April 25, 2023
During the federal COVID-19 public health emergency (PHE), we temporarily expanded our coverage to make it easier for members to access needed care. The PHE ends at 11:59 p.m. on May 11, 2023, and many of these expanded benefits will return to being covered under normal health plan benefits. That means any applicable cost-shares (deductibles, copays and coinsurance) will apply. Please make sure your employees are informed of these changes in benefits.
Under federal law, it’s your responsibility to share the following information about mid-year benefit changes with your plan enrollees. We aren’t sending letters to employees. These changes are also viewable on our COVID-19 Resource page.
Some things won’t change. For example, COVID-19 vaccinations, including boosters, will be considered preventive care. So most health plans will cover them at no cost if received from an in-network provider. And we’ll continue to cover the cost of treatment prescribed by a provider for COVID-19 as we do other regular covered services. Cost-shares may apply.
We’ll also continue to provide flexibility in accessing services virtually. During the PHE, the Centers for Medicare & Medicaid Services (CMS) identified several services that could be provided virtually (via telehealth) that normally would be covered only if provided in person. We decided to align with CMS, adding flexibility for our commercial plans. Legislation requires Medicare to continue virtual care coverage flexibility through December 31, 2024. While private carriers aren’t required to do so, we’ve elected to continue to align with CMS for these services.
Here are some examples of telehealth coverage flexibility we’ll continue to offer commercial groups:
- A wide range of telehealth services, including common office visits, mental health counseling and some preventive health screenings, delivered by many different provider types, such as doctors, nurse practitioners, clinical psychologists and licensed clinical social workers
- Telehealth services received in any health care facility, including a doctor’s office, hospital, nursing home or rural health clinic, as well as in homes
- Access to doctors using a wide range of communication tools, including telephones that have audio and video capabilities
Members can access medical telehealth care using Doctor On Demand. It’s embedded for all small (1-50) groups and available as a buy-up for fully insured groups of 51+ and self-funded groups. Most group plans also include several options for virtual behavioral health care.
With the national emergency ending Apr. 10, 2023, claims submissions and appeals requests will return to regular time limits as stated in the member’s benefit booklet. Submissions and requests received on and before Apr. 10, 2023, will have a 90-day grace period before their regular time limit applies.
Here are some other changes coming when the PHE ends:
- COVID-19 tests, if ordered by an in-network provider, will include a cost-share (copay or coinsurance).
- All pre-authorization requirements will be reinstated.
- Members who need an early or higher quantity prescription refill will need to call our Customer Service team before visiting a pharmacy.
- Over-the-counter COVID-19 tests will no longer be covered and will be an out-of-pocket expense.
- Vaccination counseling will include a cost-share (copay, deductible or coinsurance).
- Personal protective equipment (PPE) will no longer be covered.
Questions? Contact your sales representative.