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Update: Waiving cost share for telemedicine and COVID-19 treatment extended

We’re working to understand the challenges you’re facing so we can support you in delivering care to your patients when they need it most.

Telemedicine updates

To help you provide care to your patients while continuing the social distancing practices that have helped reduce the spread of disease, Horizon BCBSNJ will continue to cover telehealth and telemedicine as we do today through the public health emergency and State of Emergency declared by the Governor in Executive Order 103 of 2020. This will apply to all covered services, including the diagnosis or treatment of COVID-19, routine care, therapy and mental health care.

When telemedicine and telephone visits are provided by in-network health care professionals, member out-of-pocket costs are waived.

When a Horizon BCBSNJ member has out-of-network benefits, and the member chooses to get care from out-of-network health care professionals, telemedicine and telephone visits are available, but the member is responsible for any difference between the plan allowance and the billed amount.

Telemedicine will continue to be a covered benefit after the public health emergency and the State of Emergency with flexibility for our providers to deliver care on telemedicine platforms. More information is available in our Telemedicine policy. Horizon BCBSNJ will evaluate the expansion of coverage for certain services that was offered during the initial stage of the public health emergency once the emergency ends. 

COVID-19 treatment

To help ensure our members get the care they need for COVID-19 and remove cost as a barrier to care, we are also extending the waiver of member cost sharing for treatment of COVID-19 through August 31, 2020. This means that members will pay no deductible, copay or coinsurance for inpatient and outpatient care when claims indicate treatment was directly related to treatment of COVID-19 as the primary diagnosis.

These changes apply to Horizon BCBSNJ’s fully insured members, including those covered through Medicaid, Medicare Advantage, Individual and Small Group policies. The State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) have also agreed to administer benefits consistent with these changes. 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.