On March 18, 2020, the President signed into law the Families First Coronavirus Response Act. This law requires, among other things, that group health plans cover COVID-19 testing and related provider visits with no out-of-pocket costs. The Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted March 27, 2020, includes additional details on this testing requirement. We provide an overview of the provisions most relevant to large employers below.
COVID-19 Testing: No Out-of-Pocket Costs
Effective March 18, 2020, all group health plans—insured and self-insured—must cover COVID-19 testing without cost-sharing (no deductibles, copayments, coinsurance). Specifically:
- Coverage includes items and services furnished during office, telehealth, urgent care, and emergency room visits, provided the items/services are related to the furnishing or administration of testing or evaluation to determine the need for testing.
- Covered testing includes all FDA-approved COVID-19 testing and tests: (1) for which the developer has requested or intends to request emergency use authorization from the FDA, (2) developed in or authorized by a state, and (3) deemed appropriate by HHS.
- Plans must reimburse testing providers the negotiated rate that was in effect before the COVID-19 public health emergency.
- If a plan did not have a negotiated rate, the plan must reimburse at a cash price that the CARES Act requires providers to publish.
We recommend that employers:
- Discuss with their third-party administrators and other vendors (1) how their group health plans will implement this coverage, including any payment, coding, and billing changes that may be needed; (2) how to handle in- and out-of-network coverage for testing; and (3) future at-home testing options.
- Amend plan documents and SPDs, as necessary;
- Amend provider agreements, if necessary; and
- Determine how to communicate these coverage changes to participants.
What happens next?
We expect that the Department of Health and Human Services, Department of Labor, and Internal Revenue Service will issue implementation guidance. The Business Group will provide updates as guidance becomes available.
- Families First Coronavirus Response Act
- Business Group Coronavirus Resources
- Coronavirus Aid, Relief, and Economic Security Act
Do you have regulatory/compliance questions related to COVID-19? Please contact us.