Benefit and deadline changes due to COVID-19 - Human Resources at Ohio State

COVID-19 HR RESOURCES:

Benefit and deadline changes due to COVID-19

The below information should be read in conjunction with COVID-19-related updates that have already been incorporated into the 2022 Specific Plan Details (SPD) document for the applicable plan and the Summary of Material Modifications (SMM) issued April 21, 2022 (Benefit and deadline changes). The changes detailed on this page are:

Note, as the pandemic and the government’s response (legislation and additional guidance) evolve, additional changes may be made.

Deadline extensions clarified

Ohio State’s Faculty and Staff Health Plan, Dental Plan, Vision Plan and Disability Program

The federal government released rules last year that required employers to extend deadlines for certain actions if they occurred during a one-year period beginning on March 1, 2020. The latest guidance issued late in February 2021 provides an extension that differs by individual and is based on the earlier of (1) one year, or (2) the end of the Outbreak Period (i.e., the 60th day after the end of the National Emergency) for the following actions:

  • Requesting special enrollment changes to medical, dental and vision benefits due to marriage, birth, adoption, placement for adoption, divorce, loss of other group health insurance and loss of Medicaid or Children’s Health Insurance Program (CHIP)
  • Filing claims for medical, prescription drugs, dental, vision, long-term and short-term disability
  • Appealing adverse benefit determinations for medical, prescription drugs, dental, vision, long-term and short-term disability
  • Requesting an external review for medical, prescription drugs, dental, vision
  • Providing notice of a COBRA qualifying event due to divorce, loss of dependent status, or determination of disability by Social Security
  • Electing COBRA continuation coverage
  • Paying COBRA premiums (note, claims incurred after the paid-to-date-of-coverage will be denied unless and until the applicable COBRA premiums have been paid)

The individual deadline extensions create significant operational challenges in our plans. The university is working closely with our administrators to implement them swiftly, but you may experience slight delays while we calculate your individual election and extension periods.

Deadline examples for a special enrollment change
Birth of a child example: Your child was born on 6/1/20. Your deadline to enroll in health coverage is extended for one year from that date, or through 5/31/21. You then have the normal 30-day enrollment period under our plan, making the deadline by which you must make any enrollment election 6/30/21.
Birth of a child example: Assume that an announcement of the end of the National Emergency is made on 7/1/21. Because the Outbreak Period is defined as 60 days after the end of the National Emergency, the Outbreak Period will end on 8/30/21. Your child was born on 11/1/20. Since the end of the Outbreak Period is earlier than one year from the qualifying event on 11/1/20, the Outbreak Period date of 8/30/21 is the end of your extension to enroll your child. You then have the normal 30-day enrollment period under our plan, making the deadline by which you must make any enrollment election 9/29/2021.
Deadline examples for electing COBRA continuation coverage
COBRA election example: Your COBRA election period began 6/30/20. Your deadline to elect COBRA is extended for one year from that date, or through 6/29/21. You then have the normal 60-day election period, making the deadline by which you must elect COBRA 8/28/21.
COBRA election example: Assume that the announcement of the end of the National Emergency is made on 7/1/21. Because the Outbreak Period is defined as 60 days after the end of the National Emergency, the Outbreak Period will end on 8/30/21. Your COBRA election period began on 11/1/20. Since the end of the Outbreak Period is earlier than one year from your election deadline, the Outbreak Period date of 8/30/21 is the end of your extension to enroll in COBRA. You then have the normal 60-day COBRA election period, making your deadline 10/29/21.

For questions regarding special enrollment contact HR Connection at hrconnection.osu.edu or (614)247-myHR (6947).  For all other questions contact the appropriate plan administrator:

  • Medical claims, appeals or external review – contact Trustmark at 800-678-6269
  • Prescription drug claims, appeals or external review – contact Express Scripts (ESI) at 866-727-5867
  • Dental claims, appeals or external review – contact Delta Dental at 800-524-0149
  • Vision claims, appeals or external review – contact Vision Service Plan (VSP) at 800-877-7195
  • Disability claims or appeals – contact Unum at 866-679-3054
  • COBRA notices, elections, or payments – contact Trustmark at 866-433-0318 ext. 44124

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Coverage of prevention services and vaccines for Coronavirus

Ohio State’s Faculty and Staff Health Plan

During the public health emergency for COVID-19 and as recommended by the governing preventive service agencies, coronavirus preventive services will be covered at 100% with no out-of-pocket costs or network restrictions.  These services include an item, service or immunization intended to prevent or mitigate the coronavirus disease and that is:

  • An evidence-based item or service that has in effect a rating of “A” or “B” in the current recommendations of the U.S. Preventive Services Task Force; or
  • An immunization that has in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved.

