Fed Health Care Changes and the End of the COVID-19 Public Health Emergency
Some over-the-counter and out-of-network coverage may be different now that the pandemic emergency is over.
The COVID-19 Public Health Emergency ended on May 11, and as a result, some Federal Employee Health Benefit Program benefit provisions enacted by the Office of Personnel Management will change. OPM released public health emergency transition guidelines to FEHB carriers in a recent letter. Here are the major changes:
Laboratory & Over-the-Counter COVID-19 Diagnostic Tests
Carriers must continue providing coverage for lab and over-the-counter COVID-19 diagnostic tests. Following rules issued by OPM, carriers waived cost-sharing (out-of-pocket costs that might include a deductible, co-pay, or coinsurance) and prior authorization requirements for those services during the pandemic emergency. Now, carriers can apply cost-sharing requirements including prior authorization, though OPM is encouraging them not to.
Any COVID-19 preventive service, including the administration of COVID-19 vaccines, intended to prevent or mitigate COVID-19, must still be covered post-pandemic emergency by carriers on an in-network basis. During the pandemic emergency, carriers were required to provide both in-network and out-of-network coverage of COVID-19 vaccines. Now, carriers no longer need to provide out-of-network coverage.
Notice of Changes
If a carrier plans to modify COVID-19 benefits, OPM is encouraging carriers to provide notice to plan members about those changes including a date when plan benefits will change. Carriers can provide notice to covered individuals through an email, plan website post, or via an updated Summary of Benefits and Coverage.
The Final Word
The end of the public health emergency allows FEHB carriers the opportunity to institute out-of-pocket costs for laboratory and over-the-counter COVID-19 diagnostic tests and to stop providing out-of-network coverage for COVID-19 vaccines. Federal employees and annuitants should monitor plan communications via email, plan member website portals, and updates to the Summary of Benefits and Coverage prior to the 2024 Open Season to stay up-to-date on any COVID-19 benefit changes from your plan.
During the 2024 Open Season, make sure to review Section 2 “Changes for 2024” of the official plan brochure of your existing FEHB plan, or any FEHB plan you’re considering, to see if there are COVID-19 benefit changes for plan year 2024 that may impact you.
Kevin Moss is a senior editor with Consumers’ Checkbook. Checkbook’s Guide to Health Plans for Federal Employees is available to many federal employees for free; check here to see if your agency provides access. The Guide is also available for purchase and GovExec readers can save 20% by entering promo code GovExec at checkout.