Blue Cross Meeting Emergency Rule 36

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Blue Cross Meeting Emergency Rule 36

As you know, our state continues to battle the spread of the coronavirus (COVID-19). Here at Blue Cross and Blue Shield of Louisiana, we’re doing everything we can to minimize the virus’ impact on our members — your customers. We continue to follow CDC, federal and state recommendations about the coronavirus.

Public health officials indicate there will be a growing number of Louisiana residents testing positive for COVID-19, posing a serious threat to a large part of our state’s population. To help address the crisis, the Commissioner of Insurance for the state of Louisiana on March 18, 2020, issued Emergency Rule 36.

Blue Cross had already implemented several of the changes mandated by this rule, and we will continue to comply with Department of Insurance rules. Please note the following changes.

COVID-19 Coverage and Benefits Updates

  • Waive Prior Authorizations for Diagnostic Tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19.
  • Cover the Full Cost of Medically Necessary Diagnostic Tests that are consistent with CDC guidance related to COVID-19
  • Increase Access to Prescription Medication by waiving early refill limits on medications and allowing extended supplies of maintenance medicines (consistent with member’s benefit plan). Our pharmacy benefit manager, Express Scripts, has communicated this to pharmacists statewide.
    If members have trouble getting early refills at the pharmacy, they can show their pharmacists theseinstructions for early refills from Express Scripts; call Express Scripts at the Pharmacy number on their ID cards (18667817533) or call Blue Cross Customer Service. Members should note that the pharmacy may need to call a member’s doctor to update the prescription or for approval to fill a drug.
    Blue Cross will also waive step therapy requirements.
    We encourage members to work with their pharmacists in a way that respects social distancing recommendations or use their 90-day retail or mail order benefit.
  • Ensure network adequacy. Our strong provider networks are adequate to handle a potential increase in the need for healthcare services for COVID-19 cases, including access to out-of-network services where appropriate.
  • Notify providers of all cost-share waivers. 

Note: All of the above cost-share waivers are applicable to all Blue Cross and Blue Shield of Louisiana customers, unless self-funded groups opt out of the waivers for their employees. In addition, the Internal Revenue Service recently released guidance that confirms employer groups may waive cost-sharing for COVID-19 testing and treatment for members on high-deductible health plans. 


Top Topics for Today

Premium payments: As of today, March 19, 2020, we have not made any decisions about allowing group policy holders to waive, extend or alter current group premium payments.We are in contact with the Louisiana Department of Health and although an emergency order has not been issued, we are willing to work with our customers in the meantime.

Keeping employees active if the group’s business closes: If a group considers an employee active, we will consider them active as well. This includes variable hour and shift work employees who may not be currently getting paid but are still considered active by the group. If the group considers employees terminated, rehire provisions may apply.

For fully insured and self-funded Treaty groups, Blue Cross will continue coverage of employees through this crisis while the group considers them employees. This means the employee must still be eligible to earn vacation time, sick leave, 401K type contributions, receive a salary, etc. If the group does not continue those benefits for the employee, then they will no longer be considered an eligible employee for coverage outside of State Continuation or COBRA

Small business funding groups e‑billing: Small business funding (SBF) groups may be set up for eBilling. 

Group layoffs and coverage: According to our contracts for fully insured groups, coverage will terminate at midnight on the last day of the billing cycle for which premium has been received. Self-funded (administrative services only) group contracts are specific to each group and may have different termination language. Self-funded group members will need to contact their employers for specific provisions for coverage after layoffs.

Coverage for returning employees after layoffs: In general, groups determine eligibility waiting periods. Once established by the group, Blue Cross will administer in a non-discriminatory fashion. Please note that Affordable Care Act (ACA) created rehire provisions (most cases 13 weeks and in some cases 26 weeks). These provisions will apply in the normal course of business.

Covering employees while laid off: If an employee is not considered active by the group, Blue Cross will not consider them active as well and will not continue coverage, even if the group continues to pay premiums for the employee. 

FOR MORE INFORMATION ABOUT OUR COVID-19 RESPONSE
To learn more about what Blue Cross is doing about COVID-19, please visitwww​.bcb​sla​.com/​c​o​vid19. You will also find a list of trusted resources to help keep you and your families informed, safe and healthy.

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