Is there a special open enrollment period for individuals who have previously declined coverage?

Employer groups may enroll new members off-anniversary through a Special Enrollment Period (SEP) through June 30, 2020, with July 1 as the latest effective date. This SEP is for employees who previously declined coverage for themselves or their dependents.

• For an April 1, 2020, effective date, enrollment request must be received no later than April 15.
• For May 1, June 1, and July 1 effective dates, enrollment requests must be received on or before the 1st of the month for which enrollment is being requested.

This applies to all fully insured Small Group (1-100) and Large Group (101+) employers, and includes enrollment for medical plans, dental plans, and vision plans.

See also: Can a group or employee change plans off-anniversary?

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Which Blue Shield of California members have access to Heal?

Heal is available to Blue Shield of California members as a covered benefit, for certain lines of business (LOBs) who are located in Heal service areas.

PPO:

• Fully Insured PPO plan members
• Shared Advantage plan members
• Federal Employee Program (FEP) PPO
• Medicare Advantage PPO members
• Tandem PPO: Promotional for 2020 for Tandem PPO members – the first Heal physician visit in 2020 to Tandem PPO member is free; subsequent visits subject to office visit copay.

HMO:

• Trio HMO: Promotional for 2020 for Trio HMO members – the first Heal physician visit in 2020 to Trio HMO members is free; subsequent visits subject to office visit copay

Please note:

• Any Blue Shield HMO member who does not have the benefit can still contact Heal for a visit – they will just have to pay full cost for the visit.
• Heal will let the member know what their co-pay or full cash price is up front. It will vary according to the member’s benefit plan.

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What is the charge for a remote house call (telemedicine)?

Cost sharing is waived for remote house calls (telemedicine) for coronavirus screening for members whose plan benefits include Heal. For cash pay users, a Heal remote house call is $19.

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Can members who don’t have access to Heal as a benefit schedule a Heal visit?

Yes, if Heal is not a covered benefit, the member can contact Heal directly about scheduling a visit. The cash price varies. It is currently $159 in California, but in other states, it may be different. There may be other states where it is slightly higher. Members should always be directed to Heal to confirm the cash visit price. Heal offers remote house calls (telemedicine) for $19 for cash paying users.

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Do Heal doctors have kits to do COVID-19 testing?

Heal is now able to conduct COVID-19 testing for patients who – based on a telemedicine screening – are at risk for COVID 19. Heal launched telemedicine in response to the COVID-19 outbreak so patients can book and receive video calls within the Heal app from a Heal Doctor for coronavirus screening. There is now a symptoms checker in the app and website during booking that funnels those with symptoms to telemedicine.

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Will a member’s co-payment be waived for Heal visits?

Co-payment will be waived for visits that include a physician-prescriber testing or screening for COVID19.

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Since Teladoc cannot actually run testing since it’s a virtual visit, what is the protocol if the provider decides that the member should be tested?

Teladoc’s protocols regarding COVID-19 diagnostic testing services is as follows: Teladoc providers will notify the Teladoc leadership team of suspected cases and contact the appropriate public health departments in accordance with local reporting requirements. The public health department will take the lead to initiate diagnostic testing and guide individuals on any at-home self-monitoring, at-home supervised isolation, or quarantine requirements.

As this is an evolving situation, Teladoc will adjust their protocols, as appropriate, based upon evolving CDC and WHO guidance.

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Will Blue Shield waive copays for calls to Teladoc?

Copays and co-insurance for Teladoc visits, medical and behavioral health, will be waived for members enrolled in all Blue Shield commercial plans through September 30, 2020, whether or not related to COVID-19.

Members enrolled in Blue Shield’s Trio and Tandem plans already enjoy $0 out-of-pocket costs for Teladoc services.

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Does the standard employer group plan contract cover telemedicine?

Telemedicine services are covered under Blue Shield’s standard plan designs for fully insured and self funded (ASO and Shared Advantage/Shared Advantage+), as follows:

• For all plans, telemedicine services are available as a covered benefit through those network providers that offer such services, including Mental Health Service Administrator participating providers.
• For fully insured plans, telemedicine services are also available through Teladoc and Nurse Help 24/7.
• For self-funded plans, telemedicine services may also be available through Teladoc and Nurse Help 24/7, if the plan sponsor has elected to offer those programs.

In addition, Blue Shield is expanding access to telehealth services in response to COVID-19 by allowing providers to provide services using an expanded range of telehealth platforms. This applies to all telehealth services, including medical-related and behavioral health services, performed appropriately during the COVID-19 public health emergency.

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Are members allowed to fill their prescriptions earlier or have larger fill or refill amounts to offset difficulties with getting medications?

For the duration of the public health emergency, Blue Shield and Blue Shield Promise will
waive early refill limits on prescription medications. Blue Shield does not recommend
stockpiling medications. However, early refill limits have been adjusted so that members
can refill an extended supply of their medication according to their benefit. For any
questions regarding early refills, members may call the Members Services number on the
back of their Blue Shield member ID card.

Learn more.