New FAQ Addresses Vaccine Coverage, Incentives, And Vaccine-Based Exclusions

As the result of a joint effort, the Departments of Labor, Health and Human Services, and the Treasury (the “Agencies”) released a new FAQ entitled, “Affordable Care Act Implementation Part 50, Health Insurance Portability and Accountability Act and Coronavirus Aid, Relief, and Economic Security Act Implementation.”

The FAQ addresses rapid coverage of preventive services for COVID-19 and vaccine incentives. They are in response to the December 12, 2020, adoption by the Director of the Centers for Disease Control (CDC) of the Advisory Committee on Immunization Practices (ACIP) recommendation for vaccination guidelines.

The FAQ also discusses how the ACIP recommendation affects when plans and issuers must provide coverage without cost-sharing for COVID-19 vaccines. The guidance states that these entities must pay for COVID-19 vaccines and their administration, without cost-sharing, immediately once a vaccine becomes authorized or approved. This requirement became effective on January 5, 2021, fifteen (15) business days after the CDC’s adoption on December 12, 2020,

The FAQ also discusses the time when vaccine incentives are permitted and whether a plan may condition eligibility for COVID-19 benefits or coverage on whether participants, beneficiaries, or enrollees are vaccinated.

The guidance states that conditioning eligibility in this manner is not permitted. ERISA and federal regulations generally prohibit plans and issuers from discriminating against participants, beneficiaries, and enrollees in eligibility, premiums, or contributions based on a health factor.

Any benefits offered under the plan must be uniformly available to all similarly situated individuals. In addition, any benefit restrictions must apply uniformly to all similarly situated individuals and may not target individuals based on a health factor.

Also, any wellness program that provides a vaccine incentive, such as a premium discount to individuals who obtain a COVID-19 vaccination, must be reasonably designed to promote health, or prevent disease and provide a reasonable alternative standard to qualify for the discount.

An exception to the general prohibition on discrimination based on a health factor for wellness programs that meet federal standards is available. However, it is only accessible for premium discounts, rebates, and modifications of otherwise applicable cost-sharing mechanisms. Employers may not use the exception to deny eligibility for benefits or coverage based on a health factor.

HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.

The following two tabs change content below.

Hall Benefits Law, LLC

HBL offers employers comprehensive legal guidance on benefits in mergers and acquisitions, Employee Stock Ownership Plans (ESOPs), executive compensation, health and welfare benefits, healthcare reform, and retirement plans. We counsel a wide spectrum of clients including small, mid-sized, and large companies, 401(k) investment advisors, health insurance brokers, accountants, attorneys, and HR consultants, just to name a few. HBL is passionate about advising clients, and we are dedicated to our mission: to provide comprehensive, personalized, and practical ERISA and benefits legal solutions that exceed client expectations.

Latest posts by Hall Benefits Law, LLC (see all)

%d bloggers like this: