The U.S. Departments of Labor, Health and Human Services, and the Treasury have jointly published a set of frequently asked questions that offer guidance on a number of benefits issues related to the expansion of coverage during the COVID-19 emergency period. The questions pertain to the COVID-19 rules under the Families First Coronavirus Response Act (FFCRA) and the CARES Act and how those rules apply to certain other laws.
- Confirms that coverage for medically appropriate COVID-19 testing and related expenses applies to both insured and self-funded health plans, testing at home or at a medical facility, and in-network and out-of-network services. Any provider acting within the scope of his or her license who is providing care to an individual may determine the medical appropriateness of a COVID-19 test. Only diagnostic tests need to be covered. Coverage for multiple diagnostic COVID-19 tests must be provided if they are medically appropriate. Coverage must be provided for facility fees, such as emergency room fees, related to diagnostic COVID-19 testing.
- Identifies websites to assist in determining whether certain COVID-19-related expenses need to be covered.
- Provides that testing conducted by employers primarily for workplace safety and surveillance does not need to be covered by a health plan.
- Prohibits balance billing for diagnostic COVID-19 tests. The guidance recognizes the statutory rules do not determine the appropriate charge for such tests and related charges when a provider has not appropriately posted a fee (and the plan and provider are unable to negotiate the amount to be paid). Where applicable, state laws regarding balance billing, including dispute resolution mechanisms, if any, will apply.
- Provides that an employer that notifies plan participants of the general duration of an expansion in coverage that applies during the COVID-19 emergency period (for the coverage of diagnostic testing and other increases in coverage or reductions in cost-sharing) will not need to provide a second notice when the emergency period ends.
- Allows large employers to offer a plan that covers only telehealth services to employees who are not otherwise eligible for coverage under any of the employer’s health benefit plans and to limit the telehealth-only plan to those employees. The plan will be subject to certain of the Affordable Care Act’s (ACA’s) market reforms.
- Provides that plans that are grandfathered under the ACA and that expand coverage or reduce cost-sharing only for the emergency period will retain their grandfathered status.
- Announces that the three departments will not take enforcement action against a plan that disregards diagnostic COVID-19 testing and related expenses that are covered without cost-sharing in conducting quantitative tests under the Mental Health Parity and Addiction Equity Act (MHPAEA).
- Permits wellness programs to waive a standard that is otherwise required to qualify for a reward because of COVID-19 circumstances if the waiver applies to all similarly situated individuals.
- In view of the fact that employers offering individual coverage HRAs are relieved from specific deadlines for providing the required notice (but must provide the notice as soon as administratively practicable), encourages employers to provide the required ICHRA notice early enough to allow employees to make informed decisions.
Employers will welcome some of the guidance offered by these FAQs. For example, the guidance regarding testing for workplace safety may help certain employers make decisions in setting return-to-work policies, and the confirmation that the Departments will not penalize employers that disregard COVID-19 testing expenses under the MHPAEA quantitative tests will prevent those expanded benefits from skewing the results of those tests.