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Highlights of Your Benefits Related to COVID-19

Commercial Group Members

  • COVID-19 vaccines, under state and federal mandate, are available at no cost to our members during the Public Health Emergency
  • No cost to members for COVID-19 laboratory testing according to our policy
  • Effective January 15, 2022 members will be able to acquire eight over-the-counter COVID-19 tests at no cost per 30-day period. This includes Self-Funded groups. Federal Employee Plan members may acquire eight over-the-counter COVID-19 tests per calendar month. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.
  • No cost to members for office, urgent care, or ER visits related to COVID-19
  • For fully insured employer group plan members, no cost to members for participating provider telehealth visits, no cost for treatment, including inpatient care, for confirmed acute active COVID-19 cases through December 31, 2021.
  • For self-insured group plan members, please consult with your employer’s human resources or health benefits representative for COVID-19 related benefits
  • Extended timeframes to file appeals
  • Early medication refills available for prescriptions during state of emergency
  • Waiver of early refills limits for 30 or 90-day supplies of medications
  • Home delivery available for up to 90-day supply of medication at one time
  • If you are unsure whether your employer group’s health benefits plan is fully insured or self-funded, please inquire with your employer’s human resources or health benefits representative
  • There are several options available to members who are losing coverage

*Members of a select number of “grandfathered” employer groups may need to pay a cost share for the administration of the vaccine. If you are enrolled in a grandfathered group, please consult with your employer’s human resources or health benefits representative for COVID-19 vaccine-related benefits.

Medicare Advantage Members

  • COVID-19 vaccines, under state and federal mandate, are available at no cost to our members during the Public Health Emergency
  • No cost to members for COVID-19 laboratory testing according to our policy
  • Effective April 4, 2022, over-the-counter COVID-19 tests are available to people who have Medicare Part B or Medicare Advantage and can get up to eight free over-the-counter tests per calendar month during the Public Health Emergency. Medicare Covers Over-the-Counter COVID-19 Tests.
  • No cost to members for office, urgent care, telehealth or ER visits related to acute active COVID-19
  • No cost for treatment, including inpatient care for confirmed COVID-19 cases through December 31, 2021
  • Current two-month grace period for premium payments extended through March 31, 2021
  • Extended timeframes to file appeals
  • Early medication refills available for prescriptions during state of emergency
  • Waiver of early refills limits for 30 or 90-day supplies of medications
  • Home delivery available for up to 90-day supply of medication at one time

Medicaid, HARP, Subsidized Child Health Plus Members

  • COVID-19 vaccines, under state and federal mandate, are available at no cost to our members during the Public Health Emergency
  • No cost to Medicaid, HARP or Subsidized Child Health Plus members for vaccine counseling effective December 1, 2021. If you are undecided about getting a COVID-19 vaccine, you can talk with your healthcare provider or pharmacist about your questions or concerns. Vaccine counseling is available for the initial dose and/or second dose, including boosters. Please note: you must not have already received the dose and must not already have an appointment to receive dose
  • No cost to members for COVID-19 laboratory testing according to our policy
  • Effective Feb. 8, 2022, Medicaid and Health and Recovery Plan (HARP) members are eligible for two no-cost, over-the-counter tests per week (up to eight per month). An attending provider order is not needed. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.
  • Effective Jan. 21, 2022, Child Health Plus will cover four FDA-authorized over-the-counter COVID-19 tests , per week, at no cost. An attending provider order is not needed. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.
  • Child Health Plus point-of-care COVID-19 testing (when a test is conducted and read while at a health facility) is covered with no cost sharing, without limitation, including for purposes of travel, and school/work purposes.
  • No cost to members for office, urgent care, telehealth, or ER visits related to acute active COVID-19
  • Consistent with regular benefits, no cost share for COVID treatment
  • Grace period for premium payments
  • Extended timeframes to file appeals
  • Early prescription refills available during state of emergency for Child Health Plus members
  • Waiver of early refills limits for 30 or 90-day supplies of medications ended July 9, 2021.
  • Home delivery available for up to 90-day supply of medication

COVID-19 "Over-the-Counter” Test Kits

Effective December 13, 2021, Excellus BCBS will cover COVID-19 “over-the-counter” test kits for Medicaid Managed Care, Health and Recovery Plan (HARP), Essential Plan, and Child Health Plus plan members.

These COVID-19 “over-the-counter” test kits:

  • Are available Over-the-Counter (OTC), and must be authorized by the Food and Drug Administration (FDA);
  • Are available if you have symptoms or not; and
  • Must be ordered by a medical provider, at a limit of one test kit per week.

Please call member services at 1-800-650-4359; TTY/TDD services call 1-800-662-1220 if you have any questions about “over-the-counter” COVID-19 testing or vaccines.

COVID-19 “At Home” Test Kits
Effective December 13, 2021, Excellus BCBS will cover COVID-19 “at home” test kits for Medicaid Managed Care, Health and Recovery Plan (HARP), Essential Plan, and Child Health Plus plan members.

