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ML BeneBits

The Families First Coronavirus Response Act (Act), signed into law Wednesday, requires group health plans to provide coverage for coronavirus (COVID-19) diagnostic testing, including the cost of healthcare provider visits (as well as telehealth visits), urgent care center visits, and emergency room visits in order to receive testing. Coverage must be provided at no cost-sharing to participants.

This mandate lasts for the duration of the public health emergency declaration period and became effective March 18.

Group health plan sponsors should amend their plans and consult with their third-party administrators and insurers to ensure the group health plan complies with the mandate.

The Act leaves certain questions unanswered, such as:

  • whether all associated charges are covered, regardless of where the services are provided or if they are received from an out-of-network provider;
  • whether employers are permitted or required to extend the terms of the Act to individuals who did not enroll in group health plan coverage; or
  • whether employers who do not currently cover Telehealth must reimburse for such services.

Future Tri-Agency sub-regulatory guidance likely may address these issues. Employers should consider the possibility of having to re-adjudicate claims as this guidance is issued.

As previously noted in our earlier post, the IRS issued a Notice that permits coverage of COVID-19 testing and treatment at no cost-sharing in a high-deductible health plan without jeopardizing eligibility under a health saving account. Notably, the mandate under the Act is limited only to COVID-19 testing.