April 14, 2023
Throughout the COVID-19 pandemic, Independence Blue Cross (Independence) has been committed to helping members receive the care they need. Even though the PHE ends on May 11, 2023, Independence’s commitment to helping members stay healthy will remain as strong as ever.
Members will continue to have access to COVID-19 vaccines, testing, and virtual visits; however, Independence is required to change access to some services starting May 12, 2023 (the day after the PHE ends).
Independence’s changes of COVID-19 related services after the PHE are outlined below.
Independence post-PHE coverage of COVID-19 related services
- Vaccine: For Medicare Advantage members, the COVID-19 vaccine will continue to be covered as a preventive service at no cost when obtained from an in-network provider. If the vaccine is administered by an out-of-network provider, standard cost-sharing will apply. Network rules apply based on benefit design.
- Diagnostic testing: Medicare Advantage plan copays and coinsurance will apply to visits when members are tested for COVID-19. Diagnostic testing for COVID-19 will be paid consistent with health plan benefits, including benefits for in-network or out-of-network services. Testing should continue to be performed only when medically necessary.
- Telehealth visits: Medicare Advantage health plans’ coinsurance and copays will apply for all telehealth visits with network primary care physicians and specialists, including behavioral health providers, physical therapists, occupational therapists, and speech therapists. We will no longer waive coinsurance and copays for a COVID-19 diagnosis.
Note: If a member has coverage through an employer, benefits, and coverages may vary. Please check with the employer to confirm telehealth coverage.
- Out-of-network coverage: Medicare Advantage Personal Choice 65SM PPO and Keystone 65 HMO-POS health plans’ out-of-network coinsurance and copays will apply for all out-of-network services received when applicable. For Medicare Advantage Keystone 65 HMO health plan members, only in-network services are covered. However, for all Medicare Advantage health plans, out-of-network urgent or emergency care will continue to be covered at the health plan’s in-network rate.
- Prescription refill limits: Medicare Advantage and Select Option PDP plans will resume “refill too soon” prescription limits. For most prescription refills, this means members cannot receive a refill prior to the 23rd day of a 30-day supply. For ophthalmic drugs, this means members cannot receive a refill prior to the 21st day of a 30-day supply.
1 (800) 772-6881 x7731 | email@example.com