Apr 28, 2023
The federal government confirmed May 11, 2023, as the end of the Public Health Emergency (PHE). UnitedHealthcare has been planning for this change and reviewing recent guidance from the government agencies on how the end of the PHE affects COVID-19 vaccines, testing and treatments, and has released a Frequently Asked Questions (FAQ) document for external stakeholders.
UnitedHealthcare standard approach for COVID-19 coverage after May 11, 2023, applies to fully insured and Level Funded health benefit plans and self-funded plans that follow UnitedHealthcare standard medical benefit coverage. UnitedHealthcare recommends self-funded customers follow the standard coverage.
The post-PHE standard approach accomplishes the following goals:
- Supports return to normal plan benefits in a timely and consistent manner
- Aligns with commonly acceptable coverage for similar services
- Reduces variability in COVID related services and provider and member confusion
- Supports timely payment for providers
Beginning May 12, 2023, the UnitedHealthcare standard approach and coverage for COVID-19 vaccines, testing and treatment will be as follows:
| BENEFIT | STARTING MAY 12,2023 |
|---|---|
| COVID-19 vaccines | Cover ACIP recommended and CDC adopted COVID-19 vaccine and booster serum and administration as part of preventive benefits at zero-dollar cost share, when in network. |
| Over-the-Counter (OTC) tests | No medical or pharmacy coverage of OTC COVID-19 tests for dates of service starting after May 11, 2023, unless mandated by state regulatory requirements. Members may use their account plans, such as Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to purchase OTC tests. |
| Surveillance testing | No coverage of in- or out-of-network surveillance testing. |
| COVID-19 lab-based testing | Coverage of FDA approved or authorized COVID-19 lab tests ordered by a physician or health care provider (e.g., pharmacist, nurse or doctor) in accordance with the member’s standard medical plan benefit. |
| COVID-19 treatment | Coverage for FDA approved or authorized COVID-19 treatments, including Paxlovid and molnupiravir (Lagevrio), in accordance with a member’s standard plan benefits |
| Telehealth | Coverage for telehealth visits in accordance with the member’s standard medical plan benefit for in and out of network (subject to cost share). Includes medical and behavioral telehealth services. |
| Virtual Visits | Coverage for virtual visits in accordance with the member’s standard medical plan benefit, including medical and behavioral. |
State guidance may result in variance from UnitedHealthcare standard coverage.
