CARES ACT – COVID-19 FAQs – Cost Sharing for COVID-19 Testing

On April 11, 2020, the U.S. Department of Labor, the U.S. Department of Health and Human Services, and the U.S. Treasury (together, the departments) issued FAQ guidance regarding implementation of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), and other health coverage issues related to COVID-19.The bulk of the guidance centers on questions arising from the FFCRA/CARES Act mandate that group health plans and health insurers provide benefits for certain items and services related to diagnostic testing for COVID-19 without cost-sharing. On that subject, the guidance:

• Confirms that the mandate applies to both fully-insured and self-funded group health plans, ERISA plans, non-federal government plans and church plans, individual coverage provided through or outside of an exchange as well as student health insurance coverage (as defined in 45 CFR 147.145). (Both for-profit and not-for-profit companies are included—again, there were no exclusions).
• Discusses in greater detail the items and services for which plans and issuers must provide coverage without cost-sharing, including the circumstances under which items and services are considered to be “furnished during a healthcare provider visit.”
• It clarifies that items and services must be covered without cost-sharing “only to the extent the items and services relate to the furnishing or administration of the test or to the evaluation of such individual for purposes of determining the need of the individual for the product, as determined by the individual’s attending health care provider. The guidance lists examples of other tests (e.g. influenza tests, blood tests, etc.) that are performed to determine the individual’s need for COVID-19 diagnostic testing when the visit results in an order for COVID-19 testing.
• Confirms the departments’ position that they will not take enforcement action against any plan for not providing a modification of the Summary of Benefits and Coverage (SBC) at least 60 days before the change becomes effective for changes that provide greater coverage related to COVID-19 during the period covered by either a public health emergency declaration or a national emergency declaration, so long as plans and issuers provide notice of the changes as soon as reasonably practicable.

The guidance also provides the following information:

• An employer may offer benefits for diagnosis and testing for COVID-19 under an EAP without impacting the EAP’s status as an “excepted benefit” under ERISA.
• An employer may offer benefits for diagnosis and testing for COVID-19 at an on-site medical clinic.

Link to the full guidance here (12 page PDF). 
In response to Coronavirus, AssuredPartners has recently launched a COVID-19 resources page on our website.