all fully insured members, including those covered through Medicaid, Medicare Advantage, Individual and Small Group policies, as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).

Horizon BCBSNJ will continue to work with other self-insured customers that provide coverage for their employees on their specific plan designs.

Horizon BCBSNJ will waive PA requirements for:

• A visit to a primary care physician, urgent care center or ER for evaluation of upper respiratory symptoms, fever, shortness of breath or other symptoms that may represent COVID-19.
• Diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19.
• Lab studies or diagnostic testing for COVID-19 required during an ER evaluation or inpatient hospital stay.

Yes. To help you get the care you need, Horizon BCBSNJ is waiving out-of-pocket costs for covered services when provided through telemedicine for at least 90 days after the end of the public health emergency and State of Emergency as declared by Governor Murphy. This means, Horizon BCBSNJ is:

• Relaxing its telemedicine rules so members can get covered services by phone, video (including common video platforms such as FaceTime and Skype) and chat from in-network and out-of-network health care professionals.
• Waiving member out-of-pocket costs for members enrolled in a fully insured plan for covered services provided by an in-network health care professional for a telemedicine visit provided by primary care doctors, specialists, therapists, mental health and substance use treatment professionals, or urgent care doctors.
  • Members enrolled in self-insured plans can get care for covered services through a telemedicine visit, but will pay based on their plan’s provisions.
  • Members with out-of-network benefits who get care from an out-of-network health care professional will be responsible for costs according to their benefits.

We encourage you to call your in-network doctor to find out if they offer telemedicine (by phone, video or chat) as an option for you to get care. If they do, you may be able to avoid a visit to their office.

In addition, all Horizon BCBSNJ members have free, 24/7 access to registered nurses through Chat for Care from the Horizon Blue app. Nurses are available to answer your questions about COVID-19 symptoms, as well as other health questions or concerns, and can connect you to a doctor, if needed.

Members enrolled in a fully insured plan may also call 1-888-624-3096, 24/7, to speak with a registered nurse to understand COVID-19 symptoms and other health concerns. These members will see the following statement on the back of their member ID card: Insured by Horizon BCBSNJ.

Members enrolled in the State Health Benefits Program (SHBP) or School Employees’ Health Benefits Program (SEHBP) can call 1-800-414-SHBP (7427) to access the nurse line and Horizon Health Guide services.

Testing asymptomatic individuals is not medically indicated and against the current advice of the CDC and World Health Organization.

CDC recommends voluntary home quarantine‌ for those who have traveled to/from countries where COVID-19 has spread or who have been exposed to individuals with the virus.

We cover vaccines recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) and the U.S. Preventive Health Services Task Force (USPSTF).

Health insurance contracts issued by Horizon BCBSNJ and across the industry require that employees covered by group plans be continuously active at work, be employed full time and perform the normal and customary duties of their job.

However, through December 31, 2020, unless extended, Horizon BCBSNJ:

• Is waiving the “actively at work” requirements for all group health plans impacted by COVID-19.
• Is allowing group plan sponsors to maintain coverage for furloughed, temporarily laid-off and employees whose full-time status has otherwise been reduced.

Learn more‌ about Horizon BCBSNJ’s effort to help employees covered by group plans maintain their coverage.

At this time, diagnostic testing must be ordered by your doctor and can only be performed by certain laboratories. No referral is required for primary care, urgent care or emergency care.

Call Horizon BCBSNJ’s Special Investigations Unit (SIU) hotline and explain what happened.

• If you are covered by Horizon NJ Health, call 1-855-372-8320.
• If you are covered by any other Horizon BCBSNJ plans, call 1-800-624-2048.

Tests for COVID-19 are not offered by phone or door-to-door. Phone calls asking for your member ID number or other information for free testing/services are likely to be scams.

Current guidance about COVID-19 testing is available on the CDC website.

No. This email is likely to be a spear phishing email that could download malicious software (malware) onto your computer without your knowledge. If that happens, cybercriminals can take control of your computer, log your keystrokes or access your personal information and financial data.

A COVID-19-themed phishing email may look like it’s from the CDC. However, there are a couple of things that should tip you off:

• Scammers purposefully create a sense of urgency, curiosity or fear to fool you into taking immediate action such as clicking on a link; this is especially true for COVID-19-themed attacks.
• Be suspicious of emails that do not use your name and contain grammatical and spelling errors.

When you’re in a rush or eager for information, it’s easy to click a link you shouldn’t. Taking a few extra seconds to stop and think is always a good idea.

While many dentist offices have re-opened throughout New Jersey, Horizon BCBSNJ wants to help our members continue to feel safe and get the care they need. Through August 31, 2020, Horizon BCBSNJ will cover teledentistry for covered services.

Due to the national emergency related to COVID-19, during the time period between March 1, 2020 and until 60 days after the announced end of the national emergency, you have additional time beyond the usual 30-day (or 60-day, in certain circumstances) time period to file an appeal with Horizon BCBSNJ. This applies to you only if you’re covered under a group health plan subject to the Employee Retirement Income Security Act (ERISA).

If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.

Due to the national emergency related to COVID-19, during the time period between March 1, 2020 and until 60 days after the announced end of the national emergency, you have additional time to file a claim with Horizon BCBSNJ. This applies to you only if you’re covered under a group health plan subject to ERISA. If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.

Due to the national emergency related to COVID-19, between March 1, 2020 and until 60 days after the announced end of the national emergency, you have additional time to request a special enrollment if you’re covered under a group health plan subject to ERISA. This means that during this time period, you may elect to enroll under the group’s health plan beyond the 30- or 60-day time period usually allowed. Horizon BCBSNJ will retroactively enroll members as needed.

If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.

Due to the national emergency related to COVID-19, if you are an employee of an affected group health plan and you experience a loss in coverage, you may elect COBRA coverage past the usual 60-day limit during the time period between March 1, 2020 and until 60 days after the announced end of the national emergency. Horizon BCBSNJ will retroactively enroll those individuals as needed. This applies to you only if you’re covered under a group health plan subject to ERISA. If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.