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COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services

In an effort to promote social distancing and to support the public health effort to slow community transmission of COVID-19, effective immediately and through the end of public health emergency and State of Emergency declared by the Governor in Executive Order 103 of 2020, Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) is waiving member cost-sharing obligations for covered telemedicine services delivered by an in-network doctor or through Horizon BCBSNJ’s telemedicine platforms.

The waiver applies to qualified telemedicine visits for any covered purpose including diagnosis or treatment of COVID-19, routine care or mental health care. These changes do not alter the benefits included in any member’s plan; they only eliminate cost as a potential barrier to using those services by waiving that member’s cost-sharing obligations.

As with the previously announced cost-sharing changes, this change applies to Horizon BCBSNJ’s fully insured members, including those covered through Medicaid, Medicare, Individual and Small Group policies. The State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) have also agreed to waive cost-sharing for their members for these services. The Company will continue to work with other self-insured customers that provide coverage for their employees on their specific plan designs.

Effective immediately, Horizon BCBSNJ is:

  • Waiving member cost-sharing obligations for covered services:
    • Provided by an in-network physician or in-network mental health professional during a qualified telemedicine visit.
    • Associated with a visit to an in-network physician or in-network mental health professional including primary care physicians, specialists, therapists, LCSWs or urgent care physicians when conducted according to standards established by N.J.S.A. 45:1-61 et seq.
    • Provided through Horizon BCBSNJ’s online telemedicine service, Horizon CareOnline℠. (Not all members have coverage for Horizon CareOnline.) 
    • As with all routine, primary care, mental health or follow-up office visits, no prior authorization is required.
  • Providing reimbursement uniformity to in-network physicians for services rendered via telemedicine.
    • When conducted according to the standards for telemedicine established by N.J.S.A. 45:1-61 et seq, in-network health professionals can submit claims for all CPT codes associated with office visits along with a modifier noting that the service was provided remotely via telemedicine in order to be fully reimbursed at the same negotiated rate as an office visit. Please see our reimbursement policy for additional information

Additional Tools for patients

Horizon BCBSNJ members also have no cost, 24/7 access to licensed nurses who can talk with members and direct them to reliable sources for the latest information about COVID-19. Commercially insured members can access this service at 1-888-624-3096. Members covered through Medicaid plans can speak with a nurse at 1-800-711-5952. SHBP/SEHBP members have access to the nurse line and their Horizon Health Guide service at 1-800-414-SHBP (7427). Depending on the specific benefits included in a member’s plan, additional telehealth services, such as Chat for Care, may be available at no cost through the Company’s free Horizon Blue app and by signing in to our secure member web portal.