Do I have a virtual care benefit?

If you have telemedicine access through Highmark, we're waiving all appointment fees for the next 90 days because the safest place for you, if you're sick, is at home. Check your member portal online or call Member Services at the number on the back of your card.

Coverage and Costs - Highmark Answers

Q: Is Coronavirus testing covered by my plan and what will it cost me?

Highmark will cover Coronavirus, or COVID-19, testing at 100% when recommended by a medical professional. This means copays, deductibles, and coinsurance do not apply for this testing. This applies to most Medicare Advantage, Affordable Care Act, and select employer plans; however, please check with Member Services to see if this applies to your plan. Use the number for Member Services on the back of your card.

Where can I find information on the COVID-19 Over-the-Counter Test Reimbursement Mandate?

Beginning on Jan. 15, Highmark has been complying with federal guidelines to reimburse its members with employer-sponsored or individual insurance coverage for the cost of over-the-counter COVID tests. Our intent is to continue to fully comply with this announcement, click here to learn more.

How do I get over-the-counter tests without any out-of-pocket costs?

There are three easy ways to get FREE over-the-counter, at-home COVID-19 tests with no out-of-pocket expense to you:

Government supplied tests via USPS home delivery:
Every home in the U.S. is eligible to order up to 24 free at-⁠home COVID-⁠19 tests. The tests are completely free. Orders will usually ship in 7-12 days. Click here to order your free tests.
Mail order pharmacy – tests delivered directly to your home:
Members can order tests through Express Scripts® Pharmacy without any upfront costs. To order these tests login to the Highmark member portal at the website on the back of your member ID card and click on the pharmacy tab.
Or, click here to order your free tests – You will be prompted to login to your Express Scripts online account before placing your order.
If you do not have an Express Scripts online account, click “Register now” and follow the on-screen instructions to setup your account.

Please note that there are currently limited supplies and tests may take up to 4 weeks to arrive.

Note: If you do not have prescription coverage through your Highmark plan, please verify options with your employer.

Pick-up at your local pharmacy:
Members can visit the same pharmacy where they get their prescriptions filled – or any in-network pharmacy – and follow these easy steps:

Locate one of these 6 FDA emergency use authorized tests approved for distribution with no out of pocket cost to you:
BD Veritor At-Home COVID-19 Test
Binaxnow COVID-19 AG Home Test
CareStart COVID-19 Antigen Home Test
Celltrion DiaTrust COVID-19 Ag Home Test
CLINITEST Rapid COVID-19 Antigen Self-Test
Ellume COVID-19 Home Test
Flowflex COVID-19 AG Home Test
iHealth COVID-19 AG Home Test
INDICAID COVID-19 Rapid Antigen At-Home Test
Inteliswab COVID-19 Home Test
On/Go COVID-19 Antigen Self-Test
Quickvue At-Home COVID-19 Test
SD Biosensor, Inc. COVID-19 At-Home Test

Note: supplies may be limited, and tests may not be available at all retail pharmacy locations.

Take the test to the pharmacy counter and show your Highmark insurance card to have the test processed through your pharmacy benefit (members with a separate pharmacy benefit card will need to show that).

To locate an in-network pharmacy members can visit the Highmark member website or call the number on the back of their Highmark insurance card or pharmacy benefit card for help.

Note: If you do not have prescription coverage through your Highmark plan, please verify options with your employer.

Who can I contact at Highmark with questions about my benefits or insurance coverage?

Call the telephone number on the back of your insurance card for Member Services. This number is specific to your plan and benefits, and it helps you receive the right answers faster.

Is Coronavirus testing covered by my plan and what will it cost me?

Yes, coronavirus testing will be covered with no additional costs when performed by a medical professional. While this coverage applies to most Highmark members, every plan is a little different. If you have questions on coverage, costs, or anything else, call Member Service at the number on the back of your card. This waiver continues through the end of the federal public health emergency.

Exclusions to this coverage include testing for the following:

Public surveillance testing
Testing required to attend large gatherings and events (i.e. sports games, concerts, weddings, etc.)
Testing required to return or continue going to work or school

If the order for a test meets the coverage criteria above, the sample must be collected by authorized health care personnel.

Acceptable COVID-19 diagnostic tests may include:

Tests approved by the FDA
Tests authorized by the FDA under an emergency use authorization (EUA)
Tests for which the developer of the test has requested or intends to request EUA (until the request is denied or the developer does not submit the request within a reasonable time)
Tests that are developed in or authorized by a State
Tests that are determined to be appropriate by the secretary of Health and Human Services (HHS)

Is Coronavirus treatment covered by my plan?*

Most plans will cover coronavirus treatment when admitted to an in-network hospital. Our number one priority is your health and making sure you receive the care you need. That’s why we are waiving all costs of care if you are in the hospital being treated for Coronavirus. This includes testing when recommended by a medical professional and care once you are admitted. While this coverage applies to most Highmark members, every plan is a little different. This waiver continues through the end of the federal public health emergency.

*Exclusions may apply. If you have questions on coverage, costs, or anything else, call Member Service at the number on the back of your card.

Does my insurance cover me if I get sick when I travel?

Yes, see coverage options at your member website or your plan app or call Member Services at the number on the back of your insurance card. This number is specific to your plan and benefits, and it helps you receive the right answers faster.

Will it be covered if I am stuck in a hospital in a different city for a long time?

Yes, most plans cover you while traveling. Copays, deductibles and coinsurance may still apply. Review your coverage options at your member website or your plan app or call Member Services at the number on the back of your insurance card. This number is specific to your plan and benefits, and it helps you receive the right answers faster.

What if I can’t pay my premium due to furlough?

If you have questions about a grace period call the number on the back of your card.