Coverage and Eligibility

Blue Cross and Blue Shield of Oklahoma (BCBSOK) plans cover medically necessary health benefits, including physician services, hospitalization and emergency services.

In addition, we have put in place working solutions to help you and your members get the care they need during these uncertain times.

Cost-Sharing Waived

To make it easier for our members to get the care and treatment they need amid the COVID-19 outbreak, we are waiving member cost-sharing, including copays, deductibles and coinsurance, related to testing and treatment for COVID-19.

  • For testing: Out-of-pocket costs are covered for medically necessary lab tests to diagnose for COVID-19 until the end of the federal public health emergency (as required by the Families First Coronavirus Response Act).
  • For testing-related visits: Out-of-pocket costs for medically necessary care are covered when using network providers in any setting until the end of the federal public health emergency (as required by the Families First Coronavirus Response Act).
  • For treatment: Costs are covered for treatment received April 1, 2020, through Aug. 31, 2020, at network facilities and for out-of-network emergencies.

The policy applies to members in these group plans:

  • Fully insured plans
  • Medicare (excluding Part D)
  • Medicare Supplement
  • HSA qualified high-deductible health plans
  • Self-insured and split-funded groups  that have opted in

Telehealth Expanded

We are offering additional options for telehealth services to give fully insured members improved access to care while reducing their risk of exposure.

Currently, those insured by BCBSOK, including Medicare (excluding Part D plans) and Medicare Supplement members:

  • Can access provider visits for covered services through telemedicine or telehealth as outlined in their benefit plan.
  • Won’t pay copays, deductibles, or coinsurance on in-network covered telemedicine or telehealth services.

This means that members insured by BCBSOK, including Medicare (excluding Part D plans) and Medicare Supplement members, can access provider visits for covered services through telemedicine or telehealth as outlined in their benefit plan.

The expansion for fully insured group and retail plans is effective through Aug. 31, 2020. For Medicare and Medicare Supplement plans, the cost-sharing waiver is extended through Dec. 31, 2020.

This coverage benefit is in addition to the telehealth benefits currently offered to eligible members by MDLIVE® *, our vendor of telehealth services. MDLIVE is not available to Medicare members.

Telehealth may differ based on the plan. 

ASO customers have some choices about how we administer COVID-19 related testing, treatment and telehealth coverage for their employees.

Prescription Coverage

Members with pharmacy benefits through Prime Therapeutics®** can get an early refill on many current prescriptions. They can also sign up for mail-order delivery (up to a 90-day supply of covered non-specialty medications) with AllianceRx Walgreens Prime by calling Customer Service at the number on their BCBSOK member ID card.

Members with Group Medicare Advantage and Group MedicareRx (PDP) plans can get 90-day fills through mail order.

Prior Authorizations

We are temporarily extending approvals on existing prior authorizations for most non-emergent elective surgeries, procedures, therapies and home visits, if the service is provided by Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1, 2020 and June 30, 2020.

Relaxed Eligibility Requirements

We have relaxed the eligibility requirements for currently enrolled/covered group members through Aug. 31, 2020. You can maintain employees who were enrolled as of March 20, 2020, regardless of the eligibility definition stated in their plan or the BPA.  This includes reduced work hours, furlough, leave of absence or layoffs.

You do not need to do anything. No paperwork or email is needed, as we will accept current and accurate eligibility files. This flexibility does NOT apply to those who are newly electing coverage via a special enrollment period.

See what is being communicated directly to our members about these coverage changes.

*Virtual Visits may not be available on all plans. Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations and exclusions. Non-emergency medical service in Arkansas and Idaho is limited to interactive audio/video (video only) for initial consultation. Service availability depends on location at the time of consultation.

MDLIVE®, a separate company, operates and administers the virtual visit program for Blue Cross and Blue Shield of Oklahoma and is solely responsible for its operations and that of its contracted providers.

MDLIVE® and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without written permission.

**Blue Cross and Blue Shield of Oklahoma (BCBSOK) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSOK, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. Myprime.com is an online resource offered by Prime Therapeutics.