State Health Plan Program:

The State Health Plan put multiple temporary benefit provisions in place to assist Plan members during the COVID-19 public health emergency.  The federal government announced that the COVID-19 public health emergency ended on May 11, 2023.  Here's what it means to employees regarding coverage as it relates to COVID-19:

• The Plan will continue to cover both the cost of the COVID-19 vaccine and vaccine administration at 100% when employees receive the vaccine at an in-network provider as part of the Plan’s preventive care benefits. If employees receive any other service during the visit, the visit may be subject to a copay. This is true for all other vaccines the Plan covers.
• The Plan will cover COVID-19 tests that are administered by a provider. If members receive any other service during the visit, the visit may be subject to a copay.
• The Plan will no longer cover the cost of over-the-counter (OTC) COVID-19 tests. Members will be responsible for the cost.
• The State Health Plan will no longer cover the cost of COVID testing as it relates to return to work. This means if you have to test negative before returning to work or if a place of employment requires regular testing.

The Plan continues to cover telehealth. Members should always ask their provider if they offer telehealth services. The Plan implemented a new telehealth policy effective January 1, 2023. Below are the services that will no longer be covered at the same copay as in-person care (if a person receives these services via a telehealth appointment). The services below will continue to be covered, but members will have to pay the appropriate copay.

• Dialysis services
• Physical Therapy/Occupational Therapy evaluations
• COVID testing services
• Emergency Department Evaluation and Management Services
• Hospitalization Evaluation and Management Services
• Extended Office Visits
• New Patient Preventative/Annual Wellness Exams

Please call Customer Service at 888-234-2416 if you have any questions about your telehealth benefits.

Through Dec. 31, 2022, the State Health Plan has spent nearly $445.5 million on efforts to fight COVID, including tests, vaccines and treatment