Insurance Law Alert

The United States Department of Health and Human Services (HHS), on October 13, 2022 renewed the COVID-19 Public Health Emergency for another 90 days continuing the state of emergency through at least January 15, 2023. 

During the state of emergency, all medical plans are required to cover the cost of COVID-19 tests, both in and out-of-network as well as the cost of up to eight over-the-counter test kits per month.  Non-grandfathered plans are required to cover the cost of administering COVID-19 vaccinations and booster shots as a covered preventative service, but not the cost of the actual vaccine which currently is paid for by the federal government. It is expected, however, that the federal government is preparing to transfer the cost of vaccines and certain therapeutics as well as administration to commercial carriers and plans in the near future.  Once this happens, non-grandfathered medical plans will have to cover these costs (both the vaccine and its administration).  Currently, the plans are covering the cost of administration only. 

Once the state of emergency expires, health plans will no longer be required to cover the costs of COVID-19 testing but certainly can choose to do so as a preventative measure which may ultimately reduce healthcare costs.  Non-grandfathered plans will still be required to pay the cost of COVID-19 vaccinations but will be permitted to limit coverage to in-network providers in a PPO plan.  Grandfathered plans will not be similarly required to cover the cost of these vaccines but may choose to do so as well.

Any questions may be referred to Cynthia Borrelli.

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