End of Public Health Emergency
For the past several years, Presbyterian Health Plan has provided members benefits for COVID testing, vaccines, treatment, diagnostic screening, antibody testing, and telehealth, most often at $0 cost-share for in-and-out of network providers, with limited or no prior authorization requirements. On May 11, 2023, the COVID-19 public health emergency will end. As the public health emergency ends, we would like to inform you of what is changing to your benefits. Presbyterian Health Plan is committed to continue providing coverage of these benefits, but cost-sharing may now apply. This information is subject to change as more guidance is released by the government and is dependent upon your plan.
Individual and employer plans
Testing1: $0 - No change
Vaccines: $0 - No change
Treatment: $0 - No change
Diagnostic Screening: Cost-sharing may apply (office visit cost-sharing)
Antibody Testing: $0 - No change
Telehealth: Cost-sharing may apply
Administrative Services Only (ASO)2 plans
Testing1: Cost-sharing may apply
Vaccines: $0 - No change
Treatment: Cost-sharing may apply
Diagnostic Screening: Cost-sharing may apply (office visit cost-sharing)
Antibody Testing: Cost-sharing may apply
Telehealth: Cost-sharing may apply
Federal employee plans
Testing1: Cost-sharing may apply
Vaccines: $0 - No change
Treatment: Cost-sharing may apply
Diagnostic Screening: Cost-sharing may apply (office visit cost-sharing)
Antibody Testing: Cost-sharing may apply
Telehealth: Cost-sharing may apply
Medicare plans
Testing1: Cost-sharing may apply
Vaccines: $0 - No change
Treatment: $0 - No change for oral antivirals. Cost-sharing may apply to non-oral antivirals.
Diagnostic Screening: Cost-sharing may apply (office visit cost-sharing)
Antibody Testing: Cost-sharing may apply
Telehealth: Cost-sharing may apply
Centennial Care plans
Testing1: No change
Vaccines: No change
Treatment: No change
Diagnostic Screening: No change
Antibody Testing: No change
Telehealth: No change
1 Over-the-counter COVID-19 test kits will no longer be covered, except for Centennial Care plans.
2 These plans are self-funded and subject to ERISA. Please refer to your ID card to determine if you are enrolled in one of these plans.
In addition to the cost-sharing above, prior authorization requirements for some COVID services may no longer be waived and could be required to receive services. Please check here for the latest prior authorization requirements: Out-of-network services will apply normal cost-sharing if the benefit exists on the plan. Services will not be covered if no out-of-network benefit exists on the plan.
If you have any questions, you may find more information under the FAQ section of our website.
Thank you for allowing us to be your partner in health.