News & Events
COVID-19 Emergency Group Health Plan Provisions
April 6th 2020
On March 18, 2020, H.R. 6201 (the Families First Coronavirus Response Act, the “Act”) was signed into law. The Act, in response to the COVID-19 (coronavirus) pandemic, includes provisions that affect coverage under all group health plans, including grandfathered health plans, as specified below. The Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), signed into law on March 27, 2020, amended the Act and added additional provisions affecting coverage under group health plans. Your group health plan is required to and hereby adopt these temporary provisions, even if your Plan does not usually provide such services. If your Company wishes to offer benefits above and beyond what is required by the Act, then those changes need to be added separately from these provisions with a formal amendment to the Plan.
Many group health plans contract with a preferred provider organization (PPO) or otherwise have health care cost savings measures in effect under which benefits are administered. The Act itself does not differentiate between PPO and non-PPO providers or other health care cost savings measures for the coverage of testing for COVID-19. Further regulation or guidance may follow in this regard, and the Company may opt to apply its PPO provisions or other health care cost savings measures under the following provisions when allowed under the Act or any subsequently issued guidance or regulations. The CARES Act did add specific payment provisions specific to the pricing of diagnostic testing. Nonetheless, all Covered Individuals are encouraged by the Company to receive services from PPO providers or providers the Plan recommends for cost-effective services when possible. All other terms and provisions of the Plan remain in effect.
Coverage changes under the Plan being made as a result of the Act both the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act include the following:
Effective During the COVID-19 Emergency Period:
Coverage of Testing for COVID-19:
In accordance with the Families First Coronavirus Response Act (the Act) and its provisions as amended under the CARES Act, the Plan shall provide coverage, and shall not impose any cost sharing (including Deductibles, Copayments, and Coinsurance) requirements or prior authorization or other medical management requirements, for the following items and services furnished during any portion of the emergency period:
- In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such a test.The CARES Act added provisions addressing payment for diagnostic testing as follows: If the health plan has a negotiated rate with the provider in effect before the public health emergency, such negotiated rate shall apply throughout the period of the public health emergency. If the health plan does not have a negotiated rate with the provider, the plan shall reimburse the provider in an amount that equals the cash price for such service as listed by the provider on a public internet website, or the plan may negotiate a rate with such provider for less than the cash price.
- Items and services furnished to an individual during health care provider office visits (which term in this paragraph includes in-person visits and telehealth visits), urgent care center visits, and emergency room visits that result in an order for or administration of an in vitro diagnostic product described in paragraph (1), but only to the extent such items and services relate to the furnishing or administration of such product or to the evaluation of such individual for purposes of determining the need of such individual for such product.
- Coverage of Preventive Services and Vaccines. The CARES Act includes a provision requiring group health plans to cover (without cost-sharing) any qualifying coronavirus preventive service, meaning an item, service, or immunization that is intended to prevent or mitigate coronavirus disease 2019, effective 15 business days after the U.S. Preventive Services Task Force issues a rating of “A” or “B” for the item or service or when an immunization has in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
The Act states that the Secretary of Health and Human Services, Secretary of Labor, and Secretary of the Treasury may implement the provisions of Families First Coronavirus Response Act through sub-regulatory guidance, program instruction or otherwise; the Plan intends to comply with any such guidance, program instruction or otherwise to the extent required by same.
Effective Until December 31, 2020:
Emergency Family and Medical Leave Expansion Act
In addition to the Family and Medical Leave Act Provision of the Plan, all provisions under the Plan are further intended to be in compliance with the Emergency Family and Medical Leave Expansion Act provisions of the Families First Coronavirus Response Act, to the extent said Act applies to the Company.