On January 30th, 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)
The 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 Diagnostic Testing Without Cost Sharing: During the PHE, health plans and health insurance issuers must cover COVID-19 tests and related services without imposing any cost sharing or prior authorization or other medical management requirements. As of January 15, 2022, this coverage requirement extends to at-home COVID-19 diagnostic tests. Health plans and issuers will no longer be required to provide this first-dollar coverage when the PHE ends.
- COVID-19 Vaccines — Out-of-Network Providers: Non-grandfathered group health plans and health insurance issuers must cover coronavirus preventive services, including recommended COVID-19 immunizations, without cost sharing requirements. During the PHE, covered services may be provided by in-network or out-of-network providers. Once the PHE ends, health plans and issuers must continue to cover recommended COVID–19 immunizations without cost sharing but can limit this coverage to in-network providers.The availability, access, and costs of COVID-19 vaccines, including boosters, should not impact health plans as long as the supply of federally purchased vaccines is available. As long as the supply is available, vaccines will remain free to all people regardless of insurance coverage.
- COVID-19 Treatment: Treatment for COVID-19 was never under the auspices of the PHE and health plans were never required to waive cost sharing for any COVID treatment, however, treatments, such as Paxlovid, purchased by the federal government were free and will remain free regardless of insurance coverage while federal supplies last.
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 (or such other date as announced by the federal government). 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.
PRE-DEDUCTIBLE TELEHEALTH COVERAGE
In response to the COVID-19 pandemic, the Coronavirus Aid, Relief and Economic Security (CARES) Act allowed high deductible health plans (HDHPs) compatible with health savings accounts (HSAs) to provide benefits for telehealth or other remote care services before plan deductibles were met. This relief was not linked to the PHE or outbreak period; rather, it applied for plan years beginning before January 1, 2022. A spending bill extended this relief to telehealth services provided in months beginning after March 31, 2022, and before January 1, 2023. The Consolidated Appropriations Act, 2023 (CAA), which was signed into law on December 29, 2022, extends the ability of HDHPs to provide benefits for telehealth or other remote care services before plan deductibles have been met without jeopardizing HSA eligibility. This extension applies for plan years beginning after December 31, 2022, and before January 1, 2025. Thus, regardless of when the COVID-19 emergency periods end, HDHPs may be designed to waive the deductible for any telehealth services for plan years beginning in 2023 and 2024 without causing participants to lose HSA eligibility.
Diversified Group is tracking these developments and will be issuing further information and guidance to plan sponsors as the situation develops.