Benefit Adjustments When COVID-19 Emergency Ends

The Biden administration has announced that the COVID-19 emergency will end May 11, 2023.  Employers should prepare now for changes that will occur after the emergency declaration ends.

First, although employer plans are still expected to cover COVID-19 tests, employer plans will be able to require cost-sharing by beneficiaries for COVID-19 tests to match normal medical coverage of in-network services. Employer plans may continue covering COVID tests given in doctors’ offices as part of regular medical coverage. Health plan beneficiaries may have access to COVID tests through local governments or other sources.

Second, although most group plans are required to cover COVID vaccines as preventive services within the network, the government is expected to run out of money for paying for the vaccines this year.  The plans will have to bear the cost of the vaccines thereafter. Pfizer and Moderna are expected to raise prices significantly.

Third, federal funding for COVID treatments, like Paxlovid and Labevrio, will be exhausted this year. Plans will have to pay the full costs thereafter. 

Fourth, the transition from the federal government to the commercial markets paying for the tests, vaccines and treatments may be challenging. Employers want the IRS to issue guidance about pre-deductible coverage for COVID diagnosis and treatments under health savings account-eligible deductible health plans. It is not clear whether the current guidance will continue.

Fifth, on July 10, deadlines that were extended for special enrollment in health plans for events like losing coverage or having children will end. Employer plans must communicate to employees that the extended period for electing COBRA coverage will change from 1 year to 60 days.

Sixth, relaxed restrictions on telehealth and virtual care services for part-time and temporary staff will end. Unless Congress acts, employer plans will be out of compliance if part-timers and others who are not eligible for the major medical plan are allowed to use the virtual care services.

This article is part of our March 2023 Newsletter.

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