Coverage and member cost share have returned to pre-pandemic requirements.

On February 9, 2023, the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 would end on May 11, 2023. Some of the flexibilities that were created during the pandemic are no longer needed. This resulted in changes in coverage and cost share for most CommunityCare members.

If you have questions about your benefits, please call the Customer Service phone number on the back of your CommunityCare member ID card.

Member cost-share for COVID-19-related services

On May 11, 2023, federal mandates for coverage (without member cost-share) of certain health care services ended. Affected services provided on May 12, 2023, and after are subject to member cost share (copays and coinsurance).

This reinstatement of member cost-share for covered services includes:

• Clinical services related to COVID-19, including:
• PCP office visits
• Urgent care services
• Emergency care services
• Telehealth services
• Lab tests done in conjunction with any of the above-listed services
• • Diagnostic lab tests for COVID-19 performed in a medical setting, including eligible specimen collection.
• Pharmacy-based diagnostic lab tests for COVID-19 performed by pharmacists, including eligible specimen collection.
• Coverage for FDA approved or authorized COVID-19 treatments in accordance with a member’s standard plan benefits.

Members will not be subject to cost-share for:

• The cost of COVID-19 vaccines that have been approved by the Centers for Disease Control & Prevention (CDC) Advisory Committee on Immunization Practices (ACIP).
• The cost to administer ACIP-approved COVID-19 vaccines. Administration of such vaccines are covered as preventive services and do not require cost share for most members.



Coverage for at-home COVID-19 test kits

Coverage for at-home COVID-19 test kits will ended May 11, 2023.

Monoclonal antibodies

There currently are no monoclonal antibody treatments approved for COVID-19. Accordingly, any related services rendered on or after May 12, 2023 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 providers outside CommunityCare plans’ provider networks. For members enrolled in a plan with an out-of-network benefit, COVID-19 tests performed by out-of-network providers will be covered at the out-of-network benefit levels. Fee schedule pricing will be applied to covered lab codes only.

Authorization requirements will be reinstated for all services for which such requirements were suspended during the public health emergency.