Important Update: Communication to Participants ***Required***

Important Update: Communication to Participants ***Required***

During the COVID-19 federal Public Health Emergency (PHE), CareFirst Administrators enhanced benefits to ensure members could get the care they needed.

The federal PHE is scheduled to expire on May 11, 2023. As a result, testing for COVID-19 and in-office or virtual visit testing related services will be processed in accordance with member benefits starting May 12, 2023. This includes any applicable member cost-sharing (including copay, coinsurance and deductible) and network limitations.  Due to this change in benefits, the Summary of Material Reduction (SMR) must be distributed to Plan Participants within 60 days of the change (no later than July 11, 2023).

Additionally, CareFirst Administrators will no longer reimburse CFA members for over-the-counter at-home COVID-19 tests if purchased after May 11, 2023. For tests purchased on or before May 11, 2023, CFA members have one year from the date of purchase to submit a claim for reimbursement.

Other benefits impacted include:

• Monoclonal antibody treatment for COVID-19—we will revert to imposing member cost-sharing for monoclonal antibody treatment pursuant to the member’s contract effective May 12, 2023
• Timely filings*—extensions and changes will revert to pre-PHE time limits effective July 10, 2023:
  • Filing limitations for appeals, claims filing and disability timelines; time periods for filing appeals for adverse benefit determinations, filing a request for an external review or to provide information to perfect a request for external review

*As always with the subject of COVID-19 and overall federal legislation, these topics can be very fluid. Please note that there are additional discussions being held as it relates to timely filing that may or may not affect that specific bullet above. Once those discussions have finalized, we will notify you of any changes related to the timely filing piece.

Because our plan covers preventive services at zero cost-share, the COVID-19 vaccine will be included as a preventive service covered at zero member cost-share at an in-network provider.  With the end of the PHE, out-of-network benefits will apply.