Updated April 21, 2023
Supporting the health of our members and you—our valued business partners—are our top priorities. During the federal COVID-19 Public Health Emergency (PHE), we temporarily expanded our benefit coverage to make it easier for members to access care. The PHE ends May 11, 2023, and these expanded benefits will return to being covered under members’ 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. For most health plans they’ll be covered at no cost if received from an in-network provider. Members are advised to talk with their doctor or pharmacist about when to get vaccinated.
- COVID-19 tests, if ordered by an in-network provider, will include a cost share, such as a copay or coinsurance.
- Over-the-counter COVID-19 tests will no longer be covered and will be an out-of-pocket expense.
- We'll continue to cover the cost of FDA-approved treatment prescribed by members’ providers for COVID-19 in the same way as other regular health plan benefits. Cost shares may apply.
- All pre-authorization requirements will be reinstated.
- Members needing an early or higher quantity prescription refill will need to call Customer Service using the number on the back of their member ID card before refilling it at a pharmacy.
- Claim submission and appeals requests will return to regular time limits as stated in employer groups’ benefit booklets. Submissions and requests received on and before May 11, 2023, will receive a 60-day grace period before the time limit applies.
- 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 will align with CMS, adding flexibility for our commercial plans. Legislation requires Medicare to continue virtual care coverage flexibility through Dec. 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. Members can access virtual care services by signing in to their account.
Members with questions about their benefits or coverage should sign in to their account or call us using the phone number on the back of their member ID card. Our hours are 8 a.m. to 8 p.m. PT Monday through Friday. From Oct. 1 through March 31, we're available from 8 a.m. to 8 p.m. seven days a week. Live online chat assistance is also available 8 a.m. to 5 p.m. PT, Monday through Friday.