Healthcare Providers

Over-the-Counter Tests

The federal government now requires commercial health plans to cover the cost of over-the-counter COVID-19 tests for members. This benefit applies to tests purchased on or after January 15, 2022, and will remain in effect for the duration of the Federal Public Health Emergency. Visit our Over-the-Counter Tests page for more information on member reimbursement, claims submission and other testing options.

Costs Being Waived for Fully Insured Members

Throughout the pandemic, CareFirst has enhanced our benefits to ensure members can get the care they need. These enhancements include covering services not previously covered and waiving fully insured* member costs for select services related to COVID-19. 

We will continue to track the situation to make sure our benefits are appropriate and update as necessary. Prior notice will be given before ending any benefit enhancements.

View this chart for details on the benefit changes we’ve made. 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.

For CareFirst BlueCross BlueShield and CareFirst BlueChoice Members

Deductibles, Copays and Coinsurance

ServiceCost Share Waiver must be related to COVID-19?In-NetworkOut-of-Network
Diagnostic Test for COVID-19 YES Waive member liability for deductibles, copays and coinsurance

CareFirst/Plan Sponsor pays 100% up to charge

(no balance billing)

FDA-Authorized Antibody (Blood) Test for COVID-19 YES Waive member liability for deductibles, copays and coinsurance

CareFirst/Plan Sponsor pays 100% up to charge

(no balance billing)

Visits (regardless of setting) associated with Diagnostic Testing 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

FDA Emergency Use Authorized or Approved COVID-19 Vaccines

YES

Waive member liability for deductibles, copays and coinsurance for administration of vaccines and associated office visit

Cost of vaccine is covered by the federal government

CareFirst/Plan Sponsor pays 100% up to charge for administration of vaccines and associated office visit

(no balance billing)

Monoclonal Antibody Infusion

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

Oral Antiviral Pills for COVID-19

YES Waive member liability for deductibles, copays and coinsurance

CareFirst/Plan Sponsor pays 100% up to charge

(no balance billing)

CareFirst covers, with no cost share to the member (including our members enrolled in high deductible health plans), the appropriate diagnostic testing for COVID-19. CareFirst does not provide benefits for COVID-19 testing for surveillance, work or social purposes. This policy will apply to all CareFirst members except where testing for surveillance, work or social purposes is required by law.