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English. To view this file, you may need to install a PDF reader program. You can also log in to the SydneySM Health mobile app, go to Claims, and choose Submit a Claim. Most PDF readers are a free download. Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. Group Hospitalization and Medical Services, Inc., and First Care, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. // /ProcSet[/PDF]>>>>stream See below.). endstream endobj 455 0 obj <>>>/EncryptMetadata false/Filter/Standard/Length 128/O(a;uY[7y\\ Y)/P -1036/R 4/StmF/StdCF/StrF/StdCF/U(6Tn= )/V 4>> endobj 456 0 obj <>>> endobj 457 0 obj <> endobj 458 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/StructParents 10/Tabs/W/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 459 0 obj <>/ProcSet[/PDF]>>>>stream . Health Insurance Providers Help Vaccinate More Than 2 Million Seniors Against COVID-19 in Underserved Communities, Blue Cross and Blue Shield Federal Employee Program (FEP) Joins White House Effort to Achieve National Vaccination Goal, Blue Cross Blue Shield Association Partners with Feeding America and its Network of 200 Food Banks to Drive Education of COVID-19 Vaccination, Blue Cross and Blue Shield Companies Join National Commitment to Protect Employees and Communities from COVID-19, Health Insurance Providers Commit to Help Millions of Seniors in Underserved Communities Receive COVID Vaccines, HPV vaccination rates low despite risks of related cancers, Infographic: COVID-19 patients with high-risk conditions 3x more likely to need the ICU, Why flu shots are so important during COVID-19 pandemic, Blue Cross Blue Shield Companies Invest in COVID-19 Relief, Frequently Asked Questions about COVID-19 Vaccination, Guidance for Communities, Workplaces and Schools. 2023 Blue Cross Blue Shield Association. When filing claims online, you must use a separate claim form for each receipt and for each member. qGm1UCk3Ht}uh>.ky!R'@ E We have a nationwide network of providers that participate with Blue Cross Blue Shield of Michigan. CareFirst of Maryland, Inc. CareFirst Community Partners, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Online claim example 1: Lets say you made a one-time purchase of up to 24 tests for three members. Read Full Story Audience Communities Some testing locations may not be in your health plans network, particularly if they arent part of a medical group or facility. Please mail completed form with copy of purchase receipt(s) to: Blue Shield of California P.O. They are typically easy to use and produce rapid results. New User? If you are a Medicare Advantage, Medigap, Medicaid or Dual Eligible Special Needs Plan member, please call the number on the back of your member ID card for benefit information. Under federal guidelines, the plan covers only specific tests. To make sure the associated costs for getting diagnostic tests are covered by your BCBSTX plan: 1To download the BCBSTX app, textBCBSTXAPPto33633or search for BCBSTX in the Apple App Store or Google Play. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Your health plan covers FDA-authorized COVID-19diagnostic testingat no cost until the end of the public health emergency on May 11, 2023. The site may also contain non-Medicare related information. Reimbursement Claim Form for Over-the-Counter at-home COVID-19 Test BCBS COVID-19 Info - Benefits, Testing, and More - FEP Blue Find out if the testing site is charging a separate/additional fee to give you the test, and exercise caution if visiting a non-State regulated or out-of-network pop-up testing site which may not have the same standards or billing practices as an in-network provider with your health plan. However, you must include all required information requested in the form. At-home diagnostic tests can be purchased over the counter, online, at a local pharmacy, or from a big-box store. The process we've put in place empowers our members to buy and submit claims for tests purchased through online vendors and retail locations of their choosing. Visitcovidtests.gov, and click the blue "Order Free At-Home Tests" button. O=>WNW% If you purchase a test kit that includes two rapid tests, that will count as two of your eight covered tests. Your plan covers up to 8 tests every 30 days per covered person. Over-the-counter COVID-19 tests will not be covered by your medical or pharmacy benefits after the end of the public health emergency. You may need to visit a doctor or hospital while traveling in another state. Medicare Advantage members: You will need an order for an OTC at-home test from an authorized healthcare provider to get reimbursed at this time. Health plans are offered by Blue Shield of California. You can be reimbursed (paid back) for both: Medi-Cal members: Do NOT use this page for test reimbursement. