BCBSNC To Add Telehealth Benefit

BCBSNC To Add Telehealth Benefit

June 6, 2017

Blue Cross and Blue Shield of North Carolina (BCBSNC) has chosen to add telehealth as a standard benefit to additional segments to help reduce inappropriate urgent care and emergency department use. Telehealth can also help address the shortage of providers in areas across our state.

Telehealth is a virtual/video medical consultation by state-licensed, board-certified, US-based physicians, for non-urgent acute conditions. Telehealth is delivered using both two-way, interactive audio and video communications; a mobile app is available.

Effective July 1, 2017, BCBSNC standard health plans will include telehealth benefits for new and renewing large groups:

  • Fully-insured large groups (51+)
    • There is no additional cost for this benefit.
    • Groups may not carve out this benefit.
    • MDLIVE is the sole telehealth provider for fully-insured groups.
  • Self-funded groups (51 – 99)
    • Groups may select a standard plan with telehealth and pay the associated fee of $1.15 per employee, per month.
    • Telehealth claims will be integrated and telehealth fees will appear on groups’ statements of account.
    • MDLIVE is the sole telehealth provider for these groups.
  • Self-funded groups (100 – 249)
    • Groups may select a standard plan, which includes the telehealth benefit, and pay the associated fee of $1.15 per employee, per month. This amount is displayed on groups’ program selection charts.
    • Telehealth claims will be integrated and telehealth fees will appear on groups’ statements of account.
    • MDLIVE is the sole telehealth provider for these groups.
  • Self-funded groups (250+)
    • Self-funded groups of 250+ will still have the option of requesting one of three telehealth vendors – TelaDoc, MDLIVE, or Doctor on Demand – or continuing to exclude telehealth from their standard medical plan.
    • Self-funded groups of 250+ with standard plans will have MDLIVE as their telehealth vendor unless they choose to opt out of the telehealth benefit or select a different vendor.

Telehealth is not included for:

  • Individual, under-65 members
  • Small groups with less than 50 members
  • Groups with grandfathered or transitional plans
  • Groups with Blue Local plans
  • Groups with Balanced Funding plan designs

Members with telehealth benefits can expect to pay for this service the same way they would pay for a primary care office visit. Members with a co-payment will pay their usual co-payment for a telehealth visit, while members with a deductible and co-insurance plan will be charged no more than $45 for a telehealth consultation. The amount the member will pay depends on their current deductible and co-insurance amounts. Self-funded groups of 250+ will continue to have additional options for member responsibility.

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