The Departments of Health and Human Services, Labor, and the Treasury jointly issued Frequently Asked Questions Part 42 to address the implementation of the Families First Coronavirus Response Act (the FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and other coverage issues for health insurers and group health plans related to COVID-19.

Under these laws, health plans, including employer-sponsored group health plans, and insurers must provide COVID-19 diagnostic tests and related services without imposing on participants any cost-sharing requirements, prior authorization requirements, or medical management requirements.

This requirement applies to both in-network and out-of-network claims. The CARES Act provides that plans must pay the negotiated rate for such services or, if there is no negotiated rate, the rate that the provider publishes on its website.

These changes will require amendments to ERISA plan documents and summary plan descriptions as well as summaries of benefits and coverage required by the ACA.  Usually, these sorts of amendments must be made prospectively, but the Department of Labor has granted relief from this requirement as long as plan sponsors make the amendments within a reasonable time.

Notably, the regulators warned that they would take action against any plan that attempts to limit or increase cost-sharing for other benefits to offset any increased costs to the plan imposed by the FFCRA or CARES Acts’ requirements. This may make it difficult for employers to justify plan design changes they may want to make for reasons unrelated to COVID-19 coverage.

Read the FAQs

Contact Charles Scheim or the Stevens & Lee attorney with whom you normally work if you have any questions.