By: HUB’s EB Compliance Team

In response to the growing COVID-19/Coronavirus pandemic, Congress recently passed, and the President signed, the Families First Coronavirus Response Act (the “Act”). The Act has several provisions related to paid leave and other matters that are covered in HUB’s Coronavirus Resource Center. However, it also requires health plans to cover COVID-19 testing without cost sharing.

Covered Items and Services

The new rules apply to FDA-approved diagnostic products. They also apply to items and services furnished in connection with office visits, telehealth consultations, urgent care visits, and emergency room visits that result in the administration of an FDA-approved test. Basically, if someone goes to a doctor or hospital to get tested for COVID-19, the test and the related visit costs must be covered in full by the plan.

This new rule is incorporated into the Public Health Service Act, the Employee Retirement Income Security Act (“ERISA”), and the Internal Revenue Code. As a result, it applies to all employer-based plans, whether they are private, governmental, or church plans.  It also applies whether the plans are insured or self-funded.

Next Steps

Employers with insured coverage should work with the HUB advisor to confirm how these changes will be implemented in their plan and how they will be communicated.

Employers with self-funded plans should check with the third-party administrators (TPAs) and stop-loss carriers.  TPAs will need to make sure their systems are set up to process claims in this manner. Since this is a mandate, stop-loss carriers should cover these claims, but employers will want to work with their stop-loss carrier to confirm. Individual claims for testing are unlikely to trigger an individual stop-loss deductible/attachment point, but a large volume of tests, combined with other claims, may exceed an aggregate deductible/attachment point.

Employers also need to notify employees. The normal deadline for notifying employees of a change like this under an ERISA plan is not until 210 days after the end of the plan year in which the change becomes effective. However, given that some employees may have an imminent need, it is better to communicate this sooner rather than later.  Note that the regular ERISA distribution rules still apply.  

Of course, this is a rapidly-evolving situation. Please keep vising HUB’s Coronavirus Resource Center for the latest updates on this and other developments under this law.

If you have any questions, please contact your HUB Advisor. You can also view more compliance articles in our Compliance Directory.

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.