The federal COVID-19 public health emergency (PHE) in California will end on May 11, 2023, but state law extends PHE health plan requirements for an additional six months, until November 11, 2023. This extension affects fully insured clients, covering diagnostic and screening tests, immunization, preventive items and services, therapeutics, and up to 8 over-the-counter tests per month without cost-sharing, prior authorization, utilization management, or in-network requirements.
Out-of-network provider reimbursement will remain at least 125% of Medicare reimbursement through November 11, 2023, and at least 100% after that. Administrative Service Only (ASO) clients can customize their COVID-19 benefits through normal plan administration.
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4/28/2023
California