Recently, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury released FAQ guidance relating to group health plans under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and the Families First Coronavirus Response Act (FFCRA). Highlights from the FAQ guidance include the following:
Covered Plans and Products
COVID-19-related provisions under the CARES Act and the FFCRA apply to:
- Group health plans and insurers offering group or individual health insurance in group and individual markets, including the ACA;
- ERISA plans;
- Plans sponsored by local and state governments;
- Church plans;
- Individual market health plans; and
- Student health plans.
Plans for which COVID-19-related provisions under the CARES Act and the FFCRA do NOT apply include:
- Short-term, limited-duration insurance;
- Excepted benefits plans; and
- Group health plans that do not cover at least two current employees.
COVID-19 Items and Services Requiring Coverage
Health plans and insurers are required to provide coverage for in vitro diagnostic testing products and services — including serological tests for COVID-19 — that:
- Are approved or authorized by the Food and Drug Administration (FDA);
- A developer has requested, or intends to request, emergency use authorization from the FDA;
- Are developed in and authorized by a state, with prior notification to HHS; or
- The HHS deems appropriate
This coverage requirement includes items and services provided to an individual in a healthcare provider’s office or during a telehealth visit, as well as to visits to an urgent care center or emergency room.
Cost-Sharing
Health plans and insurers are prohibited from imposing any cost-sharing, prior authorization, or medical management requirements for COVID-19 testing and related services. If an in-network provider rate that was negotiated and in effect prior to March 13, 2020, when the COVID-19 public health emergency was declared, that rate applies throughout the declaration period. Out-of-network providers must be reimbursed in the amount of the price for services “as listed by the provider on a public Internet website, or the plan or issuer may negotiate a rate with the provider for less than such cash price.”
Plan Amendment Timing and SBC Notice Requirement Waiver
Summaries of Benefits and Coverage (SBCs) currently require an advance notice of 60 days for a material modification in any plan terms or coverage that would have a material effect on the content of the SBC. During the COVID-19 public health emergency, this requirement will not be enforced. Plans and issuers can amend plan or policy terms to add benefits or reduce or eliminate cost-sharing for COVID-19 diagnosis and treatment without having to comply with current notice of modification requirements. Instead, notice may be made as soon as reasonably practicable.
Excepted Benefits
Employers are allowed to offer benefits for COVID-19 diagnosis and testing under an Employee Assistance Program (EAP) or through an on-site clinic with no loss in status for the EAP or clinic as an excepted benefit.
Telehealth Services
Participants enrolled in high deductible health plans (HDHPs) — including those with HSAs — are no longer required to meet their deductibles before gaining access to telehealth services. Individuals enrolled in a HDHP will still be able to make and receive contributions to an HSA if their plan offers no-cost telehealth services before a deductible is satisfied. These changes apply to all telehealth coverage; they are not limited to COVID-19-related telehealth services.
The experienced, responsive team of ERISA attorneys at Hall Benefits Law helps plan administrators understand what regulations and rulings are relevant and how best to apply these rulings in practice. Learn more by calling 678-439-6236.
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