Your frequently asked questions about COVID‑19

COVID-19 vaccines continue to be an important step in reducing risk of severe disease, hospitalization, and death, as well as in slowing the spread of the virus. The Centers for Disease Control and Prevention (CDC) recommends everyone ages 6 months and older get vaccinated to help protect against COVID-19.

Currently, three vaccines are authorized and recommended in the United States to prevent COVID-19. According to the CDC, Pfizer-BioNTech or Moderna mRNA vaccines are preferred. Johnson & Johnson’s Janssen COVID-19 vaccine is available in some situations.

• Pfizer-BioNTech is authorized for anyone age 6 months and older.
• Moderna is recommended for anyone 6 months and older.
• Johnson & Johnson’s Janssen is available for people 18 years and older.

Yes. Independence covers the COVID-19 vaccine as a preventive service.

For individual, group commercial members, there is no cost sharing (co-pays, deductibles, coinsurance) when the vaccine is administered by an in-network health professional. However, if the COVID-19 vaccine is administered by an out-of-network provider, standard cost sharing will be applied based on a member’s health plan benefits.

For Medicare Advantage members, there is no cost-sharing (such as copays, deductibles, coinsurance) and the health care professional administering the vaccine does not need to be part of the Independence network. However, the health care professional must participate in the Medicare program.

Yes. Boosters are authorized for anyone 6 months and older.

• Updated boosters protect against both the original virus that causes COVID-19 and the Omicron variant BA.4 and BA.5. Two COVID-19 vaccine manufacturers, Pfizer and Moderna, have developed updated COVID-19 boosters.
• Original boosters were designed to protect against the original virus that causes COVID-19. They also provide some protection against Omicron, but not as much as the updated boosters.

The CDC shared guidelines for getting a booster. Learn more here.

Yes. Independence covers the COVID-19 booster as a preventive service.

For individual, group commercial members, there is no cost sharing (co-pays, deductibles, coinsurance) when the booster is administered by an in-network health professional. However, if the COVID-19 booster is administered by an out-of-network provider, standard cost sharing will be applied based on a member’s health plan benefits.

For Medicare Advantage members, there is no cost-sharing (such as copays, deductibles, and coinsurance) for the booster and the health care professional administering it does not need to be part of the Independence network. However, the health care professional must participate in the Medicare program.

Yes. Some people may prefer the vaccine type that they originally received, and others may prefer to get a different booster. The CDC’s recommendations allow for this type of mix and match dosing for booster shots.

For those who received the Johnson & Johnson’s Janssen shot, there is research that supports following up the initial dose with either Pfizer or Moderna could produce a stronger immunity response than a second dose of the Johnson & Johnson’s Janssen vaccine.

Yes. Independence takes responsibility as a health plan to bear the costs for the administration of COVID-19 vaccines and boosters.

Yes. However, starting May 12, 2023, cost-sharing (such as copays, deductibles, and coinsurance) will be applied for medically appropriate, FDA-approved COVID-19 diagnostic and antibody tests ordered by an in-network physician or authorized by a health care professional (unless the member has benefits that include out of network coverage). Co-pays, deductibles, and coinsurance are based on the member’s health plan benefits.

Independence does not cover tests that are needed for return to work, a condition of employment, return to school, or travel.

If you have any questions about whether you should be tested, please contact a health care professional.

Yes. However, starting May 12, 2023, Independence will no longer reimburse for over-the-counter/at-home COVID-19 tests. Until May 12, 2023, Independence will continue its coverage of up to eight FDA-approved over-the-counter COVID-19 tests per calendar month as directed by the Biden. Tests that are covered, include at-home COVID-19 test kits authorized by the Food and Drug Administration (FDA). The most common tests are BinaxNOW™, Flowflex™, InteliSwab™, On/Go™ and QuickVue^®. Covered members can get up to 8 individual tests per month without a prescription (e.g., a family of 4 would be eligible for 32 tests a month). You can get an FDA-authorized COVID-19 test kits at Walmart, Sam’s Club, Rite Aid, and Walgreens for no out-of-pocket cost. Simply go to the pharmacy counter, present your member ID card, and ask to have the test submitted to OptumRx. You can also purchase an FDA-authorized over the counter COVID-19 test kit at other stores or online retailers. Keep your purchase receipt(s) to submit for reimbursement. You will be reimbursed up to $12 per test by submitting a claim.

