COVID-19 coverage updates

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 in accordance with applicable law and plan documents, for commercial members as follows:

Connecticut and New Hampshire plans

• COVID-19 vaccines
  • In network: Covered in full¹
  • 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 it³

Maine plans

• COVID-19 vaccines
  • In network: Covered in full¹
  • Out of network: Member cost sharing applies²
• COVID-19 tests administered by providers
  • In network: Covered in full¹
  • Out of network: Member cost sharing applies²
• 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 it³

Massachusetts plans

• COVID-19 vaccines
  • In network: Covered in full¹
  • Out of network: Covered in full¹
• COVID-19 tests administered by providers
  • In network: Covered in full¹
  • Out of network: Covered in full¹
• COVID-19 treatment and COVID-19 related telemedicine
  • In network: Covered in full¹
  • Out of network: Covered in full¹
• Prior authorization
  • Prior authorization will continue to be waived for COVID-19 testing by providers, and treatment and vaccines

 

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.

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Disclosures

¹Covered in full for high deductible health plans and non-high-deductible health plans, in accordance with IRS regulatory guidance.

² Effective May 12, 2023, federal law requires COVID-19 vaccines to be covered in full when provided by in-network providers and covered in full at the out-of-network benefit level when in-network providers are unavailable.

³ Harvard Pilgrim is waiving prior authorization requirements for all non-pharmacy medical and behavioral health benefits for our commercial members. Please keep in mind that the waiver applies only during our system outage.

COVID-19 coverage update for Harvard Pilgrim Health Care Medicare Advantage Stride^SM (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 through their Red, White and Blue Medicare card.

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 own 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.

• Maine
• Massachusetts
• New Hampshire