During the federal COVID-19 Public Health Emergency (PHE), we temporarily expanded our benefit coverage to make it easier for you to access the care you needed during the pandemic. The PHE ended May 11, 2023, and these expanded benefits returned to being covered under your normal health plan benefits. That means any applicable cost shares, such as copays and coinsurance, now apply. Here's a look at the changes and how we are covering COVID-19 care and treatment moving forward:
- COVID-19 vaccinations, including boosters, are considered preventive care and for most health plans covered at no cost if received from an in-network provider. The Centers for Disease Control and Prevention (CDC) has issued the following updated vaccine recommendations:
- People 5 years and older should receive a single dose of an updated mRNA COVID-19 vaccine at least two months from their last dose of any COVID-19 vaccine;
- People 6 months to 4 years, if previously vaccinated, should receive one or two doses of an updated mRNA COVID-19 vaccine (depending on the previous COVID-19 vaccine received); if unvaccinated, they should receive three doses of the updated authorized Pfizer vaccine or two doses of the updated authorized Moderna COVID-19 vaccine.
- Talk to your doctor or pharmacist about when you should get vaccinated.
- COVID-19 tests, if ordered by an in-network provider, include a cost share, such as a copay or coinsurance.
- We'll continue to cover the cost of FDA-approved treatment prescribed by your provider for COVID-19 in the same way as other regular health plan benefits. Cost shares may apply.
- All pre-authorization requirements have been reinstated.
- If you need an early or higher quantity prescription refill, call our customer service team at the number on the back of your insurance card before getting it at the pharmacy.
- Over-the-counter COVID-19 at-home rapid tests aren’t covered and are an out-of-pocket expense. The federal government has restarted a program to mail 4 (four) free at-home COVID-19 rapid tests to every U.S. household. Visit https://www.covid.gov/tests to order tests to be shipped directly to your home at no charge.
For Washington members:
- Vaccination counseling includes a cost share, such as a copay, deductible or coinsurance.
- Personal Protective Equipment (PPE) is no longer covered.
We also continue to provide flexibility in accessing services virtually. During the PHE, the Centers for Medicare and Medicaid Service (CMS) identified several services that could be provided virtually that normally would only be covered if provided in person. We decided to align with CMS, adding flexibility for our commercial plans. Legislation requires Medicare to continue virtual care coverage flexibility through December 31, 2024. While private carriers aren't required to do so, we've elected to continue to align with CMS for these services.
Here are some examples of telehealth coverage flexibility we'll continue to offer:
- A wide range of telehealth services, including common office visits, mental health counseling and some preventive health screenings, delivered by many different provider types, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers.
- Telehealth services received in any health care facility including a doctor's office, hospital, nursing home or rural health clinic, as well as in homes.
- Access to doctors using a wide range of communication tools including telephones that have audio and video capabilities.
You can access virtual care services by signing in to your account.
If you have questions about your benefits or coverage, sign in to your account or call us using the phone number on the back of your insurance card. Our hours are 8 a.m. to 8 p.m. PT Monday through Friday. From Oct. 1 through March 31, we're available from 8 a.m. to 8 p.m. seven days a week. Live online chat assistance is also available 8 a.m. to 5 p.m. PT, Monday through Friday.