Horizon BCBSNJ covers FDA-authorized antibody testing performed by a lab that has the appropriate Clinical Laboratory Improvement Amendments (CLIA) certification and when testing is performed consistent with the Centers for Disease Control and Prevention (CDC)’s Interim Guidelines for COVID-19 Antibody Testing‌. Horizon BCBSNJ’s in-network labs—LabCorp, Quest and BioReference—are all CLIA certified.

The test must be for a diagnostic purpose consistent with CDC guidelines and ordered by your licensed doctor or health care professional. These CDC guidelines specifically note Serologic testing should not be used to determine immune status in individuals until the presence, durability, and duration of immunity is established. Currently, the clinical use of serologic or antibody testing for COVID-19 is to support a diagnosis of COVID-19 in patients who are seeking care late in their course of illness or in patients who are seeking care for late complications, such as multisystem inflammatory syndrome in children.

Antibody tests should not be used as a sole basis for diagnosis. When antibody testing is covered, members will have no cost sharing during the COVID-19 public health emergency.

Watch this video from the FDA‌ about antibody testing.

Effective immediately and through June 30, 2020, 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) will not pay any cost share amounts (copay, coinsurance, deductibles) for covered services related to the testing, diagnosis and treatment of COVID-19 for:

• All charges associated with a visit to an in-network or out-of-network primary care physician or urgent care center or Emergency Room (ER) for evaluation of symptoms identified as possible indicators of COVID-19 infection.
• All in-network and out-of-network labs for charges associated with the delivery of services connected to CDC-approved lab studies or tests for COVID-19 for members who know they have been exposed to an individual diagnosed with COVID-19 or with symptoms identified by the CDC as possible indicators of COVID-19 infection.
• All covered benefits associated with inpatient and outpatient care when delivered by in-network professionals and facilities, and when your claim indicates treatment was related to COVID-19.

The Company 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.

To help you get the care you need, Horizon BCBSNJ is relaxing our telemedicine rules to allow telephone visits with health care professionals. In addition, we are waiving out-of-pocket costs for covered services, including diagnosis and treatment of COVID-19, routine care, therapy or mental health care when provided through telemedicine.

Effective immediately and through June 30, 2020, Horizon BCBSNJ is:

• Relaxing its telemedicine rules to allow members to 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, including by telephone 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, unless Horizon CareOnline is used to get care.
  • 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.

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.

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.

Members enrolled in a fully insured plan will see the following statement on the back of their member ID card: Insured by Horizon BCBSNJ.

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, effective immediately and through May 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.
• Will re-evaluate the situation and may extend this waiver as warranted.

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.

All of our mission-critical vendors have the capability to recover business operations within 24 to 72 hours. As part of our vendor delegation process, we review and approve all of our vendor business continuity plans and redundant capabilities annually. We are working closely with these vendors to plan for and mitigate any potential disruption related to COVID-19.

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.