COVID-19 resources & information

COVID-19 vaccines given at pharmacies are covered for Blue Cross NC members, as part of our preventive care services, and reimbursement will be determined based on whether the provider is in-network or out-of-network. 

Commercial members can purchase over-the-counter (OTC) tests with their health flexible spending arrangements (health FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), or Archer medical savings accounts (Archer MSAs).

We encourage members to speak with their primary care provider about the COVID-19 vaccine and staying current on recommendations.

Individuals can also refer to the CDC’s website, which includes an easy-to-use tool to determine when they are due for a COVID-19 vaccine or booster.

Virtual (or telehealth) visits can be used with your primary care doctors, specialists, and behavioral health providers. Or any licensed NC provider who can provide telehealth services. Call your doctor before going into the office to see if telehealth is available.

The American Medical Association (AMA) has provided this table (PDF) to link the COVID-19 vaccine product codes to their associated immunization administration codes, manufacturer name, vaccine name(s), 10 and 11-digit National Drug Code (NDC) Labeler Product ID, and interval between doses. These codes are also located in the Medicine section of the CPT code set.

Blue Cross NC is currently covering telehealth services for behavioral health, primary care and outpatient visits, which accounted for more than 97% of telehealth claims received during the last two years.

The policy applies to all Blue Cross NC fully insured and administrative services only (ASO) plans, including the State Health Plan. It does not apply to Blue Cross NC members receiving care from out-of-state providers. Members who do not have a commercial plan can find more information about their telehealth coverage below.

• Medicare Advantage members should review their evidence of coverage. 
• Healthy Blue members have certain telehealth visits covered at parity under Medicaid benefits determined by the state.
• Federal Employee Program members can find details in their Service Benefit Plan Brochure.  

Effective May 12, 2023, COVID-19 tests administered by a provider that are consistent with CDC guidance and has been cleared, approved or given emergency use authorization (EUA) by the FDA are covered based on each individual’s insurance plan, and members may be responsible for a portion of their costs to include copayments, coinsurance and deductible amounts.

For more information on testing and how to find a COVID-19 test, visit NC Department of Health and Human Services.

Effective May 12, 2023, Blue Cross NC and ASO groups will cover both the cost of the vaccine and vaccine administration at 100% when members receive the COVID-19 vaccine at an in-network provider as part of our preventive care services.

If members receive the COVID-19 vaccine at an out-of-network provider, they may be responsible for the cost of the vaccine and/or vaccine administration based on their individual preventative care benefits.

The federal government has invested in a large supply of COVID-19 vaccines and will continue to cover the cost of the COVID-19 vaccine until that supply is exhausted.

COVID-19 treatments are covered based on each individual’s insurance plan, and members may be responsible for a portion of their treatment costs to include copayments, coinsurance and deductible amounts.

Blue Cross NC Medicare Advantage members will continue to be covered under the Part B preventive vaccine benefit when receiving monoclonal antibodies until the end of the calendar year that the EUA declaration ends.  Blue Cross NC Medicare Advantage members will be responsible for cost sharing when receiving treatment at an out-of-network facility, as specified under the plan benefit, beginning on June 10, 2023. COVID-19 treatment is covered with no cost-sharing for Healthy Blue members through September 30, 2024.

COVID-19 tests do not need prior approval. That means your doctor doesn’t need to ask us for approval before you’re tested for COVID-19.