To receive reimbursement for over-the-counter/at-home tests with a receipt dated May 11, 2023 or prior, members with Independence Blue Cross prescription drug coverage should submit documentation through ibx.com.

For members with a Health Savings Account or Flexible Spending Account offered through Independence Blue Cross, receipts can be submitted for reimbursement through those programs at ibx.com.

Yes. However, starting May 12, 2023, Independence will no longer reimburse for over-the-counter/at-home COVID-19 tests. Until May 12, 2023, Original Medicare will continue to cover the cost of up to eight over-the-counter/at-home, FDA-approved COVID-19 tests each calendar month for individuals with Medicare Part B (Medical Insurance), including those enrolled in a Medicare Advantage plan. For our Medicare Advantage members, this benefit is covered outside of their Independence Medicare Advantage plan and will be processed through their Medicare Part B coverage. To pay $0, visit any participating eligible pharmacy or health care provider and show your red, white, and blue Medicare card.

Yes. Independence will continue to cover in-network, inpatient treatment of COVID-19 for commercial members. Standard cost-sharing will apply. (Note: Self-funded groups will have the option of asking for a benefit exception to continue waiving cost-share). Independence Medicare Advantage members also have a $0 cost-share for in-network acute inpatient treatment of COVID-19 covered through their plan benefits. Independence is waiving the cost for out-of-network acute inpatient treatment of COVID-19 until May 11, 2023, at 11:59 p.m.

For Children’s Health Insurance Program (CHIP) members, standard coverage includes no member cost sharing for in-network, inpatient acute care treatment and emergency department visits associated with those admissions with or without a COVID-19 diagnosis.

Starting May 12, 2023, Independence will no longer waive cost-sharing for antivirals for the treatment of COVID-19. Co-pays, deductibles, and coinsurance are based on the member’s health plan benefits.

Yes. However, starting May 12, 2023, standard cost-sharing and co-pays will be applied for all telemedicine visits that individual and group commercial members have with primary care physicians and specialists, including behavioral health providers, regardless of their COVID-19 status. Cost-sharing and co-pays are based on the member’s health plan benefits.

For Medicare Advantage members, standard cost-sharing and co-pays will be applied starting May 12, 2023, for all telemedicine visits with primary care physicians and specialists, including behavioral health providers, regardless of the member’s COVID-19 status.

Until May 11, 2023, Independence will cover telemedicine for COVID-19 related services. Please see below for more specific information on how the coverage may apply to you.

Commercial Members

Telemedicine services with in-network primary care doctors, specialists, and behavioral health providers are covered until May 11, 2023, for COVID-19 related services. Services must be for testing or to diagnose COVID-19.¹ Normal member cost-sharing applies to telemedicine services that are not related to COVID-19.

Some members can also access MDLIVE for telemedicine visits.² Cost-sharing for those visits vary based on members’ benefits. If you have questions about your access to MDLIVE telemedicine services, please check your member benefits at ibx.com. To access telemedicine options, log in to the member website at ibx.com.

Medicare Advantage Members

Telemedicine services with in-and out-of-network primary care doctors, specialists, and behavioral health providers are covered at no cost until May 11. Services must be for testing or to diagnose COVID-19. Normal member cost-sharing applies to telemedicine services that are not related to COVID-19. Members can also access MDLIVE for non-emergency and behavioral health virtual visits. Cost-sharing for MDLIVE visits vary based on members’ benefits.

Medicare Supplement Members

Telemedicine services are payable as a Medicare covered service for Medicare-eligible providers until May 31, 2023.

CHIP Members

Telemedicine services with primary care physicians and specialists are covered at no cost through the until May 11, 2023, for COVID-19 related services. For non-COVID-19 visits, normal cost sharing (as applicable) applies for specialist telemedicine visits.

