Updated May 12, 2023
Important Notice: Changes to Coverage for COVID-19 Tests and Vaccines and Extension of Certain Timeframes.
CHANGES TO COVERAGE FOR COVID-19 TESTS AND VACCINES
The Department of Health and Human Services (HHS) has allowed the federal Public Health Emergency (PHE) declaration for COVID-19 to expire on May 11, 2023. Due to the expiration of the PHE, the following changes regarding coverage for COVID-19 tests and vaccines will take effect on May 12, 2023:
- Immunizations and routine vaccinations that are intended to prevent or mitigate COVID-19 will continue to be covered at no-cost to members, provided that an in-network provider is utilized. The use of an out-of-network provider will no longer be covered.
- Medically necessary diagnostic tests for COVID-19 will be covered under the outpatient lab benefit coinsurance.
- COVID-19 diagnostic testing provided through the QuestSelect network will continue to be covered at no-cost to members.
- COVID-19 diagnostic testing not provided through the QuestSelect network will be covered under the outpatient lab benefit after the Plan Deductible is met. Please refer to the corresponding Plan Benefit Profile for the appropriate benefit level.
- Over-the-counter COVID-19 tests will no longer be covered by the Plan.
EXTENSION OF CERTAIN TIMEFRAMES
Federal agencies extended a number of deadlines so plan participants and beneficiaries have additional time to make critical health coverage and other decisions affecting benefits during the COVID-19 outbreak. Specifically, effective March 1, 2020, participants and beneficiaries of health and welfare and retirement plans are provided with additional time to meet the following deadlines:
- The 30-day period (or 60-day period, if applicable) to request special enrollment under the Health Insurance Portability and Accountability Act (HIPAA);
- The 60-day election period for Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage;
- The date for making COBRA premium payments;
- The date to notify the plan of a COBRA qualifying event or determination of disability;
- The date by which individuals may file a benefit claim under the plan’s claims procedure;
- The date by which claimants may file an appeal of an adverse benefit determination under the plan’s claims procedure;
- The date by which claimants may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination; and
- The date by which a claimant may file information to perfect a request for external review upon a finding that the request was not complete.
The deadlines for the above are now subject to a deadline that ends as of the earlier of: (a) one (1) year from the date the deadline would have occurred on or after March 1, 2020, absent the extension relief; or (b) July 10, 2023. On the applicable date, the timeframes with periods that were extended will resume. In no case will the extension of time exceed one (1) year.
Even though the enclosed document states that you must act within a certain period of time, the relief provided by the Federal agencies has actually extended the time period. Nonetheless, we strongly encourage you to comply with the timeframes set forth in the enclosed document so that you do not inadvertently exceed the time extension. Please note, COBRA coverage will not be provided until payment is received for the entire period of coverage.
If you have any questions regarding this notice, please call us at 1-800-TEAMCARE (832-6227).