In early 2020, a public health emergency (PHE) and then a national emergency were declared to help our nation respond to the global pandemic.
The COVID-19 National Emergency will end on 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.
The COVID-19 Public Health Emergency will end on 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:
|Benefits||Starting May 12, 2023|
|COVID-19 Lab Test &|
|Diagnostic (FDA approved) COVID-19 lab tests that are medically necessary and ordered by a health care 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.|
Medications (i.e., Paxlovid and Lagevrio)
|Zero member cost share for these prescriptions while the government supply is available.|
Once the government supply ends, these prescriptions will be covered in accordance with the terms of the member’s Health Benefit Certificate.*
*Plans who carve out pharmacy benefits to a third-party administrator will need to consult the Pharmacy Benefit Manager.
|Telehealth – Includes|
Medical and Behavioral
|Coverage for Telehealth visits will be covered in accordance with the terms of the member’s Health Benefit Certificate.|
|COVID-19 Vaccines & Boosters||Zero member cost share for COVID-19 vaccines/boosters while the government supply is available.|
Once the government supply ends, COVID-19 vaccines/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.
Please check out our website for future updates.