The federal government has announced that the COVID-19 Public Health Emergency declared by the Department of Health and Human Services, as well as the COVID-19 National Emergency declared by the Executive Office of the President, will both expire on May 11, 2023. Consistent with the expiration of the federal emergency proclamations, Wellfleet’s fully insured health plans will revert to the plan coverage in effect prior to the issuance of the federal emergency proclamations, effective May 12, 2023.
Below is a summary of the changes to COVID-19 coverage that will take effect after the federal emergencies end for fully insured plan sponsors.
Wellfleet – During the emergency period
Wellfleet – Starting May 12, 2023
COVID-19 vaccines, including boosters & administration
Members pay $0 for the vaccine at any location.
Covered under the Preventive Services benefit; members pay $0 for the vaccine at in-network locations. Out of Network subject to cost share as defined in the schedule of benefits
COVID-19 at-home test kits, also known as over the counter, or OTC test kits
Members pay $0 for select test kits when purchased OTC and ordered by a physician. Plans to cover eight OTC COVID-19 tests per month with a $0 member cost share, when obtained with a post-service reimbursement claim.
Members will pay the retail cost of OTC test kits. They are no longer covered.
COVID-19 lab tests due to symptoms or exposure
Members pay $0 for in and out of network lab tests, including rapid diagnostic and swab-and-send tests.
Covered under the Diagnostic Laboratory, Testing and Imaging Services benefit, members will pay their copay, coinsurance or deductible based on the schedule of benefits for In or Out of Network benefits of the plan.
COVID-19 treatment including Evaluation & Management Visit (E&M) – Telemedicine, Urgent Care, ER and Office Visits Associated with COVID-19
Members pay $0 for COVID-19 associated visits (INN and OON) when there’s an associated COVID-19 diagnosis
Benefits for COVID-19 treatment including associated COVID-19 diagnosis’s will be paid according to the schedule of benefits. Members will pay their copay, coinsurance or deductible based on the In or Out of Network benefits of the plan.
COVID-19 anti-viral medications or treatments, like Paxlovid
Members pay $0 for these prescriptions under the government supply.
No change. Members pay $0 for these prescriptions while the government supply is available. After which time benefits will be paid according to the schedule of benefits of the policy.
COVID-19 emergency proclamations by certain States may have expiration dates that are not tied to the end of the federal emergency proclamations. Wellfleet will follow all federal and state mandates, as required.
Whether you’re a current Wellfleet Student member, administrator, or partner, contact us with any questions you have. We’ll look forward to hearing from you.
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Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies.