COVID-19 coverage updates
- Member Cost-Sharing: If you are enrolled in a high-deductible health plan, the Internal Revenue Service requires COVID-19 testing and treatment to apply to the deductible starting with your plan’s 2024 coverage anniversary date. If your coverage anniversary date was January 1, 2024, this requirement will take effect January 1, 2025. Please see below for details.
- At-Home Tests: Over-the-counter, at-home tests are no longer covered as of May 12, 2023.The federal public health emergency ended on May 11, 2023.
COVID-19 coverage update for commercial members
Note: You’re a commercial member if you have coverage through an employer, buy coverage through a public health care exchange or buy coverage directly from us (except Medicare Supplement plans).
The COVID-19 national emergency ended. Federal guidance paused group health plan-related deadlines (e.g., COBRA election, special enrollment periods, and claims and appeal deadlines) until the earlier of (a) one year from the date when a member was first eligible for relief under the federal guidance, or (b) the end of the outbreak period (the outbreak period ends 60 days after the end of the COVID-19 national emergency) or another date announced by the Labor Department, the Treasury Department and the IRS. Please consult with the employer offering the plan with questions about these deadlines.
The COVID-19 public health emergency ended on May 11, 2023. Effective May 12, 2023, over the counter, at-home COVID-19 tests will no longer be covered under the pharmacy or medical benefit. In addition, Harvard Pilgrim will cover COVID-19-related services, when medically necessary and under applicable law and plan documents, for commercial members as follows:
New Hampshire plans
- COVID-19 vaccines
- In network: Covered in full2
- Out of network: Member cost sharing applies2
- COVID-19 tests administered by providers
- In network: Member cost sharing applies
- Out of network: Member cost sharing applies
- COVID-19 treatment and COVID-19 related telemedicine
- In network: Member cost sharing applies
- Out of network: Member cost sharing applies
- Prior authorization
- Harvard Pilgrim is also reinstating prior authorization for services that require it
Maine plans
- COVID-19 vaccines
- In network: Covered in full2
- Out of network: Member cost sharing applies2
- COVID-19 tests administered by providers
- In network: Covered in full3
- Out of network: Member cost sharing applies
- COVID-19 treatment and COVID-19 related telemedicine
- In network: Member cost sharing applies
- Out of network: Member cost sharing applies
- Prior authorization
- Harvard Pilgrim is also reinstating prior authorization for services that require it
Massachusetts plans
- COVID-19 vaccines
- In network: Covered in full2
- Out of network: Covered in full2
- COVID-19 tests administered by providers
- In network: Covered in full3
- Out of network: Covered in full3
- COVID-19 treatment and COVID-19 related telemedicine
- In network: Covered in full3
- Out of network: Covered in full3
- Prior authorization
- Prior authorization will continue to be waived for COVID-19 testing by providers, and treatment and vaccines
Rhode Island plans
- COVID-19 vaccines
- In network: Covered in full2
- Out of network: Member cost sharing applies2
- COVID-19 tests administered by providers
- In network: Covered in full3
- Out of network: Member cost sharing applies
- COVID-19 treatment and COVID-19 related telemedicine
- In network: Member cost sharing applies
- Out of network: Member cost sharing applies
- Prior authorization
- Harvard Pilgrim is also reinstating prior authorization for services that require it
Please note: Member cost sharing includes copayments, deductibles and coinsurance. Only POS and PPO plans have out-of-network benefits. Also, COVID-19 coverage outlined above may vary if you’re enrolled in a self-insured group health plan. Please contact your employer for coverage details.
Disclosures
1COVID-19 coverage outlined above may vary if you’re enrolled in a self-insured group health plan. Please contact your employer for coverage details. Member cost sharing includes copayments, deductibles and coinsurance. Only POS and PPO plans have out-of-network benefits.
2In accordance with federal requirements, in-network Covid-19 vaccines are always covered in full, without member cost-sharing, and out-of-network Covid-19 vaccines are covered in full only when in-network providers are unavailable (see FAQs 58, Q4).
3This includes High Deductible Health Plans (HDHPs) with plan years ending on or before December 31, 2024. For subsequent plan years, HDHPs will apply the deductible to COVID-19 services in accordance with IRS regulatory guidance before being covered in full. HDHPs are designed to comply with the requirements of the Internal Revenue Service for a HDHP. See Notice 2020-15 and Notice 2023-37.
COVID-19 coverage update for Harvard Pilgrim Health Care Medicare Advantage StrideSM (HMO)/(HMO/POS) members
Over the counter/home testing kits
On May 12, 2023, following the end of the federal public health emergency, Medicare members will no longer have coverage for at-home testing kits.
Provider-ordered testing and treatment
COVID-19 tests, treatments and services ordered by a provider, including Paxlovid, will remain covered after the Federal PHE ends, and we follow federal guidelines regarding approved treatments. This coverage applies at in-network providers, urgent care centers, emergency rooms and other facilities, and at out-of-network providers in the event a member cannot easily find an in-network provider to provide timely services. COVID-19 tests that are not ordered or referred by a provider are not covered benefits.
COVID-19 vaccines
COVID-19 vaccines will remain covered after the Federal PHE ends at no cost to our members.
Telehealth/telemedicine services
Need a doctor’s appointment but don’t want to leave home? Telehealth, or, as it is often referred to, “telemedicine,” offers an alternative to in-person visits by using audio or video tools so you can speak to your doctor in real-time without leaving home. Copays for telehealth/telemedicine services will be the same as an in-person visit.
Except where specifically noted above or in other communications, on May 12, 2023, after the PHE ends, all benefit coverage will revert to the coverage terms described in your Evidence of Coverage. Please refer to your current Evidence of Coverage for details.
COVID-19 coverage update for HPHC Insurance Company Medicare Supplement members
Please visit medicare.gov for details on coverage for COVID-19-related services as of May 12, 2023.
The COVID-19 national emergency ended. As a result, group health plan-related deadlines (e.g., COBRA election, special enrollment periods, and claims and appeal deadlines) will resume the earlier of (a) one year from the date when a member was first eligible for relief under the federal guidance, or (b) the end of the outbreak period (the outbreak period ends 60 days after the end of the COVID-19 national emergency) or another date announced by the Labor Department, the Treasury Department and the IRS. This FAQ includes several examples on pages 8-12 of how deadlines for ERISA election actions will apply with the end of the outbreak period.
Note: This does not constitute legal advice. Employers, brokers, and consultants should consult with their legal counsel.
On May 11, 2023, the federal COVID-19 public health emergency ended. As such, we created state-specific overviews that compare coverage and benefits during the pandemic/public health emergency vs. what will be our policies post-May 11, 2023.