Health Insurance Exchange

The Health Insurance Exchange is committed to providing you with the most up to date information from our local carrier partners on COVID-19 as it becomes available.  Below is the guidance we have received from BCBSTX, however it is subject to change as new guidance is released.  We will keep you updated with any changes we are made aware of.

Eligibility Requirements
BCBSTX relaxed the eligibility requirements for currently enrolled/covered group members.

  • From now through April 30, employers can maintain employees who were enrolled on their plans as of March 20, regardless of the eligibility definition stated in their plan or the BPA.    
  • This includes reduced work hours, furlough, leave of absence or layoffs.  
  • Groups do not need to do anything. No paperwork or email is needed, as we will accept current and accurate eligibility files.  
  • This flexibility does NOT apply to those who are newly electing coverage via the special enrollment period (see below).

Special Enrollment Period
BCBSTX is offering groups an optional special enrollment period from March 30 to April 30. This would apply to eligible employees and their dependents who previously declined coverage and now want to enroll, or currently enrolled employees who wish to add an eligible spouse or dependent to their existing coverage.

  • Applicable enrollment changes must be received on or before Friday, May 1.
  • Effective date of coverage will be the group’s standard coverage effective date/billing date – for most groups this will be April 1.
  • This enrollment event will be for medical/pharmacy and dental coverage only.
  • Please notify me if you plan to use this special enrollment option and use the standard eligibility process to add employees.

Other Coverage Options
If you have employees who will be losing coverage, those employees may have options for alternative coverage.

  • Federal COBRA/State Continuation
  • Individual coverage

Additional Resources
BCBSTX has created materials to help you communicate these options to employees:
  An email template you can use to explain their coverage options

  • A flier that can be printed or shared electronically

Payment Extensions
Currently, grace period extensions beyond the normal business processes will not be considered.

Telehealth
Effective immediately, BCBSTX expanded telemedicine and telehealth benefits for all fully insured groups (in accordance to their benefit plans), this includes:

  • No member copays, deductibles or coinsurance on ALL in-network covered telemedicine or telehealth services. 
  • Benefits will remain in effect until April 30, 2020. (This date will be monitored and adjusted based on market need.)

COVID-19 Benefits
On March 18, 2020, the Families First Coronavirus Response Act (FFCRA) became effective requiring BOTH fully insured and ASO groups to provide coverage (FFCRA coverage) for COVID-19 testing and related services. As a result:

  • There will be no copays, deductibles or coinsurance for testing to diagnose COVID-19 or for testing-related visits with in-network providers.
  • Prior authorization will not be required for COVID-19 tests.
  • Benefits will remain in effect until the public health emergency is declared over by the federal government.

The mandate will remain in effect until the public health emergency is declared over by the federal government.  Under FFCRA, out of network is covered up to the allowed amount for lab testing and associated services. Members may be subject to balance billing if they visit an out of network provider.