Feb 09, 2023
On January 31, 2023, the Biden Administration announced that the federal public health emergency (PHE) will officially end May 11, 2023.
Fully-Insured Group Plans and IFP Plans
Impacts to fully-insured group plans and IFP plans will be minimal for six months following the end of the PHE, as SB 1473 extends coverage requirements for diagnostic testing, including the reimbursement of 8 at-home test kits per month, and vaccination, currently covered under state mandate, SB 510. Coverage for these services will continue to be waived at no member cost-share at both in- and out-of-network facilities. A new requirement under the SB 1473 mandate is to cover therapeutics at no member cost-share at both in- and out-of-network facilities for the six-month period.
After this six-month extension expires, in-network coverage for these services will continue at no member cost-share. Out-of-network coverage for these services will continue to be mandated, but cost sharing may be applied based on a member’s out-of-network plan benefits.
Self-Funded Group Plan Sponsors
Under current federal law, health plans and group plan sponsors are required to cover diagnostic testing and vaccinations at no member cost-share for both in- and out-of-network services. These requirements will no longer be mandated following the end of the PHE. Coverage and member cost-shares for both in- and out-of-network COVID-19 services will apply based on a member’s plan benefits.
In most cases, the COVID-19 vaccine is covered without cost-share under preventive services, however, if received at an out-of-network facility, out-of-network administration costs may apply.
Blue Shield is committed to supporting our clients as we navigate the end of the PHE. They will be reaching out to group plan sponsors this week, informing them of the impacts of the end of the PHE will have on their plans and members.
For the latest information from Blue Shield, visit their COVID-19 Resources Page for groups and brokers.