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Coverage of at-home test kits and oral anti-virals

Coverage of COVID-19 At-Home Diagnostic Tests

Earlier this year, the federal government mandated health insurance coverage for certain at-home, over-the-counter (OTC) COVID-19 diagnostic tests.  Effective January 15, 2022, The Ohio State University Faculty and Staff Health Plan covers up to eight (8) OTC tests per month per covered person. The university’s pharmacy benefit administrator, Express Scripts (ESI) is facilitating this coverage. You may use your benefit to get your tests at a participating retail pharmacy or through Home Delivery.

There are several ways to obtain an at-home test kit:

  • Federal Government
    • Through the United States Postal Service (USPS), households may request a total of four (4) tests to be delivered for free. To learn more and order at-home tests, visit covidtests.gov.
  • Retail Pharmacy in the ESI Express Advantage Network
    • Purchase the test at the pharmacy counter by presenting your prescription drug information or ID card found in the ESI mobile app.
  • Express Scripts Home Delivery
    • Use Express Scripts Home Delivery. Log in or register at express-scripts.com to place a test kit order through Home Delivery.

If you pay for the at-home test out of pocket, you may ask the pharmacy for a receipt and keep all test kit packaging.  Submit a claim for reimbursement using a pharmacy receipt from a retail pharmacy.

Only certain at-home test kits qualify for this coverage.  With the exceptions noted in this communication, the Plan covers OTC COVID-19 tests authorized by the U.S. Food and Drug Administration (FDA). Some examples of the FDA-authorized brands include:

  • BinaxNOW COVID-19 AG Card or Antigen Home Test
  • CareStart COVID-19 Antigen Home Test
  • Flowflex COVID -19 Antigen Home Test
  • BD Veritor At-Home COVID-19 Test
  • Cellitrion DiaTrust COVID-19 Ag Home Test
  • Cue COVID-19 Test for Home OTC Use
  • Detect Covid-19 Test
  • Ellume COVID-19 Home Test
  • iHealth COVID-19 Antigen Rapid Test
  • SCoV-2 Ag Detect Rapid Self-Test (InVios International, Inc.)
  • Lucira CHECK-IT COVID-19 Test Kit
  • MaximumBio ClearDetect COVID-19 Antigen Home Test
  • InteliSwab COVID-19 Rapid Test
  • INDICAID COVID-19 Rapid Antigen At-Home Test
  • QuickVue At-Home OTC COVID-19 Test
  • COVID-19 At-Home Test (SC Biosensor, Inc.)
  • CLINITEST Rapid COVID-19 Antigen Self-Test

The FDA maintains and updates the complete list of approved home tests.

The Plan covers tests only when they are purchased for the personal use of individuals covered under the Plan. Members cannot use tests covered by the Plan for any other purpose. Members may be asked to acknowledge that any use other than personal use constitutes fraud under the terms of the Plan.

Coverage of COVID-19 Oral Antivirals

The federal government mandates health insurance coverage pertaining to certain over-the-counter COVID-19 oral antiviral products authorized by the Food and Drug Administration’s emergency use authorization.

The plan covers the antiviral product at a $0 member cost share only when the products are purchased from a retail pharmacy with appropriate physician prescriptions.

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Coverage of COVID-19 diagnostic tests and related services

Effective February 4, 2020, through the duration of the public health emergency, as declared by the Secretary of Health and Human Services (HHS), the following items and services are covered by Ohio State’s Faculty and Staff Health Plan at 100% without any cost-sharing, prior authorization or network restrictions:

  • In vitro diagnostic tests for the detection of SARSCoV-2 or the diagnosis of the virus that causes COVID-19, and the administration of such a test, that:
    • Is FDA-approved, cleared or authorized
    • The test developer has requested, or intends to request, emergency use authorization under the Food, Drug and Cosmetic Act
    • Is developed in and authorized by a state that has notified HHS of its intention to review tests intended to diagnose COVID19
    • HHS otherwise has approved in guidance
  • Serological tests for COVID-19 used to detect antibodies against the SARS-CoV-2 virus, and are intended for use in the diagnosis of the disease or condition of having current or past infection with SARS-CoV- 2, the virus which causes COVID-19.
    • Items and services furnished during a visit to a provider’s office (including via telehealth), urgent care, an emergency room, drive up testing site or other (even nontraditional) provider visit that results in an order for or administration of an in vitro diagnostic test described above, but only to the extent the item or service relates to:
      1. the furnishing or administration of the diagnostic test or
      2. the evaluation of the individual to determine need for the diagnostic test.

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