The Federal Government announced in January 2023 that the National and Public Health Emergencies addressing COVID-19 will end on May 11th, 2023.
Effective May 12th, 2023, most medical and pharmacy plans will no longer be subject to Federal coverage requirements for COVID-19 testing, vaccinations, and treatment coverage. However, The American Worker will continue to maintain these coverages until their first renewal following May 11th, 2023. At that point, COVID-19 medical and pharmacy claims will be treated as any other illness.
What does that mean for clients with health plans?
For plans renewing on or after May 12th, 2023:
COVID-19 testing by health providers and facilities will be covered with the cost share subject to plan design.
- Self-Funded MVP/Major Medical Plans: COVID-19 testing will be covered based on the type of visit to obtain the test. Note: Tests at out-of-network providers will be subject to out-of-network benefits.
- MEC Enhanced Plans: COVID-19 testing will be covered the same as any other lab test, subject to Plan limits. Note: Tests at out-of-network providers will be subject to out-of-network benefits, if any.
- MEC Plans: COVID-19 testing by health providers and facilities will not be covered.
- Limited Medical Plans: COVID-19 testing will be covered like any other lab test, subject to Plan limits.
Over-the-counter (OTC) COVID-19 tests: All Self-Funded plans will continue to allow over-the-counter (OTC) COVID-19 tests for the protection and wellness of our members. OTC tests will be limited to 3 tests per participating member per month. Note: Limited Medical Plans are not self-funded so the OTC COVID-19 testing benefits do not apply.
COVID-19 vaccines and boosters: These services will continue to be covered as preventive services (covered at 100%) when utilizing in-network doctors, pharmacies, and local community health districts. Note: Vaccines at other out-of-network providers will be subject to out-of-network benefits, if any, and will not be covered at out-of-network pharmacies.
During the National Emergency period, the US Government has funded COVID-19 vaccine costs and the Plan has funded vaccine administration costs. When the National Emergency period ends on May 11th, 2023, the COVID-19 vaccine and administration costs will be a plan expense. Pfizer reportedly plans to price their COVID-19 vaccines at $110 to $130 per dose. For now, Moderna has committed to keeping their vaccines free.
FDA-approved prescription drug antivirals and therapeutics will be covered with the cost share subject to plan design.
- MVP/Major Medical Plans: FDA-approved prescription drug antivirals and therapeutics will be covered based on the associated formulary.
- MEC Enhanced Plans: FDA-approved prescription drug antivirals and therapeutics will only be covered for MEC Enhanced plans that cover Brand name drugs.
- MEC Plans: FDA-approved prescription drug antivirals and therapeutics will not be covered.
- Limited Medical Plans: FDA-approved prescription drug antivirals and therapeutics will be covered based on the associated formulary.
End Of DOL Time Frame Extensions:
- For qualifying events after July 10th, 2023, the COBRA election period will be 60 days, as it was prior to the Emergency period. COBRA premium will be due within 30 days of the COBRA election. Qualifying events occurring prior to July 10th, 2023, will be reviewed individually to determine the appropriate COBRA election and premium windows.
- Claims filing and appeal deadlines will be reviewed individually to determine the appropriate timeframe applied based on the date of service or date of determination, respectively.