In early 2020, a public health emergency (PHE) and a national emergency were declared to help our nation respond to the global pandemic.
The COVID-19 PHE ended May 11, 2023, removing the federally mandated coverage requirements for COVID-19 testing, related services, treatments, and vaccinations.
The COVID-19 national emergency ended May 11, 2023, but includes an additional 60-day period to extend deadlines for COBRA elections/payments, HIPAA Special Enrollment, appeals, and member submitted claims. These deadlines will return to normal timeframes starting July 11, 2023.
Here’s a summary of the changes that began 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.