COVID-19 Benefit Updates

Medical Benefit Updates

Interim changes to medical coverage for employees enrolled in a Dartmouth medical plan.

COVID-Related Treatment

The Biden-Harris Administration has annouced that the the national emergency will be ending on May 11, 2023.  Dartmouth is waiving all out-of-pocket costs for Coronavirus treatment through June 30, 2023. The plan will reimburse both in- and out-of-network health care providers at 100%. Beginning July 1, 2023, all treatement in-network and out-of-network will be subject to plan design based on your currently elected health plan.  Refer to the benefit plan summaries available online here.

Wellness

Find additional COVID-19 Coping Resources through the Wellness at Dartmouth office.

Pharmacy Benefits

COVID Vaccines

Express Scripts will cover the COVID vaccine at no cost to employees at both in-network and out-of-network pharmacies.

Cigna will cover the COVID vaccine at no cost to employees at both in-network and out-of-network providers' offices.

COVID Test Kits

On January 15, 2022, the Biden-Harris administration began requiring group health plans to cover the cost of 8 free at-home over the counter (OTC) COVID-19 tests per covered individual per month. The tests will be covered by the prescription plan through Express Scripts. Please note that these home tests will not be covered by Cigna.  The Biden-Harris Administration annouced that the the national emergency will be ending on May 11, 2023. Dartmouth will continue to cover Covid Test kits at no cost share until June 30, 2023. 

Beginning on July 1, 2023, employees may obtain up to 8 tests per member per month with a $12 per test kit (2 tests per kit) member cost share maximum.

In-Network Claims

For the HDHP, deductible and coinsurance apply.

For the OAP and CCF plans, the claim will process as Brand, but members will not pay more than $12 per test kit.  Example: Test kit indlcudes 8 tests and cost $96 (8 x $12).  The maximum you will pay is the $30 brand copay.

Out-of-Network Claims

For the HDHP, deductible and coinsurance apply.

For the OAP and CCF plans, test kits will process as 100% of the submitted rate minus the brand copay of $30. Example 1: Total test kit cost is $20.  You will pay $20 as this is lower than the brand copay ($30).  Example 2: Total test kit cost is $50. You will pay the $30 brand copay and your health plan will cover the balance.

Express Scripts has provided three simple options for getting your test kits:

  1. In Network Pharmacy
    1. Take your Express Scripts ID card to a retail pharmacy in the Express Scripts network
    2. Bring an at-home COVID-19 test to the pharmacy counter, not the regular checkout lane.
    3. Check out at the pharmacy counter and show your Express Scripts ID card.  Your at-home COVID-19 tests should automatically ring up at no cost.
  2. Express Scripts Mail-order pharmacy:
    1. Log-in (or register) to your Express Scripts account through https://express-scripts.com/#/login
    2. Click on Order At-home COVID-19 Tests
    3. Click on Acknowledge and Continue
    4. Click Add to Cart
    5. Confirm your Order
    6. To maximize your order, you may need to register individual family members separately
    7. Please allow up to 4 weeks for delivery
  3. Claim Reimbursement:
    1. Pay for your test out of pocket at a participating pharmacy and ask for a receipt.
    2. Log-in at https://express-scripts.com/#/login to find a participating pharmacy.
    3. Print the claim reimbursement form.
    4. Submit a claim for reimbursement using your pharmacy receipt.
    5. Please allow up to 4 weeks for reimbursement.

Flexible Spending Accounts (FSA)

Health Care FSA (HCFSA)

OTC Medications: 
The CARES Act inclusion of certain over-the-counter medical products as qualified expenses, now allows patients to use funds in Health Care Flexible Spending Accounts (HCFSA's) for the purchase of over-the-counter (OTC) medical products, including those needed in quarantine and social distancing, without a prescription from a physician.  It also expanded qualified medical expenses for HCFSA's, to include certain menstrual care products, such as tampons and pads.

Full "Carryover" from 2021 to 2022:

This provision allowed an additional year to spend down all unused 2021 Health Care Flexible Spending Account (HCFSA) balances.  This means that all 2021 HCFSA balances that were greater than $30 on December 31, 2021, could be used to pay for 2022 incurred expenses.  You had until December 31, 2022 to spend your remaining HCFSA 2021 balance.

All 2022 incurred HCFSA expenses need to be submitted to Sentinel no later than midnight on March 31, 2023.

Dependent Care FSA (DCFSA)

Grace Period Extension for DCFSA Expenses:

This provision allowed an extension on the grace period for all 2021 Dependent Care Flexible Spending Account (DCFSA) balances. This meant that all unused 2021 DCFSA funds could be used on services incurred in calendar year 2022.  You had until December 31, 2022 to spend your remaining 2021 DCFSA balance.  

The deadline for submitting 2021 incurred DCFSA expenses also changed. All 2021 and 2022 DCFSA incurred expenses need to be submitted to Sentinel no later than midnight on March 31, 2023. Sentinel will use funds from your 2021 DCFSA balance first.  Do not use the Benny debit card to pay for 2021 or 2022 incurred DCFSA claims after December 31, 2022.  It is recommended that 2021 and 2022 incurred expenses are reimbursed through online, phone app or paper form after that time.

DCFSA Filing Notice: When filing a claim online or via the Sentinel mobile app for services from 2021 or 2022, please be sure to select the plan year for which the service was incurred when choosing your “Pay From” option.  This will allow the claim to draw from the appropriate DCFSA balance.

Health Savings Accounts (HSA)

OTC Medications

The CARES Act inclusion of certain over-the-counter medical products as qualified expenses, will allow patients to use funds in Health Savings Accounts (HSA's) for the purchase of over-the-counter (OTC) medical products, including those needed in quarantine and social distancing, without a prescription from a physician.  It also expanded qualified medical expenses for HSA's, to include certain menstrual care products, such as tampons and pads.

Other Medications

See how your Health Savings Account can help defray health care costs during the coronavirus pandemic.

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