What the End of the COVID-19 Public Health Emergency Means for FEHB Coverage
On May 11, 2023, the Department of Health and Human Services ended the COVID-19 Public Health Emergency (PHE). As a result, some FEHB benefit provisions enacted by OPM will change going forward. OPM released PHE 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 (OTC) 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 PHE. 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-PHE by carriers on an in-network basis. During the PHE, carriers were required to provide both in-network and out-of-network coverage of COVID-19 vaccines. Post-PHE, 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 (SBC).
The Final Word
The end of the PHE allows FEHB carriers the opportunity to institute out-of-pocket costs for laboratory and OTC 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 SBC 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.