These COVID-19 “at home” test kits:

  • Are available Over-the-Counter (OTC), and must be authorized by the Food and Drug Administration (FDA);
  • Are available if you have symptoms or not; and
  • Must be ordered by a medical provider, at a limit of one test kit per week.

If you are undecided about getting a COVID-19 vaccine, you can talk with your healthcare provider or pharmacist about your questions or concerns.

Please call member services at 1-800-650-4359; TTY/TDD services call 1-800-662-1220 if you have any questions about “at home” COVID-19 testing or vaccines.

Essential Plan and Full Pay Child Health Plus Members

  • COVID-19 vaccines, under state and federal mandate, are available at no cost to our members during the Public Health Emergency
  • No cost to Child Health Plus members for vaccine counseling effective December 1, 2021.  If you are undecided about getting a COVID-19 vaccine, you can talk with your healthcare provider or pharmacist about your questions or concerns.  Vaccine counseling is available for the initial dose and/or second dose, including boosters.  Please note: you must not have already received the dose and must not already have an appointment to receive dose.
  • No cost to members for COVID-19 lab testing according to our policy
  • Essential Plan members are eligible for four no-cost, over-the-counter tests per week. An attending provider order is not needed. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.
  • Effective Feb. 8, 2022, Child Health Plus will cover four FDA-authorized over-the-counter COVID-19 tests, per week, at no cost. An attending provider order is not needed. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.
  • Child Health Plus point-of-Care COVID-19 testing (when a test is conducted and read while at a health facility) is covered with no cost sharing, without limitation, including for purposes of travel, and school/work purposes.
  • No cost to members for office, urgent care, telehealth, or ER visits related to acute active COVID-19
  • Consistent with regular benefits, no cost share for COVID treatment
  • Grace period for premium payments
  • Extended timeframes to file appeals
  • Early prescription refills available during state of emergency for Child Health Plus members
  • Waiver of early refills limits for 30 or 90-day supplies of medications ended July 9, 2021.
  • Home delivery available for up to 90-day supply of medication

COVID-19 "Over-the-Counter” Test Kits

Effective December 13, 2021, Excellus BCBS will cover COVID-19 “over-the-counter” test kits for Medicaid Managed Care, Health and Recovery Plan (HARP), Essential Plan, and Child Health Plus plan members.

These COVID-19 “over-the-counter” test kits:

  • Are available Over-the-Counter (OTC), and must be authorized by the Food and Drug Administration (FDA);
  • Are available if you have symptoms or not; and
  • Must be ordered by a medical provider, at a limit of one test kit per week.
If you are undecided about getting a COVID-19 vaccine, you can talk with your healthcare provider or pharmacist about your questions or concerns.

Please call member services at 1-800-650-4359; TTY/TDD services call 1-800-662-1220 if you have any questions about “over-the-counter” COVID-19 testing or vaccines.

COVID-19 “At Home” Test Kits
Effective December 13, 2021, Excellus BCBS will cover COVID-19 “at home” test kits for Medicaid Managed Care, Health and Recovery Plan (HARP), Essential Plan, and Child Health Plus plan members.

These COVID-19 “at home” test kits:

  • Are available Over-the-Counter (OTC), and must be authorized by the Food and Drug Administration (FDA);
  • Are available if you have symptoms or not; and
  • Must be ordered by a medical provider, at a limit of one test kit per week.

If you are undecided about getting a COVID-19 vaccine, you can talk with your healthcare provider or pharmacist about your questions or concerns.

Please call member services at 1-800-650-4359; TTY/TDD services call 1-800-662-1220 if you have any questions about “at home” COVID-19 testing or vaccines.

Qualified Health Plan Members

  • COVID-19 vaccines, under state and federal mandate, are available at no cost to our members during the Public Health Emergency
  • No cost to members for viral COVID-19 testing according to our policy
  • Effective January 15, 2022 members will be able to acquire eight over-the-counter COVID-19 tests at no cost per 30-day period. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.
  • No cost to members for office, urgent care, telehealth, or ER visits related to acute active COVID-19
  • No cost for treatment, including inpatient care for confirmed COVID-19 cases through December 31, 2021
  • The grace period for the Advanced Premium Tax Credit is extended to the end of the public health emergency.
  • Extended timeframes to file appeals
  • Early medication refills available for prescriptions during state of emergency
  • Waiver of early refills limits for 30 or 90-day supplies of medications
  • Home delivery available for up to 90-day supply of medication at one time
Need Health Insurance?
If you’re losing your employer-sponsored health insurance, there are affordable, high-quality options available to you. From free or low-cost New York state sponsored plans to individual and family plans, you can still have the peace of mind that comes with having coverage you know and trust.
Learn More
Mental and Emotional Health Resources

Physical barriers should never get in the way of human connections. As an Excellus BCBS member, you have access to a wide range of behavioral health programs and tools, as well as a full team of behavioral health specialists including our on-staff doctors, pharmacists, registered nurses, licensed social workers, and more.