Independence will give members and providers 60 days’ notice before any changes to its telemedicine policy go into effect. To see all the telemedicine services covered by Independence, visit the medical policy page on ibx.com.

Yes. Independence has a permanent telemedicine policy for fully insured and self-funded commercial members. The policy covers many of the expanded telemedicine services made available during COVID-19 and includes substantially more telemedicine services than the policy that was in place before the pandemic.

Please note that there are some services better performed face-to-face that we covered through telemedicine at the height of the pandemic to keep everyone safe and healthy that are no longer covered through telemedicine under the permanent policy. To see all the telemedicine services covered by Independence, visit the medical policy page on ibx.com.

Given Independence’s broad network, it is unlikely that a member would need to seek care from an out-of-network provider. Telemedicine visits from out-of-network providers are covered for commercial members with out-of-network coverage and are subject to the out-of-network cost-sharing under the member’s benefit plan. This applies to specialists, including behavioral health providers.

Medicare Advantage members have out-of-network telemedicine coverage, per CMS, until May 31, 2023.

Yes. Credit card payments may be used to satisfy past due premiums as well as any current amounts that are due. Independence will accept American Express, Discover, Visa, and MasterCard. To further help consumer members, Independence will waive the fees associated with credit card payments. Members can make credit card payments by:

• Calling 1-888-879-4891 (TTY: 711)
• Using eBill: Log in at ibx.com and click Manage Account

If you have questions or need additional help related to premium payments, call Independence at 1-800-503-1253 (TTY: 711).

Yes. Starting May 12, 2023, Independence will resume refill restrictions for Medicare Advantage members based on their health plan benefits.

Yes. Starting May 12, 2023, Independence will resume processing all out of network services for Medicare Advantage members at Out of Network rates, when applicable. Co-pays, deductibles, and coinsurance are based on the member’s health plan benefits.

If you are looking for more information about specific symptoms you are experiencing or have questions about your personal health, we recommend you contact your doctor. For reliable information about COVID-19, we suggest visiting the Centers for Disease Control and Prevention (CDC) website at cdc.gov/coronavirus. The City of Philadelphia and Commonwealth of Pennsylvania have also established websites with information about COVID-19.

Our comprehensive website dedicated to COVID-19 also has information and resources available. We also continue to update our Newsroom and social media channels with the latest information about COVID-19.

Unfortunately, fraud exists everywhere. Independence, like many other organizations, have received some reports of potential frauds and scams related to COVID-19.

Members should be aware of individuals attempting to profit from this emergency and should remain diligent in protecting personal and health insurance information.  Some of the reports we have received include:

• Individuals and businesses selling fake tests, treatments, and cures for COVID-19 online
• Phishing emails from entities posing as trusted organizations like the World Health Organization or the Centers for Disease Control and Prevention
• Online sellers falsely claiming to have in-demand products like cleaning, household, and health and medical supplies
• Unsolicited calls, e-mails or home visits from individuals offering free services or supplies in exchange for member numbers

Members can help to avoid fraud by following these tips:

• Reviewing medical claims submitted at comfor accuracy
• Protecting their insurance card
• Protecting their identity and not providing their Social Security Number
• Declining to provide insurance information to anyone that is not directly providing care to a member
• Being cautious of unsolicited telemarketers and recruiters

If members suspect that something potentially fraudulent has occurred with respect to their Independence Blue Cross health insurance, they should contact us. All reports can be submitted anonymously. Here are three options for submitting a report:

• Submit through the Online Fraud & Abuse Tip Referral Form at ibx.com/antifraud.
• Call the confidential anti-fraud and corporate compliance toll free hotline at 1-866-282-2707 / TTY# 888-789-0429.
• Mail the report. Write a description of your complaint, enclose copies of any supporting documentation, and mail it to Independence Blue Cross, Corporate & Financial Investigations Department at 1901 Market Street, 42^nd Floor, Philadelphia, PA 19103.