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Log in to anthem.com, go to Claims & Payment, and choose Submit a Claim. hbbd```b``)n`"EV`U`*8*I2&?tq&e@$E&">I0DjE0!c`) $L*H-`l)`l3Oz's&30t%S! [& Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Find your BCBS company. Lets say you made a one-time purchase of up to 24 tests for three members. Message and data rates may apply. You can also find an in-network doctor by. You can find a list of community-based testing sites here. qO;,lH Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. All Rights Reserved. COVID-19 benefits will change after that date. To submit a claim online, log in to, or register forMy Account, click My Documents, then Forms and select Over-the-Counter COVID-19 Test Online Claim to get started. Mail-in claim forms allow you to submit a claim for multiple members with one form. window.CE_READY = function () { CE2.listen(window, 'click', function(evt) { COVID-19 Coverage Expanded to Include Over-the-Counter Kits - Anthem See our FAQfor detailed instructions. Postal Service. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Sources: All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nation's recovery. Blue Shield of California is an independent member of the Blue Shield Association A53064-FF . For more information, view our privacy policy. Leading the way in health insurance since 1929. Additional details about at-home COVID-19 testing can be found on the Blue Cross Blue Shield website. (To submit a single form for multiple members and/or receipts, use a mail-in form instead. If you paid out of pocket for a test that was sent to a laboratory, follow the steps below to file a reimbursement claim. Site Map|Feedback|Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org, COVID-19 Testing Member Reimbursement Form (PDF), Forms for Blue Cross Blue Shield of Michigan (PPO) members, Forms for Blue Care Network (HMO) members, Prescription drug claim forms (PPO and HMO). As hospitals and emergency departments are overwhelmed, avoid going to the emergency room (ER) if you need to get tested. Blue Cross and Blue Shield Companies Cover COVID-19 Testing and See below.). If you were on a cruise, you'll use the same claim form for reimbursement of medical expenses. [CDATA[ . Centers for Disease Control and Prevention (CDC), Coronavirus, World Health Organization (WHO), Coronavirus, Keep Your Children 5 and Older Safe With a COVID-19 Vaccine, How to Manage Back-to-the-Workplace Anxiety, Anthem has a limited number of at-home diagnostic test kits available for certain members to order online. The site may also contain non-Medicare related information. According to the Centers for Disease Control (CDC) recommendations, if your over-the-counter test has a positive result, you should follow the latest CDC guidance for isolation, wear a well-fitted mask if you have contact with others and call your healthcare provider. endstream endobj 469 0 obj <>/Subtype/Form/Type/XObject>>stream Box 272540, Chico, CA 95927-2540 Questions? COVID-19 | Independence Blue Cross - IBX Once we process your claim, well mail the contract holder a reimbursement check. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. If a test is sold in a package of two, that is considered two tests, and you'll be reimbursed $24. Claim Forms | Plan Documents | bcbsm.com New User? All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nations recovery. Coronavirus Disease (Covid-19): Health Insurance Faqs You can also include multiple receipts with one form. How to get reimbursed for COVID-19 tests | Blue Shield of CA Commercial members may receive reimbursement for up to eight over-the-counter COVID-19 at-home tests per covered individual in the household per 30-days without a healthcare provider order or clinical assessment. In addition, some sites may require you to agree to their terms of use and privacy policy. this.set=function(a,c){var b="",b=new Date;b.setTime(b.getTime()+6048E5);b="; expires="+b.toGMTString();document.cookie=a+"="+c+b+"; path=/; "}; Costco, Wal-Mart, Amazon), please attach itemized register receipts to the back of this form. Y0118_22_062A_C 02082022 *CVS Caremark is an independent company that has been contracted to administer your pharmacy benefits for Blue Cross Blue Shield of Massachusetts. 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.