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Changes to our plans and benefits for 2021
December 1, 2020

This article is for all providers caring for our members

Beginning January 1, 2021, we will make changes to our health plans and benefits. Because of these changes, it is important to always check your patient’s Blue Cross ID card and to verify their eligibility and benefits using Online Services, or another similar technology.

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Commercial product coverage changes

Virtual fitness programs

We have expanded coverage for virtual fitness programs due to the COVID-19 public health emergency. This includes virtual or online fitness memberships, subscriptions, programs, or classes that provide cardiovascular and strength-training using a digital platform. This applies to all commercial products and Medex.

Change to coverage for dental services under medical plans

In 2021, we’ll no longer cover the removal of impacted teeth under some members’ medical benefits. This change will separate dental services from those covered under the medical plan. For more information about this benefit change, see our October 1 News Alert.

To access this News Alert, log in and go to News. Look for the News Alert dated October 1 for oral surgeons and dentists called “Change to coverage for dental services under our medical plans.”

Expanding behavioral health services for children, adolescents

To comply with the Massachusetts Division of Insurance Bulletin 2018-07 regarding access to services to treat child and adolescent mental health disorders, we will cover two new intermediate care services for members under age 19*:

  • Therapeutic mentoring
  • Family support and training services

These services will go into effect when accounts renew starting January 1, 2021. This policy applies to all fully-insured accounts, excluding our Medicare Advantage and Federal Employee Plans; self-insured accounts may opt out of coverage.

Intensive Community-based Treatment (ICBT) offers clinical services intended to keep the patient in their home and community. For more details, see our fact sheet.

*We will continue to cover adolescent members engaged in an ongoing course of treatment beyond their 19th birthday until the course of treatment is complete.

New plan designs

Blue Plans to offer new national network plans

In 2021, you may begin to see members with health plans that use the Blue High Performance Network SM (Blue HPNSM), including members of other Blue plans who get their care in Massachusetts. Blue HPN is a new, limited network of providers that members can access across the U.S.

To recognize Blue HPN patients, look for the “HPN” in the suitcase logo on the front of the member’s Blue Cross ID card (shown below). Please follow the same procedures to file claims, and check eligibility and benefits as you would for any BlueCard member. Be sure to recommend these members to other Blue HPN providers for in-network care.

Sample ID card

You may see members from other Blue plans in with this ID card in 2021.

Advantage Blue Performance will use the Blue High Performance Network

In Massachusetts, we’re offering Advantage Blue Performance, an Exclusive Provider Organization (EPO) plan that is paired with the Blue HPN limited network. EPO benefits are limited to emergency care at a hospital facility only for non-Blue HPN providers. We currently do not have any local members enrolled in these plans. When we do, we’ll provide more details to help you identify these members.

Medicare Advantage product coverage changes


Effective January 1, 2021, Medicare Advantage members will have coverage for telehealth services for PCP, specialist, urgently needed services and outpatient mental health services:

  • Cost share will be the same as an in-person office visit. It will not be waived for a COVID-19 diagnosis.
  • The member must use an in-network provider who offers telehealth; they will not be able to use the national AmWell service.

Change to coverage for kidney acquisition costs

Today, we cover kidney acquisition costs for your Medicare Advantage patients who need a transplant. Starting January 1, 2021, per a CMS rule, original Medicare will cover the acquisition costs for these patients. Therefore, beginning January 1, you’ll need to bill Medicare for kidney acquisition costs. For more information, see CMS’ Final Rule (FR 85 33796) dated June 2, 2020.

Partnering with new vendors for routine vision and hearing services

In 2021, we are making the following changesfor Medicare Advantage members:

  • Routine vision care and eyewear benefit will be administered through a new partnership with EyeMedTM.
  • Routine hearing exams and new hearing aid benefit will be administered through a new partnership with TruHearingTM

This means that for dates of service on and after January 1, 2021, only contracted EyeMed and TruHearing providers will be reimbursed for these services for our Medicare Advantage members.

For more information on this benefit change, see our September 8 News Alert for audiologists or our October 21 News Alert for optometrists and ophthalmologists.

To access these News Alerts, log in and go to News. Look for the News Alerts dated:

  • September 8, called “New benefit and partner for Medicare Advantage audiology services”
  • October 21, called “New partner for Medicare Advantage routine vision care and eyewear”

Post-hospitalization meal program

Members being discharged after an inpatient stay at a hospital may be eligible for up to eight weeks of meals delivered to their home, at no cost, while they recover from their illness or injury.

This benefit is managed by our Care Management team who will work with you to coordinate medically tailored meals. To refer a member for this program, please send an email to MedAdvCMReferrals@bcbsma.com.

Federal Employee Program coverage changes

The following changes will be made to our Federal Employee Program Standard Option, Basic Option, and FEP Blue Focus plans starting January 1, 2021.

  • Covering online and phone telehealth (telemedicine) for only diagnostic and treatment visits with primary care providers or specialists who are outside of the contracted Teladoc network.
    • Members will pay standard primary care and specialist copays for most non-Teladoc telehealth visits.
  • Providing preventive care benefits for bowel preparation medications associated with colon cancer screenings and certain HIV medications for members at risk for HIV.
  • Providing benefits for hearing aids up to $2,500 every five years. We previously provided benefits every three years. (This applies to FEP Standard and Basic Options only.)
  • Making formulary changes. Updated drug lists are available at fepblue.org/whatsnew.
  • Updating member costs and benefits for certain services and medications. As always, be sure to verify member eligibility and benefits.

For more details on FEP benefit changes, download plan brochures at fepblue.org/plan-brochures.

Medication coverage changes

In a September 1 News Alert, we announced changes we are making to our members’ benefits and coverage for their medications. These include:

  • Changes to prescription coverage on our formularies
  • New benefits to help reduce member costs for certain medications and improve medication adherence and outcomes
  • Requiring step therapy and prior authorization for drugs covered under our members’ medical benefits. These include:
    • Expanding prior authorization requirements for the medications listed in our Medical Benefit Prior Authorization Medication List to our commercial EPO and PPO members. Members currently taking these medications or those newly prescribed will need an approved prior authorization for coverage.
    • Updating our Medicare Advantage Part B Step Therapy Medical Policy 020 on January 1, 2021 to include the medications noted in our News Alert.
    • Adding new prior authorization requirements for Medicare Advantage members’ medications. This will apply when administered in certain outpatient settings using our members’ medical benefit. We’re implementing a new medical policy, Medicare Advantage Part B Medical Utilization (MED UM) Policy 125. Members currently taking these medications or those newly prescribed will need an approved prior authorization for coverage.

To access our News Alert, log in and go to News. Look for the News Alert (indicated with an exclamation mark) dated September 1, 2020, called "Medication coverage changes starting Jan 1."


COVID-19 Information for our clinical partners