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Information For Employers About COVID-19

Since COVID-19 began to affect our community, HMSA has committed to covering medically appropriate testing and treatment and continuing to serve our employer groups and their employees.

Important updates

  • June 2023:

    • Previously, the Biden Administration announced a definitive end to both the COVID-19 public health emergency (May 11, 2023) and the national health emergency (April 10, 2023). The U.S. Department of Labor, as allowed by the Joint Rule, subsequently exercised its discretion to determine July 10, 2023, as the end date of the Outbreak Period (60 days after the end of the public health emergency date, May 11, 2023).

    • Individuals and plans with timeframes that are subject to the relief under the Notices will have the applicable periods under the Notices disregarded until the earlier of (a) one year from the date they were first eligible for relief, or (b) July 10, 2023 [the end of the Outbreak Period]. In no case will a disregarded period exceed one year.
    • After July 10, 2023, the timeframes for individuals and plans with periods that were previously disregarded under the Notices will resume.

  • Effective May, 12, 2023:

    • The U.S. Department of Health and Human Services announced that the federal public health emergency for COVID-19 will expire at the end of the day May 11, 2023. This will result in changes to benefits that were added or extended during the COVID-19 public health emergency. As a result, the following changes will take effect starting May 12, 2023.

    • Regular cost shares and deductibles will apply for:
      • Diagnostic lab tests and testing-related services that are consistent with CDC guidance related to COVID-19. This applies to HMSA’s commercial, EUTF, HMSA Federal Plan 87, and Medicare Advantage plans.
      • Preoperative COVID-19 diagnostic testing for patients with no COVID-19 symptoms who will undergo surgery and other procedures. This applies to commercial, Medicare Advantage, and HMSA Federal Plan 87 plans. For EUTF members, regular cost shares and deductibles will apply starting June 1, 2023.
    • Audio-only (phone) visits for certain mental health conditions will be temporarily covered through Dec. 31, 2023, for commercial plans. Audio-only visits will be temporarily covered for some services through Dec. 31, 2024, for Medicare Advantage members. Continued coverage of audio-only visits for QUEST Integration members is pending guidance from the Med-QUEST Division. Check with your doctor about your telehealth and audio-only options.
    • QUEST Integration members will continue to have no copayment as part of their health plan benefits for COVID-19 services.

    Learn more about COVID-19 benefit changes. 1

*The above changes may not apply to all groups/plans. For state, federal, and self-insured groups, please contact your account representative for details.

For the latest information on COVID-19, please visit the Centers for Disease Control and Prevention website5.

Frequently Asked Questions

Plans and Benefits6 | IRS/DOL Joint Rule Extensions7 |

Plans and Benefits

Will HMSA cover COVID-19 testing for employment purposes?

No. HMSA does not cover COVID-19 testing for surveillance or employment purposes.

Will HMSA cover COVID-19 testing for travel purposes?

No. HMSA does not cover diagnostic testing for COVID-19 for travel purposes, such as to avoid quarantines associated with business or leisure travel.

Does HMSA cover COVID-19 antibody (serology) testing?

Following guidance issued by the Centers for Disease Control and Prevention8, HMSA will cover antibody tests only if one of the following conditions is met to support the diagnosis of COVID-19 illness or complications of COVID-19 in the following situations:

  • A positive antibody test at least seven days following acute illness onset in persons who had a previous negative antibody test (e.g., seroconversion) but did not receive a positive viral test might indicate SARS-CoV-2 infection between the dates of the negative and positive antibody tests.
  • A positive antibody test can help support a diagnosis when patients develop complications of COVID-19, such as multisystem inflammatory syndrome or “long COVID.”

Starting May 12, 2023, regular cost shares and deductibles will apply

HMSA will not cover antibody testing if the test is being used to indicate immunity to COVID-19. HMSA fully supports clinical advancements that improve the diagnosis, treatment, and prevention of COVID-19. However, while antibody testing may play an important public health role in the way we track COVID-19 cases and assess its impact on our population, the antibody testing is not currently recognized by the CDC as a valid diagnostic test for COVID-19 (except in the situations listed above) or a reliable test to demonstrate immunity.

Visit the CDC website8 for more information.

Is there a vaccine?

Yes. COVID-19 vaccines can lower your risk of getting and spreading the virus that causes COVID-19. Vaccines can also help prevent serious illness and death. COVID-19 vaccines are currently available at no cost, while government supply lasts. Most members won’t have to pay the vaccine administration cost through May 11, 2023. Learn more about the COVID-19 vaccine.9

Will HMSA support the Families First Coronavirus Response Act?

Yes, HMSA covers all services required by this law. For more information, read about HMSA’s COVID-19 Benefit Changes1.

