By: HUB’s EB Compliance Team
The $2 trillion rescue package (the Coronavirus Aid, Relief, and Economic Security Act known as the CARES Act) includes several benefits-related provisions of relevance to employers. Not all of them are coronavirus-related.
On the COVID-19 front, the bill makes the following changes:
- The CARES Act expands the coronavirus testing items health plans will have to cover on a first-dollar basis. The Families First Coronavirus Response Act only required coverage of FDA-approved testing for the coronavirus. The CARES Act adds to that:
- Tests that are being fast-tracked by the FDA pending approval;
- Tests for which the manufacturer says they plan to seek FDA approval;
- State-developed tests from States that have notified the U.S. Department of Health and Human Services that they are reviewing potential tests; or
- Any other tests that are approved by the Federal Government.
- The CARES Act also establishes a process for determining what a health plan has to pay for of a coronavirus test.
- If the provider is an in-network provider, the plan pays its negotiated rate. The negotiated rate will remain in effect through the duration of the declared COVD-19 emergency.
- If the provider is out-of-network, then the plan will reimburse the provider for the cash price that the provider posts on its website, unless the plan negotiates a different price. Under the CARES Act, the provider is required to post a cash price for the test on its website, or face penalties of up to $300 per day.
- Plans will also be required to cover, at no cost to participants, U.S.-government approved preventive measures for the coronavirus on an expedited basis. Specifically, once a vaccine or other preventive measure is approved, plans will need to cover on a first dollar basis starting 15 business days after it is approved. (This is significantly faster than the normal timeframe, which is the first plan year that begins at least 12 months after a preventive item or service is approved.) Like the coverage for coronavirus testing, this provision will extend to all types of group health plans, including insured, self-insured (level-funded), grandfathered, non-grandfathered, and plans knows as Minimum Essential Coverage (MEC) plans that commonly only cover preventive care services.
- For plan years before January 1, 2022, high deductible health plans (HDHPs) would be able to cover telehealth for any condition pre-deductible and still allow employees to contribute to a health savings account (HSA). To be clear, HDHPs do not have to offer telehealth, but if they do, it can be used for both COVID-19 and any other condition on a first-dollar basis during this period without impacting an employee’s ability to contribute to an HSA. This is good news because some carriers are offering these services before satisfying the deductible for more than just for treatment COVID-19 issues. These services also support social distancing and hopefully alleviates some strain on the health care system.
Employers should work with the HUB Consultant and their insurance carriers or third-party administrators (TPAs) to ensure that the proper items and services are covered. Self-funded employers will need to update their plan documents to reflect these changes. All employers will need to update their summary plan descriptions to reflect these changes as well.
HSA, HRA, and Health FSA Changes
The CARES Act expands what items can be reimbursed from health flexible spending arrangements (FSAs), health reimbursement arrangements (HRAs), and HSAs. First, it allows these accounts to, once again, reimburse for over-the-counter items. The ACA previously said over-the counter items were not reimbursable by these accounts, but they will be again under the CARES Act. Secondly, the CARES Act allows the costs of menstrual products, like maxi pads and tampons, to be reimbursed by those accounts as well. These changes are effective retroactively to January 1, 2020.
For HSAs, the account holders (mostly employees) are generally required to maintain their own records of permissible expenses. However, employers may want to communicate these changes.
For Health FSAs and HRAs, employers that want to allow these reimbursements will need to amend their plan documents and communicate this change to their employees. However, employers should check with their TPA to make sure the TPA can support this expansion.
The CARES Act also directs the Secretary of HHS to issue new rules regarding the sharing of PHI during this COVID-19 emergency. New guidance is to be issued by the Secretary of HHS no later than 180 days from the enactment of the CARES Act.
As employers know, this is a rapidly-evolving situation. Please keep visiting HUB’s Coronavirus Resource Center for the latest updates on this and other developments under this law.
NOTICE OF DISCLAIMER
The information herein is intended to be educational only and is based on information that is generally available. HUB International makes no representation or warranty as to its accuracy and is not obligated to update the information should it change in the future. The information is not intended to be legal or tax advice. Consult your attorney and/or professional advisor as to your organization’s specific circumstances and legal, tax or other requirements.