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Coronavirus Response Act Requires Health Plans to Cover COVID-19 Testing Coronavirus Response Act Requires Health Plans to Cover COVID-19 Testing

Coronavirus Response Act Requires Health Plans to Cover COVID-19 Testing

The Families First Coronavirus Response Act ("Act") became law on March 18, 2020. The Act mandates new employer-provided benefits related to the COVID-19 pandemic, including coverage without cost-sharing of testing and services related to the coronavirus.

Coverage of Testing for COVID-19
The Act requires that all group health plans (including grandfathered plans) and health insurers of individual or group policies provide coverage—without any cost sharing, prior authorization, or other medical management requirements—for the following products and services related to testing for COVID-19:
  • FDA-approved in vitro diagnostic products for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19 and the administration of these products; and
  • Items and services furnished during a visit to a provider's office (including via telehealth), urgent care, or an emergency room that results in an order for or administration of an in vitro diagnostic product described above, but only to the extent the item or service relates to (1) the furnishing or administration of the diagnostic product or (2) the evaluation of the individual to determine need for the diagnostic product.
The coverage requirement applies beginning March 18, 2020. The requirement applies to testing products and services that are furnished during any portion of a public health emergency declared by the Secretary of Health and Human Services ("HHS").
On January 31, 2020, the Secretary of Health and Human Services, Alex M. Azar II, declared a public health emergency for the entire United States regarding the coronavirus. The declaration is retroactive to January 27, 2020.
The Secretaries of HHS, Labor, and the Treasury are empowered to enforce the coverage requirement and to implement it through sub-regulatory guidance.
Most health plans and insurers likely already cover the services needed for testing COVID-19, but now they must do so without any cost-sharing or medical management requirements. Prohibited cost-sharing includes deductibles, copayments, and coinsurance. Although the Affordable Care Act ("ACA") mandated coverage of preventive care without cost-sharing, what is considered "preventive" under the ACA generally depends on recommendations and guidelines issued by the United States Preventive Services Task Force, Centers for Disease Control, or administrative entities.
The new coverage requirements apply to all group health plans that are "employee welfare benefit plans" as defined by the Employee Retirement Income Security Act ("ERISA") and any other plan contributed to by an employer (including a self-employed person) or employee organization for employees, former employees, and/or their families. This encompasses both insured and self-insured employer group health plans that cover active employees and/or retirees. It also includes group health plans sponsored by governmental and religious employers, even if they are not covered by ERISA.
As we reported in an earlier alert, the IRS has ruled that high-deductible health plans ("HDHPs") may provide health benefits associated with testing for and treatment of COVID-19 without a deductible. As a result, individuals who are covered under HDHPs that are now required to cover COVID-19 testing under the Act without cost-sharing will remain eligible to make contributions to a health savings account. The ruling was issued in Notice 2020-15 released on March 11, 2020.
For more information about the Families First Coronavirus Response Act and how it might affect your employee benefit plans, please contact Chris Sears, Kathleen Sheil Scheidt, Melissa Proffitt, Gary Blachman, Rob Gauss, Tara Sciscoe, Audra Ferguson-Allen, or the Ice Miller LLP Employee Benefits attorney with whom you work.
This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader should consult with legal counsel to determine how laws or decisions discussed herein apply to the reader's specific circumstances.
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