Are COVID-19 home test kits covered?

From Jan. 15, 2022, through May 11, 2023, HMSA will cover the cost for FDA-approved over-the-counter COVID-19 diagnostic test kits for HMSA commercial plan members Learn more about over-the-counter at-home COVID-19 tests10.

I haven’t met my plan deductible yet. Will the diagnostic testing still be covered at 100%?

Yes. The diagnostic testing will be covered at 100% for service dates March 1, 2020, through May 11, 2023, even if members haven’t met their deductible. Learn more1.

Are there new billing codes for providers so that patients aren’t charged for office visits related to COVID-19?

Yes, all HMSA participating providers have access to the proper billing codes to ensure that patients aren’t charged for office visits tied to COVID-19 testing through May 11, 2023.

Will my employees have access to telehealth benefits?

Yes. For commercial plan members, regular cost shares and deductibles apply for telehealth visits.

Medicare Advantage and QUEST Integration members will continue to have no copayment as part of their 2023 plan benefits for all telehealth visits, including e-visits. View a list of more FAQs about our telehealth benefits11.

Will my employees have access to audio-only visits?

Phone, or audio-only visits are not a benefit for commercial, EUTF, HMSA Federal Plan 87, and some self-insured plan members, but was a temporary benefit exception during the COVID-19 public health emergency. HMSA will continue to cover audio-only visits for certain mental health conditions until Dec. 31, 2023.

For Medicare Advantage members, phone visits are temporarily covered for some services through Dec. 31, 2024.

Continued coverage of phone visits for QUEST Integration members is pending guidance from the Med-QUEST Division. We will update this guidance when available.

Check with your doctor about what telehealth and audio-only options are available for you. View a list of more FAQs about our telehealth benefits11.

IRS/DOL Joint Rule Extensions

On May 4, 2020, the U.S. Department of Labor and Internal Revenue Service posted to the Federal Register, “Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID–19 Outbreak.” 12HMSA will adhere to the appropriate timeframe extensions related to COBRA, for those specific situations, until no longer applicable. The parameters of the COBRA law currently remain unchanged.

June 2023:

Previously, the Biden Administration announced a definitive end to both the COVID-19 public health emergency (May 11, 2023) and the national health emergency (April 10, 2023). The U.S. Department of Labor, as allowed by the Joint Rule, subsequently exercised its discretion to determine July 10, 2023, as the end date of the Outbreak Period (60 days after the end of the public health emergency date, May 11, 2023).

  • Individuals and plans with timeframes that are subject to the relief under the Notices will have the applicable periods under the Notices disregarded until the earlier of (a) one year from the date they were first eligible for relief, or (b) July 10, 2023 [the end of the Outbreak Period]. In no case will a disregarded period exceed one year.
  • After July 10, 2023, the timeframes for individuals and plans with periods that were previously disregarded under the Notices will resume.

This overview of recent federal guidance is provided as a courtesy for general informational purposes only, may not reflect the most up-to-date information, and does not and is not intended to constitute business or legal advice. You should consult your legal adviser for more information.

Has the federal government issued any relief for participants of employee benefit plans that may have been affected by the COVID-19 pandemic?

Yes, the Internal Revenue Service and the U.S. Department of Labor issued regulations (“Joint Rule”) to help participants of certain group health plans maintain health coverage during the pandemic. The Joint Rule provides an extension of certain participant deadlines to enroll in coverage due to a qualifying event, elect and pay for COBRA coverage, and make or appeal benefit claims decisions.

How do I know if the relief provided in the Joint Rule applies to me?

If you’re an employer, contact your employment counsel to determine if you’re required to offer these extensions to your employees. More information on the Joint Rule 12.

How are deadlines under COBRA affected under the Joint Rule?

The deadline for an eligible employee to enroll into COBRA coverage is extended to July 10, 2023 (60 days after the end of the public health emergency). For employees already enrolled in a COBRA plan, the deadline to pay monthly premiums are extended until 30 days after the end of the outbreak period.

What is the outbreak period and when will it end?

As described in the Joint Rule, the outbreak period generally runs from March 1, 2020, until 60 days after the end of the public health emergency. The national emergency ended April 10, 2023; the outbreak period is March 1, 2020, through July 10, 2023 (60 days after the end of the public health emergency).

How are deadlines to enroll for coverage under a special enrollment period affected?

Special enrollment periods generally allow employees to enroll in a group health plan outside of the normal open enrollment period if they experience a qualifying event such as loss of coverage, birth or adoption of a child, or marriage. Under the Joint Rule, the SEP is extended 30 days (or 60 if applicable) after either 1) the end of the outbreak period or 2) the end of one year following the qualifying event, whichever comes first.

CURRENT AS OF 08/31/2023