BENEFIT CHANGES RESULTING FROM THE END OF THE COVID-19 PUBLIC HEALTH EMERGENCY
In January 2020, the Secretary of Health and Human Services established the Public Health Emergency for COVID-19 (“Public Health Emergency”). Pursuant to related legislation, the Plan was required to make certain changes to your benefits for the duration of the Public Health Emergency, and you received various notices from the Plan regarding these changes.
The federal government has announced the Public Health Emergency will end at the end of the day on May 11, 2023. Below is a description of how the end of the Public Health Emergency will impact your Plan benefits.
1. COVID-19 Vaccines Through December 31, 2023 — The Plan will continue to cover approved COVID-19 vaccines and vaccine boosters at 100% with no deductible and no cost-sharing, whether received from a Preferred Provider, Nonpreferred (Participating Provider), or a Nonpreferred (Nonparticipating Provider). Effective January 1, 2024 — The Plan will cover approved COVID-19 vaccines and vaccine boosters the same as any other preventive care benefit as follows:
Preferred Providers: 80%, after deductible
Nonpreferred (Participating Providers): 60% of Allowed Amount,* after deductible
Nonpreferred (Nonparticipating Providers): 60% of Allowed Amount,* after deductible
*You may be responsible for the difference between what the Plan pays (the “Allowed Amount”) and what the Provider bills the Plan.
2. COVID-19 Diagnostic Testing (Excluding Over-The-Counter Tests) Through December 31, 2023 — The Plan will continue to cover diagnostic COVID-19 tests at 100% with no deductible and no cost-sharing, whether received from a Preferred Provider, Nonpreferred (Participating Provider), or a Nonpreferred (Nonparticipating Provider). 2 Effective January 1, 2024 — The Plan will provide coverage for diagnostic COVID-19 tests as an “Other Professional Services” benefit as follows:
Preferred Providers: 80%, after deductible
Nonpreferred (Participating Providers): 60% of Allowed Amount, after deductible
Nonpreferred (Nonparticipating Providers): 60% of Allowed Amount,* after deductible
*You may be responsible for the difference between what the Plan pays (the “Allowed Amount”) and what the Provider bills.
3. Over-the-Counter (“OTC”) COVID-19 Tests Through December 31, 2023 — The Plan will continue to reimburse up to eight OTC COVID-19 tests per month per eligible family member for tests obtained through ExpressScripts. Reimbursement is limited to $12 per test. Effective January 1, 2024 — The Plan will no longer provide reimbursement for OTC COVID-19 Tests. 4.Virtual Care Telehealth The Plan’s Virtual Care Telehealth benefit will continue to be available with no changes.
END OF CERTAIN PLAN DEADLINE EXTENSIONS
Separate from the Public Health Emergency, the COVID-19 National Emergency became effective on March 1, 2020. Related guidance required the Plan to disregard the period beginning March 1, 2020, and ending 60 days after the end of the National Emergency (the “Outbreak Period”) when calculating the deadlines listed below. The Plan will no longer be required to disregard the Outbreak Period as of July 10, 2023. This means the timeframes listed below will begin (or resume) running as of July 11, 2023.
- HIPAA Special Enrollment Period – The 31-day period to enroll dependents following the birth, adoption/placement for adoption, marriage, or loss of other coverage (60-day period for a participant to enroll dependents following the loss of eligibility under CHIP or Medicaid).
- Claims and Appeals – Deadlines for filing a claim, an appeal of a denied claim, or a request for external review of a denied appeal. The examples below illustrate how the end of the Outbreak Period impacts Plan deadlines:
Example 1: Mary married her new spouse Shawn on November 15, 2022 (i.e., during the Outbreak Period). Mary would normally have had until December 16, 2022 to enroll Shawn in the Plan (i.e., 31 days from the date of their marriage). The deadline for Mary to enroll Shawn was tolled until the end of the Outbreak Period (July 10, 2023). Mary has until August 10, 2023 (31 days after the end of the Outbreak Period) to enroll Shawn in the Plan. 3
Example 2. Victor receives a claim denial letter on August 1, 2023 (i.e., after the end of the Outbreak Period). Because the Outbreak Period has ended, there is no tolling and normal deadlines apply. Victor must file an appeal within 180 days of the date he received the claim denial letter.
If you have any questions regarding this notice, please contact the Trust office at (866) 239-1708.
In accordance with the requirements of the Employee Retirement Income Security Act of 1974, as amended (ERISA), this notice serves as a “summary of material modifications” to the Plan. Please keep this summary with your copy of the Plan booklet. In the event of any conflict between this document and any other written or oral statement regarding these Plan changes, this document will control.