Apr 21, 2023
The federal COVID-19 public health emergency (PHE) will officially end next month, on May 11, 2023, impacting coverage for COVID-19 services, as well as eligibility for individuals enrolled in Medi-Cal plans. A summary of changes to coverage and member cost-share for testing, vaccines, and treatments by line of business (LOB) can be found here and additional details can be found below:
Groups may see new enrollment of individuals due to the redetermination of those currently enrolled in Medi-Cal. Eligible individuals will be granted a special enrollment period (SEP) to enroll in a previously declined employer-sponsored plan, if they are no longer eligible for Medi-Cal.
Additionally, with the recent announcement from President Biden on the end of the National Emergency, effective immediately on April 10, 2023, the Department of Labor (DOL) extension of certain standard deadlines related to COBRA continuation coverage, special enrollment, claims submissions, and appeals during the "Outbreak Period" (March 1, 2020 to 60 days after the PHE ends), will also come to an end on June 9, 2023. The length of the deadline extension is one year from the date that individuals and plans were first eligible for relief, or until June 9, 2023, whichever comes first.
Fully-Insured/Flex-Funded Group Plans
There will be no changes to coverage and cost-share for members enrolled in a fully-insured plan for six months following the end of the PHE, until November 2023. This includes the continued member cost-share waiver for diagnostic testing, including the reimbursement of 8 at-home test kits per member, per month, vaccines, and therapeutics. After this six-month extension expires, in-network coverage for these services will continue at no member cost-share, however member cost-share may be applied based on a member’s out-of-network plan benefits. Coverage for treatment other than therapeutics is currently based on an individual’s in- or out-of-network benefits, which will not change with the end of the PHE.
Self-Funded Group Plans
Following the end of the PHE, self-funded group plan sponsors will no longer be required to waive the member cost-share for diagnostic testing. Coverage and member cost-shares for both in- and out-of-network COVID-19 testing and testing services will apply based on a member’s plan benefits. Coverage and cost-share waivers of the COVID-19 vaccines will continue to be required under the Advisory Committee on Immunization Practices (ACIP) preventive services recommendations when services are provided in network, but out-of-network coverage will not be mandated, and out-of-network cost sharing will be permitted. There will be no changes to coverage and cost-sharing for treatment, which will continue to apply based on an individual's in- or out-of-network benefits. Blue Shield encourages your clients to consider these benefit changes when determining any plan changes for the following plan year.
Additional COVID-19 information can be found on Blue Shield's Group COVID-19 Resources Page.
