During the federal COVID-19 Public Health Emergency (PHE), we temporarily expanded our benefit coverage to make it easier for you to access the care you needed during the pandemic. The PHE ends May 11, 2023, and these expanded benefits will return to being covered under your normal health plan benefits. That means any applicable cost shares, such as copays and coinsurance, will apply. Here’s a look at the changes and how we’ll be covering COVID-19 care and treatment moving forward:
- COVID-19 vaccinations, including boosters, will be considered preventive care and for most health plans covered at no cost if received from an in-network provider. Talk to your doctor or pharmacist about when you should get vaccinated.
- COVID-19 tests, if ordered by an in-network provider, will include a cost share, such as a copay or coinsurance.
- We’ll continue to cover the cost of FDA-approved treatment prescribed by your provider for COVID-19 in the same way as other regular health plan benefits. Cost shares may apply.
- All pre-authorization requirements will be reinstated.
- If you need an early or higher quantity prescription refill, you’ll need to call our customer service team using the number on the back of your insurance card before getting it at the pharmacy.
- Over-the-counter COVID-19 tests will no longer be covered and will be an out-of-pocket expense.
For Washington members:
- Vaccination counseling will include a cost share, such as a copay, deductible or coinsurance.
- Personal Protective Equipment (PPE) will no longer be covered.
We’ll also continue to provide flexibility in accessing services virtually. During the PHE, the Centers for Medicare and Medicaid Service (CMS) identified several services that could be provided virtually that normally would only be covered 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:
- 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.