More Guidance on COVID-19 Testing and Vaccine Coverage Requirements

February 26, 2021, the Departments of Labor, Health and Human Services, and the Treasury (Agencies) issued new FAQs detailing additional guidance for group health plan coverage of COVID-19 testing and vaccines.

March 02, 2021

February 26, 2021, the Departments of Labor, Health and Human Services, and the Treasury (Agencies) issued new FAQs detailing additional guidance for group health plan coverage of COVID-19 testing and vaccines. We summarize below the most significant guidance for employers:

Testing Coverage

Generally, both insured and self-insured group health plans must cover COVID-19 testing without cost-sharing, prior authorization, or other medical management requirements. The new FAQs specify, among other things, that:

  • Asymptomatic individuals. Group health plans cannot use medical screening criteria to deny (or require cost-sharing on) claims for COVID-19 testing for asymptomatic individuals with no known or suspected exposure to COVID-19.
  • Diagnosis/treatment vs. other purposes. Plans are not, however, required to cover testing for public health surveillance or employment purposes.
  • State/local testing sites. Plans must cover testing from licensed or authorized providers, including from state or locality-administered sites and drive-through sites.
  • Point-of-care tests. Plans also must cover, without cost-sharing, point-of-care tests such as rapid antigen tests.

Vaccine Coverage

As with testing, insured and self-insured group health plans must cover, without cost-sharing, all COVID-19 vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). The new FAQs specify, among other things, that:

  • Priority groups. Plans cannot deny coverage because a participant is not in a category recommended for early vaccination. Likewise, provider decisions to decline to give the vaccine because they are not in a prioritization category is not subject to ERISA’s claims and appeals procedures.
  • EAPs and On-site clinics. Employers can offer vaccine benefits through EAPs and on-site clinics—for example, to employees who are not enrolled in the employer’s group health plan—without running afoul of ERISA requirements that generally apply to group health plans.

Effective Date

These FAQs interpret existing law and regulations and therefore are effective immediately.

What's Next?

We will provide a more detailed discussion of this and other new COVID-19 guidance in our next regulatory and compliance webinar on March 18, 2021 at 12:00PM ET. Members can register here.

We expect that in the coming weeks and months, agencies will continue to issue guidance related to COVID-19, the workplace, and employer-sponsored health coverage. We will keep our members updated of any new guidance.

Resources

If you have questions, comments, or concerns about these or other regulatory and compliance issues, please contact us.

We provide this material for informational purposes only; it is not a substitute for legal advice.

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