June 2021 Updates: COVID-19 treatment cost share waiver
Throughout our almost 90-year history, the health and well-being of our members and helping you care for your patients have been our top priorities. That's why, during these unprecedented times, we've taken bold steps to help ensure our members can get the care they need.
We've reached a turning point in the fight against COVID-19
COVID-19 case numbers are shrinking thanks to the increased availability of COVID-19 vaccines, prompting state and federal governments to ease restrictions. We, too, are adjusting our response as the situation improves.
As previously communicated, we will end the cost share waiver for members’ out-of-pocket costs (copays, deductibles and coinsurance) for claims for inpatient and outpatient treatment of COVID-19 after June 30, 2021. At that time, our COVID-19 treatment cost share waiver will have been in place for almost 18 months. Other major health insurance carriers in New Jersey ended their waivers earlier this year, or never waived these costs at all.
This change impacts Horizon BCBSNJ’s fully insured members, including those covered through Medicaid, Individual and Small Group policies, Medicare Advantage, including Braven Health, as well as most of our self-insured plan members. Other self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and we will continue to work with them to administer their plan designs as directed.
No member cost sharing for COVID-19 diagnostic testing or telehealth visits
For members of fully insured and self-insured health plans, COVID-19 diagnostic testing performed at doctors’ offices, urgent care centers and in Emergency Rooms, will continue to be covered without member cost sharing. This waiver of member out-of-pocket costs will be in place until the end of the federal public health emergency for self-insured plans and for fully insured plans, after the end of both the federal public health emergency and 90 days following the end of the State of Emergency declared by Governor Murphy
For fully insured and State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members, all in-network telehealth visits (as per NJ PL 2020 c.7/c.47) will also be covered without member cost share until 90 days after the end of the State of Emergency.
For self-insured health plan members (excluding SHBP and SEHBP members), telehealth visits for care not related to a primary diagnosis of COVID-19 will require member cost sharing effective January 1, 2022. Telehealth visits related to a primary diagnosis of COVID-19 will continued to be covered without member cost sharing until the end of the federal public health emergency.
Vaccines are available at no cost to members
Please continue to encourage your patients to get vaccinated and to follow the recommendations of the Centers for Disease Control and Prevention (CDC) and the New Jersey Department of Health to get a Food and Drug Administration (FDA)-authorized COVID-19 vaccination. You can share our brochure, Every shot counts — the COVID-19 vaccines, with your patients as an additional resource.
Help for New Jersey’s essential workers
Please keep in mind, under New Jersey state law, essential workers diagnosed with COVID-19 may have treatment costs covered under Workers’ Compensation (WC) benefits. WC covers 100 percent of medical costs, without copays or deductibles, from the first date of injury or illness to the date that maximum medical improvement is achieved. Under WC, this period may extend for one day or a lifetime. This is important since many COVID-19 cases appear to have long-lasting medical implications.
We’re proud of our work to support you and our members during the COVID-19 public health emergency. We will continue to work with physicians and hospitals to get our members access to the care they need, including access to vaccinations to stop the spread of COVID-19.
The law described above is no longer effective as of June 4, 2021, given that Governor Murphy declared an end to the public health emergency in the State of New Jersey relating to COVID-19. As such, the law’s rebuttable presumption that “essential workers” who contracted COVID-19 during the public health emergency contracted it in the workplace ended effective June 4, 2021.
With the expiration of the law, the rebuttable presumption will only apply for claims with dates of service March 9, 2020 through June 4, 2021, although essential workers may still be eligible for Workers’ Compensation after the expiration date. In such cases, the burden of proof for establishing compensability for a COVID-19 infection will return to the higher standard of establishing that the illness was contracted in the workplace and was work-related.