Agency Guidance Regarding Coverage for At-Home COVID-19 Tests

Employee Benefits

Agency Guidance Regarding Coverage for At-Home COVID-19 Tests

On January 10, 2022, the Departments of Labor, Health and Human Services (HHS) and the Treasury (collectively, the Departments) issued a new set of FAQs addressing group health plan and health insurance issuer coverage for at-home COVID-19 diagnostic tests. FAQ Part 51 further expands upon and updates past guidance issued by the Departments regarding requirements under the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief and Economic Security Act (CARES Act).

Key Takeaways for Group Health Plans:

  • Group health plans must cover over-the-counter (OTC) COVID-19 tests under section 6001 of the FFCRA, with or without an order or individualized clinical assessment by an attending health care provider.
  • Plans and issuers must begin providing coverage for OTC COVID-19 tests available without an order or individual assessment purchased on or after January 15, 2022, and during the public health emergency.
  • FAQ Part 51 does not modify the Department’s prior guidance with respect to coverage of COVID-19 testing for employment or public health screening purposes. .[1]
  • Group health plans will need to ensure appropriate systems are in place for processing reimbursements. This may require working directly with TPAs and carriers.

Background

Guidance under FAQ Part 43 issued in June 2020 stated that plans and issuers must cover, without cost-sharing, COVID-19 tests intended for at-home testing when the test is determined to be medically appropriate for the individual by an attending health care provider who has ordered the test.[2]

President Biden announced on December 2, 2021, plans for expanding free at-home testing while stating that during the public health emergency, individuals who purchase OTC at-home COVID-19 diagnostic tests can seek reimbursement from their group health plans or health insurance issuers to cover the costs of the tests.[3] However, the announcement noted that COVID-19 testing for workplace screening would remain consistent with current guidance. In his announcement, President Biden, also directed the Departments to issue guidance by January 15, 2022, to clarify the above requirements, which they have provided under FAQ Part 51.

Regulatory and Legislative Strategy Group

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