How the End of the National and Public Health Emergencies Impact Health Plans

On January 30^th 2023, President Biden announced that both the public health emergency and the national health emergency declarations due to COVID-19 would expire simultaneously on May 11, 2023. Below outlines the impact to private health insurance once the emergencies expire.

THE PUBLIC HEALTH EMERGENCY (PHE) was initially declared by the Department of Health and Human Services on January 31, 2020 and continuously renewed the declaration every 90 days subsequently. Employer-sponsored health plans have been required to comply with certain coverage requirements during the COVID-19 public health emergency periods, including the following:

COVID-19 In-Network Diagnostic Testing without cost sharing;
COVID-19 In-Network Vaccines covered without cost sharing (plan still responsible for administration of the vaccine);
COVID-19 Out-of-Network Coverage for Vaccines and Testing without cost sharing;
OTC At Home Test Kits – Up to 8 tests per month available through the plan’s PBM.

Diversified Response: Diversified Group will be taking the following actions due to the ending of the Public Health Emergency

Item	Plan/Diversified Action/ Amendments	Actions/Decisions
In-Network Diagnostic Testing Without Cost Sharing	Cost share waivers for INN COVID-19 testing will continue until the plan’s next renewal. Upon renewal, the plan will be amended to cover COVID-19 testing subject to current applicable INN benefit levels.	Plans may opt, upon renewal, to maintain INN cost sharing waivers for COVID-19 testing (for both non-HSA and HSA plans). Discuss with your sales representative during the renewal.
In-Network Coverage for COVID-19 Vaccines Without Cost Sharing	Coverage for in-network vaccines without cost sharing will be maintained on all plans. The COVID-19 vaccine has been added to the ACA list of preventive benefits, which require 100% INN coverage without cost share.	N/A
Coverage for OON Vaccines and Testing Without Cost Sharing	OON coverage for vaccines and COVID-19 testing without cost sharing will end upon renewal. OON COVID-19 vaccines and testing without cost sharing will end upon renewal. OON COVID-19 vaccines or testing will be subject to the current applicable OON benefit levels.	N/A
OTC At Home Test Kits Available Through the Plan’s PBM	Our PBM’s will no longer cover OTC at home test kits effective May 11, 2023. OTC at home test kits are not covered under the medical plan.	Should the plan want to continue OTC at home test kit coverage under the PBM, please notify your sales representative or account manager. Coverage will end as of or on May 11^thbut it can be added back via amendment if you affirmatively opt into coverage with your PBM.

Additionally, upon renewal, plans that have document language that address non-emergency ambulance for COVID-19 patients or hospital quarantines, will be amended to remove this language.

NATIONAL EMERGENCY – OUTBREAK PERIOD: Various deadlines related to employer-sponsored group health plans were extended during the COVID-19 national emergency/outbreak period. The national emergency/outbreak period began in March 2020, when former President Donald Trump declared a national emergency due to the COVID-19 pandemic, and it will continue until 60 days after the end of the COVID-19 national emergency. On January 30, 2023, the Biden Administration announced its plan to end the COVID-19 national emergency on May 11, 2023. Under this timeline, the outbreak period will end on July 10, 2023. These deadline extensions included: HIPAA Special Enrollment events, COBRA notice and premium payment deadlines, and claims and appeals deadlines.

Diversified Response: Diversified will not be issuing an amendment related to the ending of the National Emergency’s deadline extensions. Prior amendment language did include a sunset clause which tied the deadline extensions to the ending of the National Emergency. We will continue to monitor extension deadlines as they arise and assist you in determining the appropriate dates to apply. If you have questions on a deadline, please reach out to your account manager.

Plan Sponsor Actions:

Notify your employees immediately that OTC test kits will no longer be covered under the plan’s PBM effective May 11, 2023; AND/OR
IF the plan wants to maintain coverage for OTC at home test kits, notify your Diversified sales representative or account manager. Note: Coverage will end May 11 regardless, once notified this coverage will be reinstated, so there will likely be a gap in coverage that participants should be made aware of;
Prior to your next renewal, determine if the plan wants to maintain cost share waivers for COVID-19 testing or amend the plan to revert to pre-pandemic coverage levels; AND
Notify your employees of any change in coverage made to COVID-19 benefits. This would include: If in-network testing will be subject to cost sharing upon renewal, out-of-network testing and vaccines will now be covered at OON levels, OTC at home tests will no longer be covered under the plan effective May 11.

The Administration’s FAQs issued on the ending of the emergencies does strongly encourage plans to notify their participants of any changes to the plan regarding COVID-19 coverage. Below is some sample language you can use and/or modify to notify employees of these changes happening immediately.

Sample Communication Piece for Employees:

During the National Health Emergency, group health plans have been required to extend certain participant deadlines in an attempt to support employees during the pandemic to ensure that health plan provisions were flexible given the issues with delays and interruptions during the pandemic. The Departments of Labor, Health and Human Services, and Treasury have indicated that these extensions will end July 10, 2023. These deadlines relate to:

The 30 day period to request special enrollment rights under HIPAA
The 60 day election period for COBRA elections, as well as extension for payments and notifications
Benefit claims, appeals and external reviews

In addition, during the pandemic, over the counter at home test kits were covered under your pharmacy benefit (up to 8 tests with no cost sharing per month). With the ending of the public and national health emergencies pertaining to COVID-19, over the counter at home test kits will no longer be covered under the plan effective May 11, 2023.