By: HUB’s EB Compliance Team

On Saturday, April 11, the Departments of Labor, Treasury, and Health and Human Services (the “Departments”) released a set of FAQs on the Families First Coronavirus Response Act and the CARES Act. The FAQs provide some clarity on issues raised by those statutes.

Background

In response to the COVID-19 crisis, Congress passed two pieces of legislation that impact group health plans. The first, passed on March 18, was the Families First Coronavirus Response Act (FFCRA) which required nearly all health plans to cover testing for coronavirus without cost sharing, prior authorization, or other medical management techniques. This coverage requirement also applies to services provided during a visit that “relate to the furnishing or administration” of a COVID-19 test or that relate to the evaluation of whether the person needs a COVID-19 test as part of a visit with a health care provider.

The second law, passed on March 27, is the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act.  Among other items we discussed here, the CARES Act:

  • expanded the groups of tests that health plans had to cover under the FFCRA,
  • established a price-setting mechanism for tests administered by out-of-network providers,
  • requires health plans to cover vaccines and other preventive measures within 15 days after they are approved (none are yet approved as of the date of this posting); and
  • allowed high deductible health plans to cover telehealth for any condition (not just COVID-19) before the deductible was satisfied to help facilitate social distancing, but only through plan years beginning before January 1, 2022.

Clarity on Coverage and Communication

The FAQs provided additional clarity on these requirements.  Specifically:

  • Diagnostic tests include tests for antibodies (FAQ 4), which means they also must be covered without cost sharing, prior authorization, or medical management.
  • Similarly, other items covered as part of a visit with a health provider can include other tests, such as blood tests or even tests for other ailments (e.g., influenza test), if the provider thinks they are necessary to determine whether a COVID-19 test is appropriate and if the visit ultimately results in an order for or administration of a COVID-19 diagnostic test (FAQ 5).
  • A “visit” to a healthcare provider can include both traditional and non-traditional settings, including drive-through screening and testing sites where licensed health care providers are administering diagnostic testing for COVID-19 (FAQ 8).
  • Normally, if there is 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, the Departments 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 (FAQ 9). 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 deadline for plan changes 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.
  • States may impose additional requirements on health insurance issuers related to COVID-19 that go beyond what the federal government requires (FAQ 10). Presumably, this will not apply to self-funded plans.

Other Issues

Additionally, the FAQs give some information on the effect of COVID-19 coverage on other benefits. For example, employee assistance programs (“EAPs”) can cover COVID-19 diagnosis and testing (but not treatment) during the public health emergency or national state of emergency and still be considered excepted benefits (FAQ 11). As a reminder, excepted benefits are those that do not have to comply with many of the requirements under the Affordable Care Act or the portability requirements under the Health Insurance Portability and Accountability Act of 1996, as amended. 

Notably, the FAQs state that on-site clinics where employers offer medical care on-site are always excepted benefits (FAQ 12). This means they can provide COVID-19 diagnosis and testing as well.

Finally, for plans expanding telehealth, for both COVID-19 and other services not related to COVID-19, the Departments will not enforce the 60-day advance notice requirement described above for SBCs (FAQ 14). The Departments are encouraging the widespread use of telehealth (whether for COVID-19 or other types of visits, including mental health and substance use disorder services) to keep individuals home to help prevent exposure to COVID-19. Therefore, deductibles and copayments may be removed for all telehealth visits without impacting HSA-eligibility for those enrolled in HDHP coverage. Again, notice is required to employees and participants as soon as reasonably practicable (among the other conditions described above).

Next Steps

Employers should work with their HUB consultant and insurance carrier (for insured plans) or third party administrator and stop loss providers (for self-funded plans) to ensure that their plans are covering the correct items. 

Additionally, employers should confirm whether the health plan changes result in SBC-required updates. If so, then employers should make sure the updated SBCs are distributed promptly, noting that the Department will not be enforcing the 60-day advance notice requirement for changes that enhance benefits for COVID-19 testing or telehealth benefits. Employers will still need to provide the updated SBC or Summary of Material Modification as soon as practicable.

For the latest information on the COVID-19 crisis and its effect on employers, please keep visiting HUB’s Coronavirus Resource Center. 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.