COVID-19 PHE’s end will bring changes

Coverage and member cost-sharing will revert to pre-pandemic requirements

The federally declared public health emergency (PHE) related to the COVID-19 pandemic will end on May 11, 2023. This will result in changes in coverage and cost-sharing requirements for members of Arkansas Blue Cross and Blue Shield’s and Health Advantage’s fully insured health plans, as described below.

Please note: Coverage and cost-sharing changes for members of self-funded health plans administered by BlueAdvantage Administrators of Arkansas or Health Advantage are determined by the employers or plan sponsors who fund those self-funded plans. If you have questions about coverage for such plans, please call the number on the back of the health plan member ID card.

Member cost-sharing for COVID-19-related services

On May 11, 2023, federal mandates for coverage (without member cost-sharing) of certain healthcare services will end. Affected services rendered May 12, 2023, and thereafter will be subject to member cost-sharing requirements of the member’s plan (copays/deductibles/coinsurance, etc.).

This resumption of member cost-sharing requirements for covered services includes:

• Clinical encounters associated with COVID-19, including:
  • Office visits.
  • Urgent care clinic visits.
  • Emergency department visits.
  • Telemedicine visits.
  • Lab evaluations performed in conjunction with any of the above-listed types of clinical encounters.
• Diagnostic lab testing for COVID-19 performed in a medical setting – including eligible specimen collection.
• Pharmacy-based diagnostic lab testing for COVID-19 performed by pharmacists – including eligible specimen collection.
• All U.S. Food and Drug Administration-approved therapeutic agents used to treat COVID-19 – e.g., Veklury.

This resumption of member cost-sharing requirements will not include (meaning that members will not be subject to cost-sharing):

• The cost of COVID-19 vaccines that have been approved by the Centers for Disease Control & Prevention (CDC) Advisory Committee on Immunization Practices (ACIP).
• Charges for administration of ACIP-approved COVID-19 vaccines – which are covered as preventive services and therefore do not require cost-sharing for most members.

Coverage for at-home COVID-19 test kits

Coverage for such tests will end May 11, 2023.

Monoclonal antibodies

There currently are no monoclonal antibody treatments approved for COVID-19. Accordingly, any related services rendered May 12, 2023, and thereafter will not be covered.

Out-of-network COVID-19 testing

After May 11, 2023, there will be no coverage for COVID-19 tests performed by entities that are not contracted participants in our health plans’ provider networks. Fee schedule pricing will be applied to covered lab codes only.