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Frequently Asked Questions

The COVID-19 national emergency and public health emergency declarations ended May 11, 2023 per the Biden Administration’s announcement on January 30, 2023. This brought about the return to pre-COVID-19 pandemic health insurance coverage per members’ policies as originally written. Below is a summary of what changed as of result of the end of these emergency declarations.

FOR MEMBERS (Not on a Medicare Advantage Plan):

Vaccines

What’s changed: Effective end of day May 11, 2023, the requirement to cover COVID-19 vaccines received out-of-network at no-cost to members expired. However, Sanford Health Plan will continue to waive cost-share requirements for COVID-19 vaccines received in-network and out-of-network, aligning with the SHP flu vaccine benefit.

At-home COVID Test

What’s changed: Over the counter COVID-19 tests are no longer covered by Sanford Health Plan. However, members can choose to pay for over-the-counter COVID-19 tests with flex dollars or over-the-counter Medicare Advantage benefits as available through their specific plan design.

Clinical Diagnostic COVID-19 Tests

What’s changed: As of May 11, 2023, the cost-share waiver for clinical diagnostic testing ended, and coverage is now based on the member’s benefit plan.

Standard COVID-19 Treatment

What’s changed: No change. Medically necessary treatment for COVID-19 will remain covered in accordance with the member’s benefit plan.

COVID-19 Related Telehealth/Virtual Care Visits

What’s changed: Effective end of day May 11, 2023, the cost-share waiver for telehealth (or virtual care) visits ended, and coverage will be based on the member’s benefit plan (e.g., similar to office-visit cost-share requirements).

COVID-19 Related Telehealth/Virtual Care Visits for HSA HDHP Plans:

What’s changed: The current safe harbor allowing for plans to provide coverage of COVID-19 related diagnostic telehealth visits without cost-share in HSA-eligible HDHPs will expired as of end of day May 11, 2023. Please note: This is separate from the cost-share waiver for treatment via telehealth, which ended in 2021). This coverage may be extended through December 31, 2023, as permitted under the CAA Sec. 4151, if desired by a self-funded group.

FOR PROVIDERS:

COVID-19 Testing Provider Reimbursement

What’s changed: As of May 11, 2023, if the plan does not have a negotiated rate with a provider for COVID-19 diagnostic testing services, the plan is no longer required to reimburse the cash price for such service that is listed by the provider on a public website.

Prior Authorization for in-patient care:

What’s changed: Sanford Health Plan has resumed requiring prior authorization for any in-patient care including those related to COVID-19 at the end of day May 11, 2023.

Telehealth Reminder:

What’s changed: Sanford Health Plan has resumed requiring all telehealth services to be provided using a HIPAA compliant platform per pre-pandemic regulations at the end of day May 11, 2023.

If you have questions about your coverage, please contact our customer service team at (800) 752-5863 (TTY: 711) Monday through Friday from 8 a.m. to 5 p.m. CT.