October 6, 2022


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COVID-19 health insurance coverage changing in 2022

WAUSAU, Wis. (WSAW) – As the world begins to close in on nearly two full years in the COVID-19 pandemic, health insurance agencies are shifting how much they are covering come 2022.

Jenny Shermo, the chief growth officer for Security Health Plan in Marshfield said they have completely covered all COVID-19 testing and in-patient treatment and monitoring since the pandemic began, noting that other insurance providers stopped that coverage after a year. She explained they had been monitoring the federal recommendations of what insurance agencies should cover and the trends in the usage of the benefits to determine if changes would make too big of an impact.

Starting Jan. 1, 2022, Security Health Plan will no longer completely cover in-patient treatment and monitoring for all of its plans.

“It would be like just like any other hospital stay, your normal cost-sharing according to your plan benefits would apply.”

It also will not be covering COVID-19 testing that is not considered “medically necessary.”

“If there’s been an exposure or any sort of symptoms, then those will continue to be covered just as they always have been at no cost to members, the only change would be for those that are more routine screenings similar to how, you know, drug testing or sports-related physicals work today that there isn’t a medical necessity.”

Shermo explained the trends have shown a shift in their medical activity, largely back to pre-pandemic care. The need for COVID treatment and testing flows with the waves seen in the general public, with more use in the winter compared to the summer. The testing Security Health Plan has been processing, in particular, has been mostly due to what will soon be considered “medically necessary” reasons anyway.

“Out of more than 175,000 COVID tests since this started, it’s less than half of a percent have been for routine purposes.”

That is what the City of Wausau has been seeing from its employees as well. Toni Vanderboom, the city’s human resources director said it has not had a testing requirement for employees to return to work for a while and with the Centers for Disease Control and Prevention changes this week recommending five days of quarantine, the early return to work testing will not be necessary.

“I think everybody — employees and HR departments — have found COVID to be really challenging. It’s been a changing process throughout the pandemic,” Vanderboom expressed.

The city’s COVID policies are written to follow whatever the current CDC recommendations are, which means it has had to change the policies 8-10 times over the last nearly two years.

“It’s hard to keep employees up-to-date so they know what they need to do and expectations.”

The changes in health insurance fall in line with what the current CDC recommendations would have covered.

“The first thing that we do when we find out that an employee has been exposed is we ask them their vaccination status because current CDC, DHS, and county recommendations vary depending upon an employee’s vaccination status,” Vanderboom said.

Those who are showing symptoms or who have had a possible exposure are recommended to get tested. That testing, Shermo said, would be completely covered. Though, if someone has questions about what COVID-related medical procedures would be covered, she always recommends that people ask.

For the latest CDC guidelines, click here.

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