Q: Can employer sponsored health plans be modified to expand their coverage for treatment of COVID-19, such as waiving deductibles, or lowering ER copays related to COVID-19 for treatment (in addition to the required coverage for screening and testing)?

A: Maybe, Yes. However, fully-insured health plans are limited to the changes their insurance carrier will allow. Individual carriers establish their own policies for plan modification, which includes not allowing any form of modification.

Self-Insured plans may make mid-year plan design changes by working with their TPA and stop-loss carriers. Note that for self-funded plans using carriers as their TPA/administrative services only providers, some of those carriers have issued notices to their customers offering the opportunity to opt-in or opt-out of this coverage voluntarily.

These changes should be communicated to employees/participants.  Normally, if there’s a material change in plan terms mid-year that affect the content of the most recent Summary of Benefits and Coverage (“SBC”), an updated SBC must be distributed at least 60 days before the change can take effect.  However, these FAQs state that the federal government will not enforce this deadline against plans that adopt these required changes, or other changes to provide greater coverage for testing or treatment of COVID-19, with less than 60 days’ advance notice.  However, plans must provide notice as soon as they reasonably can.  This relief only applies while the COVID-19 national state of emergency or public health emergency are in effect.   Once these have been lifted, the standard rules will apply. 

Additionally, the Departments reserve the right to take enforcement action against plans that attempt to offset the cost of COVID-19 testing and treatment by raising the cost sharing, or limiting coverage of, other benefits.

Employers should review their SBC to see if changes are necessary.  Even if they are not, employers will want to communicate any changes to their covered employees and dependents as soon as they reasonably can.

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