HIGHLIGHTS

  • The FFCRA and the CARES Act include a number of changes for health plans and health insurance issuers.
  • Health plans and issuers must cover COVID-19 testing without any cost-sharing requirements.
  • HDHPs may cover telehealth and other remote care services without a deductible.
  • The Departments have issued FAQs on these coverage changes.

IMPORTANT DATES

March 18, 2020Health plans and issuers must cover COVID-19 testing without imposing any cost-sharing requirements.

March 27, 2020
HDHPs can cover telehealth or other remote care services without a deductible.

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The Departments of Labor, Health and Human Services and the Treasury (Departments) have provided answers to frequently asked questions (FAQs) regarding health coverage issues related to COVID-19, including implementation of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security Act (CARES Act).

These new laws require health plans and issuers to cover certain items and services related to the diagnosis of COVID-19 without imposing any cost-sharing requirements (including deductibles, copayments and coinsurance) or prior authorization or other medical management requirements. According to the Departments’ FAQs, health plans and issuers must provide notice of the changes to plan participants as soon as reasonably practicable.

According to the Departments, their approach to implementation of the new coronavirus-related requirements will focus on assisting (rather than penalizing) group health plans, health insurance issuers and others who are working diligently and in good faith to comply with the new requirements.

This Compliance Bulletin contains the Departments’ FAQs.

ACTION STEPS

Employers that sponsor group health plans should become familiar with the FFCRA’s and CARES Act’s changes for their health plans. The Departments’ FAQs clarify that the Affordable Care Act’s 60-day advance notice requirement does not apply to these changes. However, health plans and issuers must notify plan participants of the changes as soon as reasonably practicable.

Overview of New Laws

The FFCRA

The FFCRA was enacted on March 18, 2020. Section 6001 of the FFCRA generally requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide benefits for certain items and services related to diagnostic testing for the detection of SARS-CoV-2 or the diagnosis of COVID-19 (referred to collectively as COVID-19) when those items or services are furnished on or after March 18, 2020, and during the applicable emergency period. Under the FFCRA, plans and issuers must provide this coverage without imposing any cost-sharing requirements (including deductibles, copayments and coinsurance) or prior authorization or other medical management requirements.

The CARES Act

The CARES Act was enacted on March 27, 2020. Section 3201 of the CARES Act amended section 6001 of the FFCRA to include a broader range of diagnostic items and services that plans and issuers must cover without any cost-sharing requirements or prior authorization or other medical management requirements.

Additionally, section 3202 of the CARES Act generally requires plans and issuers providing coverage for these items and services to reimburse any provider of COVID-19 diagnostic testing an amount that equals the negotiated rate or, if the plan or issuer does not have a negotiated rate with the provider, the cash price for such service that is listed by the provider on a public website. (The plan or issuer may negotiate a rate with the provider that is lower than the cash price.)

State Laws

As discussed in Q9 below, nothing in the FFCRA or the CARES Act prevents a state from imposing additional standards or requirements on health insurance issuers with respect to the diagnosis or treatment of COVID-19, to the extent those standards or requirements do not prevent the application of a federal requirement.

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