In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. However, you must include all required information requested in the form. endstream endobj startxref Fill Online, Printable, Fillable, Blank COVID-19 Testing Member Reimbursement Form Non-Medicare Advantage (Blue Cross Blue Shield of Michigan) Form Use Fill to complete blank online BLUE CROSS BLUE SHIELD OF MICHIGAN pdf forms for free. Online claim example 1: Lets say you made a one-time purchase of up to 24 tests for three members. W006259 COVID-19 Testing Member Reimbursement Form - Non-Medicare Advantage Please use this form to request reimbursement for COVID-19 tests you have paid for out of your own pocket. 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. Everyone qualifies. In addition to your benefits, every home in the United States is eligible to orderfree COVID-19 home test kits through the federal government atcovidtests.gov. In addition to your BCBSRI benefits, every home in the United States is eligible to orderfree COVID-19 home test kits through the federal government atcovidtests.gov. At this time, about half of the insurers reviewed are implementing their testing coverage policy using only reimbursement. In the face of COVID-19, every question, answer and vaccination is important. this.get=function(a){for(var a=a+"=",c=document.cookie.split(";"),b=0,e=c.length;b/ProcSet[/PDF]>>>>stream This coverage applies to all BCBSRI health plans except Medicare. Wu3B= e&gZ-h'BR$djC?Wn>2esFdUb'$K6Q To print and mail your claim, download theclaim form (PDF). All of the content provided on this website or on the linked websites is for informational purposes only and is not intended to serve as medical, legal or tax advice. All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. At-home COVID-19 testing As of Jan. 15, 2022, and through the end of the public health emergency, all individuals with pharmacy coverage through Blue Cross Blue Shield of Michigan and Blue Care Network have more ways to get at-home COVID-19 rapid diagnostic tests at no cost. Updated April 15, 2022. this.check=function(){var a=this.get(f);if(a)a=a.split(":");else if(100!=e)"v"==h&&(e=Math.random()>=e/100?0:100),a=[h,e,0],this.set(f,a.join(":"));else return!0;var c=a[1];if(100==c)return!0;switch(a[0]){case "v":return!1;case "r":return c=a[2]%Math.floor(100/c),a[2]++,this.set(f,a.join(":")),!c}return!0}; cRequired for employment purposes. For full details onbenefits, services and network coveragewhich may vary by health planfind each BCBS companys statement below: The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. All Rights Reserved. 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. Receipt required. 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. Please note that orders will be held for 72 hours and cannot be picked up at the drive-through. Blue Cross Blue Shield COVID At-Home Test Reimbursement Form. Please ask at the pharmacy counter. Once we process your claim, the contract holder will receive a reimbursement check by mail. Please enter the NDC or UPC number from the cash register receipt or test package. Find and download forms often used by our members. Health plans are offered by Blue Shield of California. Once you receive a confirmation from CVS Pharmacy, your order will be waiting for you at the front store register. For members of BCBSRI Medicare Advantage and Plan 65 Medical, Vision, Dental Claims and Reimbursement Forms Prescription Drug Forms Coverage and Premium Payment Forms Personal Information Forms Medicare Forms HIPAA. OTC tests, also known as self-tests, detect if you are currently infected with COVID-19. If your employer has asked you to submit receipts to your pharmacy benefit plan, please dont submit them here. At-home diagnostic tests can be purchased over the counter, online, at a local pharmacy, or from a big-box store. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. Increasing access to prescription medications. Pregnant members can use this form to request a blood pressure monitor at no cost. endstream endobj 462 0 obj <>/ProcSet[/PDF]>>>>stream The California Department of Health Care Service (DHCS) will reimburse the cost of your at-home tests purchased from March 11, 2021, to January 31, 2022. Forms for members enrolled in individual, family and employer plans with Florida Blue. Sign in or register at Caremark.com (You must be a CVS Caremark member) follow the latest CDC guidance for isolation. Read our Nondiscrimination and Language Assistance notice. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. The Contraceptive Exception Form allows members to apply for coverage, or formulary tier, exception for a contraceptive drug/product. COVID-19 At-Home Test Member Reimbursement Form Please use this form to request reimbursement for actual cost of FDA-approved COVID-19 at-home test(s). Instead of showing your BCBSRI member ID card at the pharmacy counter, you provide that information online and then pick up the home test kits at a CVS Pharmacy location. You will need an order for an OTC at-home test from an authorized healthcare provider to get reimbursed at this time. endstream endobj 471 0 obj <>/Subtype/Form/Type/XObject>>stream Reimbursement requests take up to 4-6 weeks to process, Questions? As of January 15, Americans with private insurance are supposed to be reimbursed for the cost of the tests. Visit covidtests.gov, and click the blue "Order Free At-Home Tests" button. There are different ways to submit your reimbursement depending on your plan. Your Blue Cross and Blue Shield of Illinois (BCBSIL) health plan gives you access to the care you need during the COVID-19 pandemic. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. For other FDA-approved home test kits (that are generally not available at pharmacies), you can submit a claim for reimbursement. Throughout the pandemic, CareFirst has enhanced our benefits to ensure members can get the care they need. Member Forms. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Youll be reimbursed up to $12 per individual test. Online claim example 2: If you made two separate purchases and each purchase covered three members, you would need to submit six separate claim forms. Effective, Jan. 15, 2022, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will cover the cost of FDA-authorized, over-the-counter (OTC) COVID-19 tests through BCBSOK/Prime Therapeutics pharmacy benefits. Your commercial plan will reimburse you up to $12 per test. A nurse case manager with Blue Cross & Blue Shield of Rhode Island found that listening, without judgment, to one patients concerns made all the difference. You can submit any number of receipts on a single claim form. The number one priority for Blue Cross Blue Shield (BCBS) companiesespecially as the nation faces this unprecedented health crisisis getting their members across the country the care they need. To pay no out-of-pocket costs, order your tests online through cvs.com or the CVS Pharmacy mobile app for store pickup1. Please note that taxes and other fees are not covered. // ]]>, // endobj window.CE_READY = function () { CE2.listen(window, 'click', function(evt) { if (evt.target.id=== 'QSIFeedbackButton-btn' || (evt.target.matches && evt.target.matches('#QSIFeedbackButton-btn *')) ) { CE2.set(1, 'feedback'); } }); }

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