We know you have questions regarding the novel coronavirus (COVID-19) as you look to make critical decisions affecting your employees and your business. We want to help ensure you are prepared to make informed decisions. In this newsletter, we’re addressing some of the most prominent questions in the market to keep you up to date.
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Eligibility and billing questions
: Will Blue Shield of California continue to enforce active at-work provisions for fully insured employer groups that have reduced their workforce or workforce hours? Answer
: The terms of our group service agreements continue to apply to employee eligibility for coverage. Please refer to the agreement and note that there are provisions in most group service agreements that may allow for continued coverage for members who are impacted by a temporary suspension of work or temporary reduction of hours in certain circumstances, such as a layoff, furlough, or approved leave of absence. This may be permitted under the employer’s policies regarding coverage, under the following conditions:
- If the subscriber ceases active work because of a disability due to illness or bodily injury, or because of an approved leave of absence or temporary layoff, payment of dues for that subscriber shall continue coverage in force in accordance with the employer’s policy regarding such coverage.
- If the employer is subject to the California Family Rights Act of 1991 and/or the federal Family and Medical Leave Act of 1993, and the approved leave of absence is for family leave pursuant to such Acts, payment of dues for that subscriber shall keep coverage in force for the duration(s) prescribed by the Acts. The employer is solely responsible for notifying employees of the availability and duration of family leaves.
Please also note that employees who lose eligibility for coverage due to a reduction of hours or suspension of work may have the right to continue coverage under COBRA or Cal-COBRA. Please refer to your group service agreement for additional information. Question
: For groups in industries affected by COVID-19 closures, will Blue Shield of California provide a grace period other than the usual 30 days for premium billing? Answer
: We are evaluating every decision or request from the State and Federal Government and our senior sales leaders are meeting daily to make proposals and decide on next steps. For now, we’re referring all clients back to their existing contracts and highlighting provisions that help in a time like this.
Business continuity questions
Blue Shield of California is committed to ensuring our stakeholders have uninterrupted access to the services they need. In these times of uncertainty, Blue Shield of California is actively working around the clock with its brokers, employers, providers, and members to support those affected by COVID-19. We have already taken actions to preserve both the safety of our people and continuity of our business operations, and we continue to closely monitor the situation. We have enabled nearly our entire workforce – around 6,800 employees – to work from home so we can continue to provide uninterrupted service to our partners.
Question: Will there be any disruption or delay in processing claims?
Answer: Over the last several years, Blue Shield of California has made significant investments in its technological infrastructure and contingency planning. We are happy to report that there has been no material changes in claim reporting lag, claim processing lag, or other claim-payment related procedures as a result of new business protocols resulting from the recent COVID-19 pandemic.
Question: With Blue Shield transitioning to teleworking, what will be the impact for Customer Operations, including call centers?
Answer: We have augmented staff through cross-training and are actively working with our vendors to increase their staffing levels. As a result, there has been no material changes in processing or service levels in our call centers, utilization management, or case management.
Question: What about medical management?
Answer: We are pleased to share that we have no disruptions for medical management, and we will continue to monitor the situation to ensure our members have access to care. The Blue Shield of California team is meeting several times a day to assess current practices and review service level trends for both utilization management and case management and is actively adjusting practices as needed.
Blue Shield philanthropy supports some of our communities most impacted by COVID-19
With the onset of the COVID-19 pandemic, some of the most underserved communities are facing massive needs with an elevated sense of urgency. As part of our ongoing dedication to philanthropy, Blue Shield is announcing two contributions to help some of these communities: $500,000 for the Oakland COVID-19 Relief Fund
, and $100,000 for the nonprofit MedShare
$300,000 of Blue Shield’s total contribution to the Oakland Relief Fund is earmarked to set up drive-through testing for the virus with the help of medical experts from Brown & Toland Physicians. MedShare will use our contribution to fund essential equipment at community health clinics to help stem the spread of coronavirus.
Continuing to communicate with our members
In order to keep our members informed about COVID-19 and options for care, we’re sending out a number of scheduled communications over the next two weeks. Distributing the most urgent information as quickly as possible is our top priority. In an effort to avoid overwhelming members with emails, we’ll be sending out additional information on a staggered schedule (see below). All communications related to COVID-19 are available on our Coronavirus (COVID-19) resource page
the same day they are sent. Urgent care centers as an alternative to the Emergency Department
COVID-19, coverage for testing, how to get care and more
- Fully-Insured email communication: Week of March 23
- ASO member email communication: Week of March 30
- Fully-Insured email communication: sent March 19
- Fully-Insured mailer*: March 24
- ASO member email communication: Week of March 23
- ASO member mailer* communication: Week of March 30
* Direct mail will be distributed to members who are not registered on blueshieldca.com or have not opt’ed in to receiving email communications.
Member communications and other relevant information are available on our Coronavirus (COVID-19) resource page
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