Frequently Asked Questions
Updated March 17, 2023
Overview
On January 30, 2023, the Biden administration announced that federal emergency declarations related to the COVID-19 pandemic would expire on May 11, 2023. As outlined below, there are several coverage and cost-share waivers tied to the federal public health emergency (PHE) that may affect members insurance coverage and out-of-pocket costs.
Will my benefits or insurance coverage change after the PHE expires?
Given our ongoing commitment to support our members, clients, and providers throughout the COVID-19 pandemic, we will extend the following waivers to health plan members with employer-sponsored or individual health insurance coverage until June 1, 2023*:
- $0 in-network and out-of-network COVID-19 vaccines
- $0 in-network and out-of-network COVID-19 diagnostic and antibody testing
- $0 over-the-counter (OTC) COVID-19 testing
- $0 Prescription antiviral treatment
- $0 in-network and out-of-network related services to diagnose COVID-19 – office visit (in-person or telehealth), emergency room, or urgent care
For Medicare Advantage members, we will extend the following waivers with Medicare Advantage insurance coverage until June 1, 2023*:
- $0 in-network and out-of-network COVID-19 vaccines
- $0 in-network and out-of-network COVID-19 diagnostic and antibody testing
- $0 in-network and out-of-network related services to diagnose COVID-19 – office visit (in-person or telehealth), emergency room, or urgent care
- $0 inpatient COVID-19 treatment – covered through 12/31/23 for Medicare Advantage members
*While this coverage applies to most members, every plan is a little different. If you have questions on coverage, costs, or anything else, please call Member Service at the number on the back of your card.
** West Virginia Members: Please note that WV State mandates may continue to be in place and extend coverage of these services after 6/1/2023. Please continue to check back here for updates.
After June 1, 2023, the services above may have associated out-of-pocket costs based on your plan coverage.
Will my health plan continue to pay out-of-network claims as in-network for Medicare Advantage members?
No, due to government regulations all out-of-network claims will be processed according to your Medicare Advantage plan benefits beginning on June 11, 2023.
If you choose to see an out-of-network provider on or after June 11th, and your plan has out-of-network benefits, you may see a change in the amount you owe. If you choose to see an out-of-network provider on or after June 11th, and your plan does not have out-of-network benefits, you will have to pay the full amount owed (except for urgent or emergency care).
Please check your Summary of Benefits to find out if your Medicare Advantage plan has out-of-network benefits.
Will my health plan continue to cover inpatient COVID-19 treatment?
For members with employer-sponsored or individual health insurance coverage we will continue to cover inpatient COVID-19 treatment based on the member’s plan coverage for in-patient services. This may mean there will be associated out-of-pocket costs based on your plan.
For Medicare Advantage members, in-patient COVID-19 treatment will be fully covered through December 31, 2023.
Will my health plan continue covering COVID-19 vaccines, tests, antibody treatments or antiviral treatments under an Emergency Use Authorization (EUA)?
Yes, we will continue to cover EUA vaccines, tests, and treatments. The ending of the PHE will not impact FDA’s ability to authorize tests, treatments, or vaccines for emergency use.