COVID-19 Public Health and National Emergency has expired

COVID-19 Testing Changes: Coverage of Over-the-Counter (OTC) Tests Ended on May 12, 2023

During the Public Health Emergency, laboratory-based polymerase chain reaction (PCR) and over the counter (OTC) antigen tests were required to be covered without cost-sharing. The Health Plan was also required to cover eight free OTC tests per month, with a $12 limit per test. As of May 12, 2023, the Health Plan only covers COVID-19 tests in accordance with both Cigna’s and Optum RX’s standard policies:

Now the Health Plan only covers COVID-19 tests in accordance with both Cigna’s and Optum RX’s standard policies:

• Cigna Medical Plan – OTC test kits are no longer covered under the Cigna medical plan. PCR tests continue to be covered under the medical benefit for both Tiers based on the standard lab benefit provisions for that Tier (which may be different for in and out-of-network coverage).
• Optum RX Plan – OTC test kits are no longer covered under the Optum RX plan.

COVID-19 Vaccine Coverage: Vaccines Obtained Through the Cigna Medical Plan or Optum RX Plan Are Now Covered

During the Public Health Emergency, the Fund covered COVID-19 vaccines at no cost to the participant, through both the Cigna medical plan and the Optum prescription drug plan, for all Tiers.

Currently, the Fund’s two Tiers continue to cover COVID-19 vaccines at no cost, but only when obtained from an in-network provider through the CIGNA medical plan – which would also include retail pharmacies that are in-network with Cigna. Coverage for vaccines obtained from an out-of-network medical provider is based on the rules for your Tier of coverage. The Fund also covers vaccines obtained at a pharmacy with Optum RX for both Tiers.

For a complete list of in-network providers, including locating retail pharmacies under the Cigna Plan, please visit www.mycigna.com. To locate an in-network pharmacy with Optum RX, visit www.optumrx.com.

COVID-19 Antiviral Medication Treatment Changes for the Optum RX Plan

Since 2022, the Federal Government provided COVID-19 antiviral prescription drugs at no cost; this supply is expected to run out sometime in 2024. This medication is currently only being administered under the Optum RX benefit and is not available under the Cigna medical plan. Optum RX will continue covering this medication at 100% (meaning no cost to you) as long as supplies from the Federal Government last. After that supply of drugs from the Federal Government has been exhausted, the Health Plan will charge a co-payment of 30% of the cost of the medication under all 3 Tiers. This medication will fall into Optum RX’s expected Non-Preferred/Non-Formulary drug class category, with a quantity limit of 1 treatment course per fill and up to 2 courses permitted per year. There is a possibility that Optum RX could place this drug class in a different category in the near future in which the out-of-pocket copayment cost would eventually become cheaper.

Here are two charts that summarizes how each of the benefit items will be covered under either the Cigna Medical/Optum RX Plans beginning May 12, 2023:

If you have medical coverage through an HMO Plan, please check with your HMO provider as to how they will be covering these specific benefit items beginning May 12, 2023. Details can also be located online with your applicable HMO provider. For Emblem Health – HIP NY, visit, www.emblemhealth.com. For any of the Kaiser HMO plans, please visit www.kaiserpermanente.org.

COBRA (Election and Payment), Special Enrollment, and Claims and Appeals Deadlines Changes after July 10, 2023

As previously announced, certain deadlines were extended (up to one year) during the COVID-19 pandemic. Specifically, the deadlines to elect and pay for COBRA, request special enrollment, and submit a claim or appeal were extended during the “Outbreak Period,” ended July 10, 2023.

Since the Outbreak Period ended on July 10, 2023, all days after that will count toward any applicable deadline. For example, for someone enrolled in COBRA, payment is normally due on the first day of the month, with a 30-day grace period. Therefore, the COBRA payment for the month of June 2023 would normally be due June 1, with a grace period until July 1. However, because the days during the Outbreak Period did not count toward the deadline to pay for COBRA, the 30-day grace period started to run on July 11 (i.e., until August 9, 2023 only). However, any COBRA payment beginning August 2023 forward will be subject to the regular deadlines (described in the Summary Plan Description), since that period moving forward fell after the end of the Outbreak Period.

The end of the Outbreak Period that took place on July 10, 2023, meant that those first offered COBRA before July 10, 2023, had 60 days after July 10, 2023 (or until September 8) to elect COBRA (except that your deadline will not be extended for more than one year). Please note that the extended deadlines did not affect your responsibility to make full payment of COBRA premiums retroactive to the first day for which you are eligible for COBRA coverage, in the event that you timely elected such coverage. In addition, since claims incurred in any month you are eligible for COBRA will not be paid until you timely elect and pay for COBRA coverage for that month, you may need to re-file claims submitted before you elect and pay for COBRA for that month.

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