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 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. 

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. 

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.

Maine
Massachusetts
New Hampshire
Rhode Island