Plan Sponsor Notice: Planning for the COVID-19 Emergencies

Plan Sponsor Notice:

Planning for the COVID-19 Emergencies Ending on May 11

On January 30, 2023, the federal government announced that the two national emergencies addressing

COVID-19, the public health emergency (PHE) and the national emergency, will end on May 11, 2023.

Starting May 12, 2023, health plans and group plan sponsors will no longer be subject to federal

requirements for coverage of COVID-19 testing, vaccinations and treatments.

Below is a summary of the changes to COVID-19 coverage that will take place once the federal

emergencies end for self-funded plan sponsors.

Please note that, as a self-funded plan sponsor, you may elect to extend coverage through the end of

2023 or the end of your plan year. If you would like to consider that, please contact your account team

by March 31, 2023.

Aetna® plan sponsors who have carved out pharmacy benefits to a third-party administrator will need to

consult their Pharmacy Benefit Manager on all benefits other than lab-based COVID-19 tests (covered

under the medical plan benefit), and the COBRA, HIPAA and Special Enrollment Period deadline changes.

During the emergency period

Starting May 12, 2023

COVID-19

vaccines,

including

boosters

Members pay $0 for the vaccine at

any location.

The government covers the

ingredient cost of the COVID-19

vaccine and requires plans to cover

all vaccines at 100%, both in and

out of network.

Members will pay $0 for the vaccine at in-network

locations.*

Many pharmacies now have ample supply of the

government funded vaccines.

Although timing is unknown, it is likely that COVID-

19 vaccines will be commercially available in the

summer or fall. At that time, we expect the COVID-

19 vaccine will be added to the Aetna standard

seasonal vaccine program.

Note that, once federal supply is exhausted, the

vaccines will continue at 100% coverage for in-

network administration. Normal plan cost share will

apply for out-of-network administration, like the flu

vaccine.

COVID-19 at-

home test kits,

also known as

over-the-counter,

or OTC test kits

Members pay $0 for select test kits.

Plans cover eight OTC COVID-19

tests per month with a $0 member

cost share, if obtained at a

pharmacy, or with a post-service

reimbursement claim.

Members will pay the retail cost of test kits. They

are no longer covered.

Members will be able to get an at-home test kit for

around $12 per test, or $24 for a box of two from

CVS® and other retailers.

Members can also use funds from a health savings

account or a flexible spending account toward test

kits.

COVID-19 lab

tests

Members pay $0 for lab tests,

including rapid diagnostic and

swab-and-send tests, at in-network

locations.

Members will pay their copay, coinsurance or

deductible at in-network locations. It will be applied

to their out-patient testing benefit, which is part of

their medical plan.

Evaluation &

Management

Visit (E&M) -

Telemedicine,

Urgent Care, ER

and Office Visits

Associated with

COVID-19 tests

Members pay $0 for COVID-19

associated visits (INN and OON)

when there’s an associated COVID-

19 test done within 2 days before

or 2 days after.

Members will pay their copay, coinsurance or

deductible for COVID-19 associated visits (INN and

OON) when there’s an associated COVID-19 test

done within 2 days before or 2 days after.

COVID-19 anti-

viral medications

or treatments,

like Paxlovid*

Members pay $0 for these

prescriptions.

No change. Members will pay $0 for these

prescriptions while the government supply is

available.

Pharmacist

Assessment and

Prescribing of

Paxlovid program

For plan sponsors with this

program, members pay $0 for

pharmacist assessment and

prescribing of Paxlovid at

pharmacies, including CVS.

No change.

For plan sponsors with this program, coverage will

continue, consistent with their current benefits.

COVID-19

monoclonal

antibodies

Members pay normal cost sharing

for EUA-approved monoclonal

antibody treatments.*

No change. Members will continue to pay normal

cost sharing for EUA-approved monoclonal antibody

treatments.*

COBRA, HIPAA,

special

enrollment and

benefit claims

and appeals

The national emergency extended

deadlines for:

• COBRA elections

• Paying COBRA premiums

• Electing HIPAA special

enrollment

• Filing claims, appeals and

requests for external

review

Deadlines return to normal timeframes starting July

10, 2023.

*Under an EUA declaration, the FDA may authorize unapproved medical products or unapproved uses of

approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-

threatening diseases or conditions.

Certain state COVID-19 requirements may have expiration dates that are not tied to the end of the

federal emergencies. Aetna will follow all federal and state mandates, as required.

We will continue to provide updates if needed.

Sincerely,

Your Aetna Account Team

Policies and plans are insured and/or administered by Aetna Life Insurance Company or its affiliates

(Aetna). Providers are independent contractors and are not agents of Aetna. Provider participation may

change without notice. Refer to Aetna.com for more information about Aetna® plans. Aetna and CVS

Pharmacy® are part of the CVS Health® family of companies. For a complete list of other participating

pharmacies, log in to Aetna.com and use our provider search tool.

1979000-01-01 (3/23)