Important Notice - Federal Declaration of the End of the COVID-19 Emergency Status
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Notice describing restoration of pre-pandemic benefit rules and timeframes for Michigan Conference of Teamsters Welfare Fund (MCTWF) members, affecting coverage, cost sharing, telehealth, disability (Weekly Accident & Sickness), COBRA, and other plan deadlines effective July 11, 2023.
All MCTWF benefits and time period requirements that were mandated because of COVID-19 will be restored back to the original benefit/requirements on July 11, 2023.
Members will be responsible for applicable deductibles, coinsurances, copayments, or charges for COVID-19 testing, treatment, and medically necessary services for dates of service July 11, 2023 and after.
At‑home COVID-19 tests will no longer be covered under the pharmacy benefit nor reimbursed after July 11, 2023.
Telehealth expanded no-cost sharing for out-of-network eligible providers will end and applicable copays, deductibles, or other charges will apply for dates of service July 11, 2023 and after; MDLIVE $0 copay will continue through March 2024.
A COVID-19 diagnosis will no longer automatically qualify a participant for Weekly Accident & Sickness benefits effective July 11, 2023; claims will be reviewed for a range of health factors.
COBRA elections, payments, and other extended timeframes will revert back to pre-pandemic deadlines on July 11, 2023.
Post-Emergency Coverage and Administrative Criteria
Post-emergency coverage and administrative criteria
Summary of coverage and administrative changes effective with the end of federal COVID-19 emergency declarations:
Coverage changes - COVID-19 testing, treatment, and related services
- COVID-19 testing performed at a hospital, doctor's office, or pharmacy will be subject to applicable member cost sharing (deductible and/or coinsurance) as required by the member's MCTWF benefit plan.
Effective July 11, 2023.
- Medically necessary services to evaluate the need for and administer COVID-19 tests will be subject to applicable deductibles, coinsurances, copayments, or charges as required by the member's MCTWF benefit plan.
Effective July 11, 2023.
- COVID-19 treatment that was previously paid in full by MCTWF will be subject to applicable deductibles, coinsurances, copayments, or charges as required by the member's MCTWF benefit plan.
Effective July 11, 2023.
- At‑home COVID-19 tests will no longer be covered under the pharmacy benefit and will no longer be reimbursed for purchases of at‑home test kits.
Effective July 11, 2023.
COVID-19 vaccine coverage continuation
- COVID-19 vaccines and CDC‑recommended boosters will continue to be covered in full with no member cost share when obtained at an in‑network provider or pharmacy for members who have both MCTWF medical and pharmacy benefits.
Telehealth benefits
- MDLIVE telehealth consultations will continue to have a $0 copay through March 2024.
- The expanded telehealth no‑cost‑share benefit for eligible providers outside the MDLIVE network will end; telehealth visits outside MDLIVE will be subject to applicable plan copays, deductibles, or coinsurance as required by the member's MCTWF benefit plan.
Cost sharing for non‑MDLIVE telehealth applies to dates of service July 11, 2023 and after.
Weekly Accident & Sickness (short‑term disability) eligibility
- A COVID-19 diagnosis will no longer automatically qualify a participant for Weekly Accident & Sickness benefits; claims will be reviewed for a range of health factors before approval.
Effective July 11, 2023.
Administrative timeframes and COBRA
- The 'Outbreak Period' tolling of deadlines ends; all COBRA elections, payments, and other extended timeframes revert to pre‑pandemic deadlines.
- Other paused timeframes (special enrollment requests, claim filing, appeals, and external review deadlines) revert to their original pre‑pandemic deadlines.
- These administrative reversion rules are effective July 11, 2023.
Coding and Date Thresholds
| No codes listed |
Provider Billing and Telehealth Guidance
Bill members for COVID‑19 services on/after July 11, 2023
Providers may bill members applicable deductible and/or coinsurance for covered COVID-19 testing, treatment, and medically necessary services for dates of service on or after July 11, 2023. At‑home COVID-19 tests will no longer be covered under the pharmacy benefit or reimbursed after July 11, 2023.
- Effective July 11, 2023, members will be billed applicable deductible and/or coinsurance for COVID-19 testing performed at hospitals, doctors' offices, or pharmacies.
- Effective July 11, 2023, members will be responsible for any deductibles, coinsurances, copayments, or charges for medically necessary services to evaluate or administer COVID‑19 tests and for COVID‑19 treatment.
- At‑home COVID‑19 tests are no longer covered under the pharmacy benefit and will not be reimbursed if purchased after July 11, 2023.
Telehealth cost‑sharing changes; MDLIVE $0 copay retention
Continue offering MDLIVE telehealth consultations with a $0 copay through March 2024. For all other telehealth visits, revert to standard plan cost‑sharing (applicable copays, deductibles, or coinsurance) for dates of service on or after July 11, 2023.
- MDLIVE service: $0 copay continues through March 2024.
- Expanded telehealth outside MDLIVE: members will be responsible for applicable copays, deductibles, or other charges for dates of service July 11, 2023 and after.
Key Definitions
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