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.
If you live or work in Essex County, you can make an appointment to get the COVID-19 vaccine through an Essex County vaccination site. To make an appointment, go to EssexCOVID.org or call 1-973-877-8456 (TTY 711).
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
I heard the government is setting up a website so people can order free at-home COVID-19 tests online. Is that true?
Yes. The Biden-Harris Administration launched a new website where residential households in the U.S. can order one set of four free OTC, at-home tests. Orders will ship free starting in late January 2022. This option is available to all of our members, regardless of which health plan they have.
The state of New Jersey also offers New Jersey residents the option to order a free saliva-based PCR test, shipped directly to their homes.
Does my insurance cover over-the-counter, at-home testing for COVID-19?
Yes. Horizon health plans have always covered testing to diagnose a COVID-19 infection when a doctor orders the test.
However, beginning January 15, 2022, for our commercial market members, Horizon health plans will cover up to eight over-the-counter, at-home tests per member every 30 days when the tests are for personal use to diagnose a COVID-19 infection. Members do not need a doctor to prescribe these at-home tests. This coverage will be available through the end of the federal Public Health Emergency (PHE) period.
If you purchase the over-the-counter, at-home tests to test for going to work or to school, for travel or for some other reason not related to illness, then your testing is considered for “surveillance.” These claims are not covered by your health plan.
You can read more about the new guidance from the Biden-Harris Administration online at cms.gov/files/document/11022-faqs-otc-testing-guidance.pdf.
Which members have this new coverage for over-the-counter, at-home COVID-19 testing?
Members enrolled in Commercial market health plans have this new coverage beginning January 15, 2022. The coverage requirement applies to members enrolled in fully insured and self-insured health plans.
Horizon will administer the coverage for fully insured and self-insured health plans that have prescription drug benefits with us through our pharmacy benefits manager (PBM), Prime Therapeutics LLC.
Fully insured and self-insured health plans that carve out their pharmacy benefit to a different PBM will need to work with their PBM to administer these benefits to their members, although some exceptions may apply.
This coverage requirement also applies to members enrolled through the Federal Employee Program (FEP). FEP members must submit a paper health benefits claim form with their receipts to their local BCBS Plan for reimbursement. The contract holder will receive a check in the mail after the claim is processed. Instructions on how to submit claims are available.
Are some members excluded from this new over-the-counter, at-home COVID-19 testing coverage?
Yes, Medicare Advantage and Medicaid members do not have this exact coverage.
However, they do have access to the kits available through the Biden-Harris Administration’s website where residential households in the U.S. can order one set of four free OTC, at-home tests.
Medicare Advantage plans cover COVID-19 testing when ordered by a doctor. Medicare Advantage members also have access to free at-home tests at community health centers and Medicare-certified health clinics. Up to 50 million of these tests are provided by the U.S. Department of Health & Human Services at no cost. You can learn more about this program at hrsa.gov/coronavirus/testing-supplies.
Medicaid plans already cover at-home COVID-19 testing at no cost. The State of New Jersey will soon implement a new coverage requirement for Medicaid members to cover over-the-counter, at-home COVID-19 testing.
What is the difference between “diagnostic testing” and “surveillance testing?”
If you need to be tested because you have symptoms, or because you were exposed to someone who has COVID-19, then your testing is considered “diagnostic.” You are being tested to diagnose an infection. Claims for diagnostic testing are covered by your insurance with no out-of-pocket costs.
If you need to be tested to go to work or school, for travel or for some other reason not related to illness, then your testing is considered for “surveillance.” These claims are not covered by insurance.
Which at-home COVID-19 tests are eligible for coverage?
At-home COVID-19 tests that are authorized by the U.S. Food & Drug Administration (FDA) as Over-the-Counter (OTC) are eligible for coverage. These tests are given at home and the results are read at home, without involving a doctor, other health care professional or lab.
I bought over-the-counter, at-home tests before January 15, 2022. Will Horizon cover those?
This requirement is effective January 15, 2022. At-home tests purchased before January 15, 2022 are not covered unless the tests were ordered by a doctor to diagnose a COVID-19 infection.
How do I get over-the-counter, at-home tests covered by my insurance?
Beginning January 15, 2022, you will be able to go to a retail pharmacy and obtain up to eight tests at the pharmacy counter without member cost sharing when the tests will be used to diagnose a COVID-19 infection. In addition, many pharmacies, including retail, can ship over-the-counter, at-home COVID-19 test kits to you. Please note that tests often come in packages of two tests; in those instances, you can get four packages.
Regardless of how you get your tests — retail or online — every eligible member, including your spouse and dependents if they are enrolled through your plan, will be eligible to get up to eight tests per member every 30 days. However, due to supply and demand, pharmacies and online retailers may limit the number of tests you can buy at one time.
Any test purchased for surveillance purposes (for example, testing required to go to work or school, for travel or for some other reason not related to illness) is not covered by insurance.
How do I submit a claim for over-the-counter, at-home COVID-19 tests?
If you buy eligible tests at the retail pharmacy counter or have them shipped to you from a retail pharmacy, you do not need to submit claims.
If you choose to pay out-of-pocket and buy tests to diagnose a COVID-19 infection outside of the arrangements we make for you, you will need to submit a pharmacy claim form to Prime Therapeutics LLC for reimbursement. You will be reimbursed for the cost of the test or $12 per test, whichever amount is lower.
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.
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
- Horizon Behavioral Health Website
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.