Oct 11, 2023
Following the end of the public health emergency (PHE), some of the flexibilities enabled by the COVID-19 emergency declarations are phasing out. Beginning six months after the federal PHE ended (as of Nov. 11, 2023), health plans will no longer be required to cover COVID-19 testing services, immunizations and therapeutics at no cost share when delivered by an out-of-network provider. Health plans are still required to cover items and services related to COVID-19 at no cost share when completed by an in-network provider.
Sutter Health Plus will not make any changes to out-of-network coverage for COVID-19 related services through Dec. 31, 2023. They will implement the following coverage and cost share changes beginning with new and renewing plans as of Jan. 1, 2024:
- Out-of-network COVID-19 testing, including related provider services (e.g., office visits, urgent care, emergency room services, etc.) will be covered at standard benefit cost sharing. Cost sharing will apply based on where the services are received.
- COVID-19 over-the-counter tests purchased without a prescription at an out-of-network non-participating pharmacy will be limited to eight tests per member per month, reimbursed up to $12 per test.
- Out-of-network treatment for a confirmed diagnosis of COVID-19 will be only covered if it is provided at an urgent care location or emergency department. These services will have the standard urgent care or emergency services cost share based on place of service.
Sutter Health Plus will continue to cover COVID-19 immunizations, prescription drugs and therapeutics at no cost share when delivered by in-network or out-of-network providers. For current information about COVID-19 health plan information and FAQs, visit Sutter Health Plus COVID-19 Coverage, Cost and Access to Care.
Your employer clients will receive a similar notice later this week.
Contact your Amwins Connect Regional Sales Manager with questions.
