The federal government has announced the end of the Public Health Emergency (PHE) on May 11, 2023. UnitedHealthcare has prepared for this change by reviewing recent government guidance on how it affects COVID-19 vaccines, testing, and treatments. The standard approach for COVID-19 coverage after May 11, 2023, will apply to fully insured and Level Funded health benefit plans, as well as self-funded plans following UnitedHealthcare's standard medical benefit coverage. UnitedHealthcare recommends that self-funded customers adhere to the standard coverage.
The post-PHE standard approach aims to:
• Support the timely and consistent return to normal plan benefits
• Align with standard coverage for similar services
• Reduce variability in COVID-related services and minimize provider and member confusion
• Facilitate timely payments for providers
From May 12, 2023, UnitedHealthcare's standard approach and coverage for COVID-19 vaccines, testing, and treatment will include:
• COVID-19 vaccines — Coverage of ACIP-recommended and CDC-adopted COVID-19 vaccines and boosters, with zero-dollar cost share for in-network services.
• Over-the-Counter (OTC) tests — No coverage of OTC COVID-19 tests after May 11, 2023, unless mandated by state regulations. Members can use account plans, such as Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), to purchase OTC tests.
• Surveillance testing — No coverage for in- or out-of-network surveillance testing.
• COVID-19 lab-based testing — Coverage of FDA-approved or authorized COVID-19 lab tests ordered by a healthcare provider in line with the member's standard medical plan benefit.
• COVID-19 treatment — Coverage for FDA-approved or authorized COVID-19 treatments, including Paxlovid and molnupiravir (Lagevrio), according to a member's standard plan benefits.
• Telehealth — Coverage for telehealth visits, including medical and behavioral telehealth services, in accordance with the member's standard medical plan benefit for in- and out-of-network services (subject to cost share).
• Virtual Visits — Coverage for virtual visits, including medical and behavioral visits, in line with the member's standard medical plan benefit.
State guidance may result in variations from UnitedHealthcare's standard coverage. Self-funded customers who followed the standard approach during the PHE and will follow UnitedHealthcare's COVID-19 post-PHE standard do not need to take any action.
For questions, please contact your broker or UnitedHealthcare representative. Customers seeking information on coverage, taxes, mandates, or mental health parity should consult their counsel or tax advisor.