Accessing benefits during a disaster or emergency

What you need to know

You'll have access to your benefits during a public health emergency or disaster. When one of these events is declared, and until it ends, we'll:

  • Temporarily reduce out-of-network cost sharing amounts to in-network amounts.
  • Waive referral requirements in full or in part, where applicable
  • Make changes that benefit you effective immediately, without the required 30-day notice

Who declares a disaster or public health emergency?

The Centers for Medicare & Medicaid Services (CMS) states that a declaration of a disaster may be made by:

  • A Presidential declaration of a disaster or emergency under either:
    • The Stafford Act
    • The National Emergencies Act
  • A secretarial declaration of a public health emergency under Section 319 of the Public Health Service Act.
  • A declaration of emergency or disaster by the governor of your state or territory

If the President declares a disaster, the secretary of Health and Human Services may also authorize waivers or modifications under section 1135 of the Public Health Service Act.

When does a disaster or public health emergency end?

The public health emergency or state of disaster ends 30 days after when any of these occur:

  • The source that declared the public health emergency or state of disaster says it's over
  • CMS declares that the public health emergency or state of disaster is over
  • Thirty days have passed since the public health emergency or state of disaster was declared and not end date was given,
    • or 30 days after a declaration end date is provider

We'll let CMS know if we can't resume normal operations by the end of the public health emergency or state of disaster.

CMS also requires us to:

  • Explain your payment terms and conditions if you live in a disaster area and get care from an out-of-network provider during a declared emergency or disaster 
  • Notify you each year of any special requirements that are in effect during a disaster or emergency
  • Share these special requirements with you on our website