As of May 12, COVID-19 vaccines, testing, and treatment are now covered like any other condition (unless otherwise required by state or local mandates):
- COVID-19 vaccines are covered under preventive benefits at applicable plan cost shares, typically $0.
- COVID-19 PCR tests are covered under the outpatient diagnostic lab benefit at applicable plan cost shares.
- COVID-19 home antigen tests aren’t covered, which is consistent with current plan coverage that does not cover over-the-counter tests.
- COVID-19 treatment is covered under the drug benefit with applicable plan cost shares.
- Out-of-network services for COVID-19 — such as home antigen tests, treatment, and vaccines — only are covered for urgent care and emergency services on HMO and EPO plans, when legally required, or when out-of-network coverage is included in a Kaiser Permanente member’s plan.
If you’re a self-funded plan sponsor, then you’ll need to follow all the changes outlined above unless you request different coverage for COVID-19-related services.
For more details about the end of the federal COVID-19 public health emergency and how it may affect your employees and coverage, visit account.kp.org.