Healthcare Providers

Costs Being Waived for Fully Insured Members

As of March 16, CareFirst has removed cost sharing on behalf of our fully insured members as detailed in the chart (link below). Providers are encouraged not to collect member cost sharing for these services. If a member does owe a copay or coinsurance after the claim is processed, you can bill the member as you do for all other claims.

We are also partnering closely with our self-insured customers to implement similar measures.

Prescription Drug Information (only for members with CareFirst Rx coverage)

CareFirst is waiving early medication refill limits on 30-day maintenance medications consistent with the member’s benefit plan at any in-network pharmacy. We are also encouraging members to use the 90-day mail order benefit.

Deductibles, Copays and Coinsurance

ServiceCost Share Waiver must be related to COVID-19?In-NetworkOut-of-network
Diagnostic Test (Nasal Swab) for COVID-19

Effective Date:
2/4/20 until 12/31/20 (unless otherwise required by law)

YES Waive member liability for deductibles, copays and coinsurance CareFirst/Plan Sponsor pays 100% up to charge
FDA-Authorized Antibody (Blood) Test for COVID-19

Effective Date:
4/11/20 until 12/31/20 (unless otherwise required by law)

YES Waive member liability for deductibles, copays and coinsurance CareFirst/Plan Sponsor pays 100% up to charge
Visits (regardless of setting) associated with Diagnostic Testing

Effective Date:
2/4/20 until 12/31/20 (unless otherwise required by law)

YES Waive member liability for deductibles, copays and coinsurance CareFirst/Plan Sponsor pays 100% up to our allowed amount, but member can be balance billed
Treatment of COVID-19 (regardless of setting)

Effective Date:
2/4/20 until 12/31/20 (unless otherwise required by law)

YES Waive member liability for deductibles, copays and coinsurance CareFirst/Plan Sponsor pays 100% up to our allowed amount, but member can be balance billed