Updated September 25, 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 ended May 11, 2023, and these expanded benefits returned to being covered under members’ normal health plan benefits. That means any applicable cost shares, such as copays and coinsurance, apply. Here's a look at the changes and how we're covering COVID-19 care and treatment moving forward:
- COVID-19 vaccinations, including boosters, are considered preventive care. For most health plans they're covered at no cost if received from an in-network provider.
- The Centers for Disease Control and Prevention (CDC) has issued the following updated vaccine recommendations:
- People 5 years and older should receive a single dose of an updated mRNA COVID-19 vaccine at least two months from their last dose of any COVID-19 vaccine;
- People 6 months to 4 years, if previously vaccinated, should receive one or two doses of an updated mRNA COVID-19 vaccine (depending on the previous COVID-19 vaccine received); if unvaccinated, they should receive three doses of the updated authorized Pfizer vaccine or two doses of the updated authorized Moderna COVID-19 vaccine.
- 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, include a cost share, such as a copay or coinsurance.
- Over-the-counter COVID-19 tests are no longer covered and will be an out-of-pocket expense. The federal government has restarted a program to mail 4 (four) free at-home COVID-19 rapid tests to every U.S. household. Members can visit https://www.covid.gov/tests to order tests to be shipped directly to their home at no charge.
- 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 have reinstated.
- Members needing an early or higher quantity prescription refill can call Customer Service at the number on the back of their member ID card before refilling it at a pharmacy.
- Claim submission and appeals requests have returned to regular time limits as stated in employer groups’ benefit booklets.
- Vaccination counseling will include a cost share, such as a copay, deductible or coinsurance.
- Personal Protective Equipment (PPE) will no longer be covered.
We 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.