COVID-19 PHE’s end will bring changes

Coverage and member cost-sharing will revert to pre-pandemic requirements

The federally declared public health emergency (PHE) related to the COVID-19 pandemic will end on May 11, 2023. This will result in changes in coverage and cost-sharing requirements for members of Arkansas Blue Cross and Blue Shield’s and Health Advantage’s fully insured health plans, as described below.

Please note: Coverage and cost-sharing changes for members of self-funded health plans administered by BlueAdvantage Administrators of Arkansas or Health Advantage are determined by the employers or plan sponsors who fund those self-funded plans. If you have questions about coverage for such plans, please call the number on the back of the health plan member ID card.

Member cost-sharing for COVID-19-related services

On May 11, 2023, federal mandates for coverage (without member cost-sharing) of certain healthcare services will end. Affected services rendered May 12, 2023, and thereafter will be subject to member cost-sharing requirements of the member’s plan (copays/deductibles/coinsurance, etc.).

This resumption of member cost-sharing requirements for covered services includes:

• Clinical encounters associated with COVID-19, including:
  • Office visits.
  • Urgent care clinic visits.
  • Emergency department visits.
  • Telemedicine visits.
  • Lab evaluations performed in conjunction with any of the above-listed types of clinical encounters.
• Diagnostic lab testing for COVID-19 performed in a medical setting – including eligible specimen collection.
• Pharmacy-based diagnostic lab testing for COVID-19 performed by pharmacists – including eligible specimen collection.
• All U.S. Food and Drug Administration-approved therapeutic agents used to treat COVID-19 – e.g., Veklury.

This resumption of member cost-sharing requirements will not include (meaning that members will not be subject to cost-sharing):

• The cost of COVID-19 vaccines that have been approved by the Centers for Disease Control & Prevention (CDC) Advisory Committee on Immunization Practices (ACIP).
• Charges for administration of ACIP-approved COVID-19 vaccines – which are covered as preventive services and therefore do not require cost-sharing for most members.

Coverage for at-home COVID-19 test kits

Coverage for such tests will end May 11, 2023.

Monoclonal antibodies

There currently are no monoclonal antibody treatments approved for COVID-19. Accordingly, any related services rendered May 12, 2023, and thereafter will not be covered.

Out-of-network COVID-19 testing

After May 11, 2023, there will be no coverage for COVID-19 tests performed by entities that are not contracted participants in our health plans’ provider networks. Fee schedule pricing will be applied to covered lab codes only.

Resources for Health Advantage

Nurse24^sm

24/7, free consultation with a registered nurse

• Fully Insured, Arkansas Blue Cross Employees, AR State Police: 800-318-2384
• Arkansas State Employees / Public School Employees: 866-458-0408

Virtual Health

Access to medical help through your smartphone, tablet, and/or computer when unable to see your primary care physician.

Chronic Care Advocacy Program

Enrollees can contact case managers 8 a.m. – 6:30 p.m.

Case Management

Enrollees can contact case managers 8 a.m. – 4:30 p.m. Members not enrolled in case management who would like to speak to a registered nurse about COVID-19 or any healthcare needs can call 800-225-1891.