Coverage and Eligibility

Blue Cross and Blue Shield of Montana (BCBSMT) health plans cover medically necessary health benefits, including physician services, hospitalization and emergency services.

In addition, we have put in place working solutions to help our members access the care they need during these uncertain times.

Cost-Sharing Waived

To make it easier for our members to get the care and treatment they need amid the COVID-19 outbreak, we are waiving member cost-sharing, including copays, deductibles and coinsurance, related to testing and treatment for COVID-19. The treatment waiver applies to costs associated with COVID-19 treatment at in-network facilities and treatment for out-of-network emergencies.

  • For testing: Out-of-pocket costs are covered for medically necessary lab tests to diagnose for COVID-19 until the end of the federal public health emergency (as required by the Families First Coronavirus Response Act).
  • For testing-related visits: Out-of-pocket costs for medically necessary care are covered at no cost-share at in-network provider offices, urgent care clinics, emergency rooms or by telemedicine.
  • For treatment: Costs are covered for treatment received April 1, 2020, through Dec 31, 2020, at network facilities and for out-of-network emergencies.

We will reassess this policy as circumstances warrant. The policy applies to members in these plans:

  • Fully insured
  • Individual and family
  • Medicare (excluding Part D)
  • Medicare Supplement
  • Medicaid
  • HSA Qualified high-deductible health
  • Self-insured and split-funded groups that have opted in

Telemedicine Expanded

We are offering additional options for telemedicine services to give fully insured members improved access to care while reducing their risk of exposure. Members insured by BCBSMT, including Medicare (excluding Part D plans) and Medicare Supplement members, can access provider visits with in-network providers for covered services through telemedicine as outlined in their benefit plan.

Cost-share waivers for fully insured group and retail plans will end on Dec. 31, 2020. That means copays, deductibles and coinsurance will apply after Dec. 31.

For Medicare (not Part D) and Medicare Supplement plans, the cost-share waiver ends Dec. 31, 2020.

This coverage benefit is in addition to the telemedicine benefits currently offered to eligible members by MDLIVE®, our vendor of telemedicine services. MDLIVE is not available to Medicare members.

Telemedicine benefits may differ based on the plan. 

ASO customers have some choices about how we administer COVID-19-related testing, treatment and telemedicine coverage for their employees.

Prescription Coverage

Members with pharmacy benefits through Prime Therapeutics®** can get an early refill on many current prescriptions. They can also sign up for mail-order delivery (up to a 90-day supply of covered non-specialty medications) with AllianceRx Walgreens Prime or by calling Customer Service at the number on their BCBSMT member ID card.

Members with these Medicare plans can get 90-day fills through mail order:

Prior Authorizations

For Transfers. Prior authorization from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals and skilled nursing facilities will not be required through Dec. 31, 2020. This will help promote availability of acute care capacity for COVID-19 patients during this public health emergency. It also allows our members to continue to access medically necessary care. Transfers to a behavioral health facility will still require prior authorization.

On Previously Approved Elective Surgeries, Procedures and Therapies.  We are temporarily extending approvals on existing prior authorizations for most non-emergent elective surgeries, procedures, therapies and home visits, if the service is provided by Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1, 2020 and June 30, 2020.

Relaxed Eligibility Requirements

We have relaxed the eligibility requirements for currently enrolled/covered group members. Employers can maintain employees who were enrolled on their plans as of March 20, 2020 through Sept. 30, 2020, regardless of the eligibility definition stated in their plan or the BPA. This includes reduced work hours, furlough, leave of absence or layoffs. This flexibility does not apply to those who are newly electing coverage via a special enrollment period.

See what is being communicated directly to our members about these coverage changes.

*Virtual Visits may not be available on all plans. Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations and exclusions. Non-emergency medical service in Arkansas and Idaho is limited to interactive audio/video (video only) for initial consultation. Service availability depends on location at the time of consultation.

MDLIVE®, a separate company, operates and administers the virtual visit program for Blue Cross and Blue Shield of Montana and is solely responsible for its operations and that of its contracted providers.

MDLIVE® and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without written permission.

Insurance products issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148. Blue Cross and Blue Shield of Montana is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD®  and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.