At Horizon Blue Cross Blue Shield of New Jersey, our top priorities are the health and well-being of our members, employees, and the thousands of health professionals we rely on for good care.
Horizon BCBSNJ waived the deductible on all Telemedicine calls to make it easier for customers to get the coverage they needed and for providers - often working remotely themselves - to be able to provide it without having to figure out how to collect the copay.
Horizon BCBSNJ is spending $2.35 million to donate 500,000 N95 respirator masks and 81,000 face shields to Governor Murphy’s coordinated response effort. To help New Jersey residents who are feeling the economic impact of the COVID-19 pandemic, we also donated $100,000 to the Community Food Bank of New Jersey and $60,000 to the Jewish Family Service of Atlantic and Cape May.
To help address the medical, social and economic impacts of the COVID-19 pandemic, Horizon BCBSNJ has donated $2 million to the New Jersey Pandemic Relief Fund, the response and support organization established by Tammy Murphy, New Jersey’s First Lady. This contribution reflects our continuing commitment to invest in the health and well-being of our members and communities.
Medical personnel at Horizon BCBSNJ have responded to answer the “Healthcare Professionals Call to Serve” issued by Governor Phil Murphy on March 27, 2020. To support employees with medical training who wish to serve, Horizon BCBSNJ has expanded paid-time-off for volunteer service to provide those employees answering the Call with 40 hours of compensated volunteer time.
Questions About Coverage
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.
WHAT IS COVID-19?
COVID-19 is a respiratory disease caused by a specific strain of coronavirus (SARS-CoV-2). Coronaviruses are a large family of viruses often causing mild to moderate upper-respiratory tract illnesses, similar to the common cold or flu.
WHAT ARE THE SYMPTOMS?
Respiratory symptoms, such as a cough, difficulty breathing and fever. People who are elderly and/or have underlying health conditions are more at risk for severe complications. Symptoms of coronavirus may appear two to 14 days after exposure.
HOW DOES IT SPREAD?
The virus is thought to spread from person-to-person through droplets produced when someone with the virus coughs or sneezes. This can happen when people are in close contact with one another (within six feet), usually for a prolonged period of time.
HOW CAN I PROTECT MY FAMILY?
There is currently no vaccine to prevent COVID-19, so the best way to prevent illness is to follow common-sense steps to help improve your chances of avoiding exposure.
Latest COVID-19 News
- World Health Organization
- Centers for Disease Control and Prevention: Coronavirus Disease 2019
- National Institutes of Health
- The New Jersey Department of Health
You can also call the New Jersey Department of Health 24-hour public hotline at 1-800-222-1222 or 1-800-962-1253 if you are using an out-of-state phone line.
- Coping with Stress, US Centers for Disease Control & Prevention (CDC)
- Mental Health and Coping During COVID-19, US Centers for Disease Control & Prevention (CDC)
- Taking Care of your Emotional Health, US Centers for Disease Control & Prevention (CDC)
- Coronavirus & Mental Health: Taking Care of Ourselves During Infectious Disease Outbreaks, American Psychiatric Association (APA)
- Speaking of Psychology: Coronavirus Anxiety, American Psychological Association
- Addiction Resources during COVID-19, Shatterproof
- Taking Care of Your Mental Health is More Important Now Than Ever, Pyschhub
Family Care Information
- Helping Children Cope with Emergencies, US Centers for Disease Control & Prevention (CDC)
- Taking Care of your Family during Coronavirus Fact Sheet, Center for the Study of Traumatic Stress (CSTS)
- Five ways to view coverage of the Coronavirus, American Psychological Association
- Parent/Caregiver Guide to Helping Families Cope with COVID-19, The National Child Traumatic Stress Network
- Just for Kids: A Comic Exploring the New Coronavirus, National Public Radio
- Talking to Teens & Tweens about Coronavirus, The New York Times
Q&As and General Resources
- Q&A on coronaviruses, World Health Organization (WHO)
- Coronavirus & Emerging Infectious Disease Outbreaks Response, Center for the Study of Traumatic Stress (CSTS)
- Research Information: Pandemics, American Psychological Association
- An Introduction to COVID-19 Tests, U.S. Food and Drug Administration (FDA)
- Virtual Health & Wellness Programs and Resources offer live webinars and recorded videos on a variety of wellness topics that can help you ease stress and stay active.