BlueChoice HealthPlan of South Carolina and BlueCross BlueShield of South Carolina COVID-19 Pandemic Group Eligibility Guidelines Extended Through December 31, 2020
End of the COVID-19 Emergency Periods
On Jan. 30, 2023, and again on March 29, 2023, the Biden administration announced that the COVID-19 public health emergency (PHE) and national emergency declarations were expected to end on May 11, 2023. However, on April 10, 2023, President Biden signed a bill that ended the national emergency (but not the public health emergency) on that day. The end of these federally declared emergencies will also lead to the end of certain pandemic-related COVID-19 benefit requirements and relief provisions. As a result, the administration of plan coverage will revert to pre-PHE benefits and processes. Generally, this means that plan administration will return to the standard terms of the plans. A summary of the forthcoming changes by product is included in the following information for fully insured, level-funded and ASO group health plans offered by BlueCross BlueShield of South Carolina and BlueChoice HealthPlan. ASO groups that wish to cover COVID-19 benefits differently than described in the following information should contact their marketing representative.
Government guidance issued on March 29, 2023, serves as an additional resource to the following information: https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-58.
Existing COVID-19 Federal Supply
At-Home and Over-the-Counter (OTC) Tests
|At-home and OTC COVID-19 tests will no longer be covered (reimbursed) after May 11, 2023.
PCR and Rapid Tests Ordered or Administered by a Health Professional
Regular coverage and cost sharing will apply starting May 12, 2023, to the test and associated doctor visit according to plan benefits.
Employer groups who offer HSA-eligible HDHPs may continue to cover testing for members who have not yet met their deductible, without jeopardizing their eligibility for an HSA, until further notice from the IRS.
Regular coverage and cost sharing applies, as it did during the PHE, according to plan benefits.
Pharmaceutical treatments (e.g., Paxlovid™) obtained from the federal government are not affected by the end of the PHE and will remain free, based on the federal supply. Treatment obtained from sources other than the federal supply will be covered according to the plan’s terms of coverage and subject to cost sharing requirements.
Employer groups who offer HSA-eligible HDHPs may continue to cover treatment for members who have not yet met their deductibles, without jeopardizing their eligibility for an HSA, until further notice from the IRS.
HSA-eligible HDHPs may continue to offer telehealth to members who have not yet met their deductibles, without jeopardizing their eligibility for an HSA, until the end of plan years beginning in 2024 (i.e., until Dec. 31, 2024, for calendar year plans).
The exemption that allowed large employers to offer “stand-alone” telehealth plans that are exempt from many rules under the ACA will last until the end of the latest plan year that began during the PHE (until Dec. 1, 2023, for calendar-year plans).
|Extended Deadlines (COBRA, HIPAA, Claims and Appeals)
Emergency relief — which extended by up to one year certain deadlines that otherwise would have expired after July 10, 2022 — will end July 10, 2023. The normal, un-extended COBRA, HIPAA, and claims and appeals time-frames are scheduled to begin applying on July 10, 2023. Although the national emergency ending on April 10, 2023, could shorten the above date by one month, July 10, 2023, should remain as the emergency relief expiration date unless a different date is specifically listed in future government guidance.
Individual deadlines that will shift include:
Examples of the timeline impacts are available in the following government FAQs:
The relief that allowed plans to provide certain documents “as soon as administratively possible” will also end.