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 & Related Services | 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. |
| Over-the-Counter (OTC) 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 Anti-viral 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.