Deadline and Benefits Coverage Changes

The below information is a Summary of Material Modification (SMM) and should be read in conjunction with the 2023 Specific Plan Details (SPD) document of The Ohio State University Faculty and Staff Health Plan.

Deadline Extensions Ending

Earlier this year, the end of the COVID-19 National Emergency was announced, which impacts certain Ohio State benefit plan deadlines that were previously extended through the National Emergency.

The National Emergency was initially set to end May 11, 2023, which defined the end of the Outbreak Period. Previously, the National Emergency allowed for extensions of several benefit-related deadlines that differed by individual and were based on the earlier of (1) one year, or (2) the end of the Outbreak Period. Although the National Emergency ended earlier than anticipated (on April 10, 2023), the Department of Labor has informally suggested that plans should continue to use the original end of the Outbreak Period, which will be July 10, 2023 (60 days after May 11, 2023). What this means for certain Ohio State benefit plans and provisions is outlined below.

The plan deadline extensions made available through the National Emergency applied to the following Ohio State benefit plans:

• Faculty and Staff Health Plan
• Dental Plan
• Vision Plan
• Disability programs

Through the National Emergency, these plans allowed for extensions of several deadlines:

• 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)

With the end of the National Emergency, these deadline extensions will end at the end of the day on July 10, 2023 (the end of the Outbreak Period) and normal plan deadlines, as defined within each plan, will resume on July 11, 2023. If any further guidance is issued that may impact these dates, we will communicate as soon as possible.

See examples of extended deadline.

Benefits Coverage Changes

In addition, the end of the COVID-19 Public Health Emergency was announced to be May 11, 2023.

The Public Health Emergency required health benefit plans to provide certain levels of benefit coverage for COVID-19-related services. Therefore, when the Public Health Emergency ends the following changes will be incorporated into the OSU Faculty and Staff Health Plan effective on May 12, 2023.

COVID-19 Vaccines
COVID-19 vaccines will continue to be covered at 100% with no out-of-pocket cost if they are obtained by a network provider. Out-of-Area coverage does not have network restrictions.

COVID-19 At-Home Diagnostic Tests
COVID-19 at-home diagnostic tests will no longer be covered, consistent with other over-the-counter retail health care products.

COVID-19 Oral Antivirals
Coverage for COVID-19 oral antiviral medications will be based on the benefits of your elected health coverage (i.e., deductible, coinsurance, copayment, network restrictions), although you may not experience this coverage change until the existing supply of government-purchased oral antiviral medications is depleted.

COVID-19 Diagnostic Tests and Related Services
COVID-19 diagnostic tests and related services will be based on your elected health coverage (i.e., deductible, coinsurance, copayment, network restrictions). This includes:

Qualifying 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.

• Serological tests for COVID-19 used to detect antibodies against the SARS-CoV-2 virus.
• 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 result 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 the furnishing of the test or evaluation of individual to determine need for a diagnostic test.

Detailed coverage information for these services if incurred prior to May 12, 2023, can be found here.