Agencies Issue Interim Final Rule on COVID-19 Preventive Services Coverage

The Departments of Treasury, Labor, and Health and Human Services have issued an interim final rule (IFR) regarding group health plan coverage of COVID-19 testing and vaccines.

Under the Affordable Care Act (ACA), group health plan providers must provide certain preventive services with no cost sharing. Under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), preventive services related to COVID-19 must be covered within 15 business days after such services receive an “A” or “B” recommendation from the U.S. Preventive Services Task Force (USPSTF). In addition, group health plans must include coverage for immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) and adopted by the Director of the Centers for Disease Control and Prevention within 15 business days.

Qualifying COVID-19 Preventive Services

Plans must cover the cost of a vaccine’s administration, even if a third party like the federal government pays the cost of the vaccine itself. If the primary purpose of an office visit is to receive a COVID-19 vaccine and the office visit is not billed separately, then the health plan must cover the cost of the office visit with no cost sharing. However, if an office visit is billed separately, the plan may impose cost sharing.

Grandfathered plans and plans providing excepted benefits or short-term, limited-duration coverage are not required to comply with the rules regarding qualifying COVID-19 preventive services.

COVID-19 Testing Services

Under the CARES Act, health plans – including grandfathered plans but not plans providing excepted benefits or short-term, limited-duration coverage – are required to cover a number of COVID-19-related testing services or items. Providers of these tests, whether in- or out-of-network, must be reimbursed according to either the price listed by the provider on its website (a CARES Act requirement) or a lower negotiated rate. 

The IFR is effective as of November 2, 2020, and it will be enforced until the end of the COVID-19 public health emergency.

The ERISA attorneys at Hall Benefits Law help our clients manage legislative and regulatory changes to employee benefit plans. To get help with benefit plan legal compliance, call 678-439-6236.

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