In early 2020, a public health emergency (PHE) and then a national emergency was declared to help our nation respond to the global pandemic.
The COVID-19 national emergency will end May 11, 2023, but includes an additional 60-day period to extend deadlines for COBRA elections and payments, HIPAA special enrollment, appeals, and member submitted claims. These deadlines will return to normal timeframes starting July 11, 2023.
The COVID-19 PHE will end May 11, 2023, removing the federally mandated coverage requirements for COVID-19 testing, related services, treatments, and vaccinations.
Here’s a summary of the changes that will begin May 12, 2023:
|Benefit||Starting May 12, 2023|
Lab Tests &
|Diagnostic (FDA approved) COVID-19 lab tests that are medically necessary and ordered by a healthcare provider (including testing-related services) will be covered in accordance with the terms of the member’s health benefit certificate.|
COVID-19 Home Tests
|No coverage for OTC COVID-19 home tests. Members may use their health savings accounts (HSA) and flexible spending accounts (FSA) to purchase OTC tests.|
|COVID-19 Antiviral |
Medications (i.e., Paxlovid and Lagevrio)
|$0 member cost share for these prescriptions while the government supply is available. |
Once the government supply depletes, these prescriptions will be covered in accordance with the terms of the member’s health benefit certificate.*
*Plans that carve out pharmacy benefits to a third-party administrator will need to consult the pharmacy benefit manager.
|Telehealth (Medical and Behavioral)||Telehealth visits will be covered in accordance with the terms of the member’s health benefit certificate.|
|COVID-19 Vaccines |
|$0 member cost share for COVID-19 vaccines and boosters while the government supply is available. Once the government supply depletes, COVID-19 vaccines and boosters will be covered in accordance with the terms of the preventive benefits in the member’s health benefit certificate.|
More information can be found on the U.S. Department of Health & Human Services website.