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California state laws add six months to the federal Public Health Emergency (PHE) requirements on health plans to continue covering COVID-19 tests, vaccines and treatment from any licensed provider (in- or out-of-network) with no prior authorization or enrollee cost sharing. The federal PHE ended on May 11, 2023, and state laws extend these requirements for six months through November 11, 2023.
After November 11, 2023, enrollees can continue to access COVID-19 tests, vaccines and treatment with no prior authorization or cost sharing when they access these services through their health plan’s network. Health plan enrollees can be charged cost-sharing only if these services are provided out of network after November 11, 2023.
| CARRIER | COVERAGE AFTER NOVEMBER 11, 2023 | RESOURCES |
|---|---|---|
| Aetna | In-network coverage for the following services will continue at no member cost-share, however member cost-share may be applied based on a member’s out-of-network plan benefits: vaccines, COVID-19 anti-viral medications or treatments (like Paxlovid). Standard member cost-share will apply for lab tests, telemedicine, urgent care, emergency room, and office visits associated with COVID testing. OTC COVID tests will no longer be covered. |
|
| Anthem Blue Cross | Standard member cost-share will apply for out of network services including testing and therapeutics. | |
| Blue Shield of California | Member cost-share will continue to be waived for in-network diagnostic testing, vaccines, and therapeutics. After November 11, 2023, cost-share for out-of-network COVID-19 services will no longer be waived for most plans and member cost-share may be applied based on a member’s out-of-network plan benefits. Members can continue to submit a request for reimbursement for up to 8 at-home COVID-19 tests per month. Coverage for treatments other than therapeutics is based on an individual’s standard in- or out-of-network benefits, which is not impacted by either the end of the PHE or six-month extension period. |
|
| CaliforniaChoice | Members should refer to their enrolled health plan. | - |
| Cigna + Oscar |
Lab tests, including PCR and rapid antigen, and treatment will be will be covered in-network at the standard plan deductible and cost-share. Over-the-counter tests will continue to be covered . |
|
| Covered California for Small Business | Members should refer to their enrolled health plan. | - |
| Health Net | NG PPO and HDHP/HSA Plans What's Changing
NG HMO Plans |
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| Kaiser Permanente® | Details will be shared at a later date. | |
| MediExcel Health Plan | Not announced. | |
| Sharp Health Plan | Not announced. | |
| Sutter Health Plus | No changes will be made through December 31, 2023. Beginning January 1, 2024 for new and renewing plans:
Sutter will continue to cover COVID-19 immunizations, prescription drugs and therapeutics at no cost share when delivered by in-network or out-of-network providers. |
|
| UnitedHealthcare | In-network coverage for vaccines will continue at no member cost-share, however member cost-share may be applied based on a member’s out-of-network plan benefits. Lab tests, treatment, telehealth, and virtual visits will be covered at the members standard plan benefits. OTC COVID tests will no longer be covered. | |
| Western Health Advantage | Details will be shared at a later date. |
