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:
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.