Effective immediately for all fully insured members, including those covered through Medicaid, Medicare, 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 is waiving member cost-sharing obligations for:

• All services associated with the diagnosis of COVID-19 per Centers for Disease Control and Prevention (CDC) guidelines.
• All charges associated with a visit to an in-network primary care physician or urgent care center or an in-network or out-of-network Emergency Room (ER) for evaluation of symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough and shortness of breath).
• All charges associated with a visit to an in-network primary care physician or urgent care center or an in-network or out-of-network ER for COVID-19 testing for members who know they have been exposed to an individual diagnosed with COVID-19.
• 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 (fever, cough and shortness of breath).

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.

All Horizon BCBSNJ members have no cost, 24/7 access to licensed nurses who can assist members with symptoms that are consistent with suspected COVID-19 infection. This service is available through the Company’s free Horizon Blue app, by signing in to our secure member web portal, or by phone at 1-888-624-3096. Members may also use those services to consult with a nurse about other health concerns and potentially avoid a visit to a doctor’s office or urgent care facility.

If Horizon BCBSNJ members have our telemedicine service, Horizon CareOnline, included in their benefits, they can use it for health care guidance from a licensed doctor.

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).

Most of these supplies are not currently covered.

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.

Horizon BCBSNJ will waive early medication refill limits on 30-day prescription maintenance medications (consistent with the member’s benefit plan) and/or encourage members to use their 90-day mail order benefit, if available. Horizon BCBSNJ will also ensure formulary flexibility if there are shortages or access issues and not hold patients liable for additional charges stemming from obtaining a non-Preferred medication resulting from shortages or access issues.

This applies only to members who have prescription coverage through their Horizon BCBSNJ health plan. Check with your benefits administrator or your benefits documents.

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.