  • If you already have a therapist or mental health clinician, Ask your participating provider if they offer telehealth visits via telephone, e-mail or video. Telehealth visits are covered for participating providers at no charge.
  • For self-insured group plan members, please consult with your employer’s human resources or health benefits representative for COVID-19 related benefits.
  • Our telemedicine partner, MDLIVE offers access to licensed therapists and psychiatrists by appointment. Plan coverage and cost may vary. For self-insured group plan members, please consult with your employer’s human resources or health benefits representative for COVID-19 related benefits
  • If you believe you may have symptoms of COVID-19, please call your primary care doctor. Telehealth visits can be an option for initial screenings if offered by your provider, and are covered for participating providers at no charge. Our telemedicine partner MDLIVE is currently unable to order COVID-19 tests.
  • Download the free Wellframe app to chat via text with an Excellus BCBS health coach or nurse who can provide access to our team of behavioral health specialists for support and access to resources.
You’re not alone. Excellus BCBS is here to support you when you need it most.
Additional Options for Mental & Emotional HealthSupport Resource Articles
Wellframe: Health Care Experts and Support at Your Fingertips

Free to all members, our nurses and health coaches are available to chat with you via text through the Wellframe app. Wellframe is also a helpful resource to manage conditions such as pre-diabetes, diabetes, obesity, and more.

  • Connect with a dedicated nurse care manager
  • Conveniently text with health care professionals when you need it
  • Create a personalized health plan and track progress
  • Receive daily tips, reminders, and videos on a host of different topics

Downloading the Wellframe app is simple and easy. Use access code Excellus when registering. For more information, log into your online account to get started.

Need help setting up Wellframe? View the Wellframe Quickstart Guide or call our Care Management Team at 1-800-277-2198 (TTY: 1-800-662-1220) Monday through Friday 8 a.m. to 5 p.m.
24/7 Nurse Call Line

Outside of this COVID-19 crisis, we know that having any health symptoms at all can be scary right now. Because we’re focused on your health and well-being, our team of nurses, social workers, respiratory therapists and mental health coaches are here to support you.

24/7 Nurse Line: You can speak with a nurse by phone anytime – 24 hours a day, seven days a week. Our specially trained registered nurses can answer your questions and provide support .

Ask a Nurse Today! Call 1-800-348-9786 (TDD/TTY 1-800-662-1220).

The 24/7 Nurse Call Line is a service provided to our members to support their relationship with their health care providers. The information provided is intended to help educate members, not to replace the advice of a medical professional. If you are experiencing severe symptoms such as sharp pains, fever, loss of bodily function control, vomiting or any other immediate medical concern, dial 911 or contact a physician directly.

Early Prescription Refills

 Our pharmacy team has been closely monitoring the supply of medications that are available during the COVID-19 outbreak. We’re taking several actions to ensure our members have access to clinically appropriate medications.

  • Waiving early medication refill limits on 30 or 90-day prescription maintenance medications (consistent with your benefit plan) during state of emergency for our Commercial fully-insured members.
  • Obtain up to a 90-day supply of your medication at one time by using safe and easy home delivery. Your medications will be delivered right to your home.
  • If you’re a Medicare member, get started with home delivery service.
  • All other members, connect with a mail service pharmacy.
No-Cost Telehealth Visits

Telehealth visits are covered for participating providers at no cost for most members. Please refer to your Subscriber Benefit Contract for additional information. For self-insured group plan members, please ask your human resources or health benefits representative about COVID-19 related benefits.

Ask your doctor if they offer telehealth visits via telephone, e-mail, or video chat.

Some common conditions for telehealth visits include:

  • Adults: allergies, cold and flu, ear infections, fever, headaches, joint aches and pains, nausea and vomiting, pink eye, rashes, sinus infections, urinary tract infections; behavioral health conditions such as addiction, stress, depression, and PTSD.
  • Children: cold and flu, constipation, earache, fever, nausea and vomiting, pink eye
  • Certain conditions requiring specialized care such as dermatology, acute chiropractic care, and nutrition consulting can also be treated with a telehealth visit. Check with your specialist to see if they offer this option.

When your doctor isn’t available, telemedicine may be an option for you. Whether you need a consultation for acute, non-emergency conditions, or someone to talk to during a challenging time, our partnership with MDLIVE gives you convenient access to medical and behavioral health care 24/7/365 from the comfort of your home.

Note: At this time MDLIVE is unable to order COVID-19 tests. Please contact your doctor or local county health department if you believe you have COVID-19 symptoms.

Learn about Telemedicine and Schedule Appointment
Reminder: Personal Protective Equipment (“PPE”) Used by Providers

You are not responsible for any charges from a Health Plan participating provider beyond your applicable deductible, copayment, or coinsurance, including any fees charged for PPE. If you have paid PPE charges to a Health Plan participating provider, you should contact the provider and obtain a refund. If you would like to submit a complaint to us about charges for PPE from a participating provider, please contact us toll-free:

  • Commercial Group, Medicare, and Qualified Health Plan members, call 1-800-499-1275 
  • Medicaid and Child Health Plus members, call 1-800-650-4359
  • Essential Plan members, call 1-877-626-9298 
Stay Informed
The best way to stay informed and have access to your coverage is online. Let’s get you set up online today. For help or questions with your insurance plan, call the number on your Member Card for personalized care, or contact us.
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