Agency FAQs Clarify COVID-19 Coverage Requirements

By The CIP Group

March 3, 2021

Health Plans and Issuers Must Cover COVID-19 Diagnostic Items and Services Without Cost-sharing

On Feb. 26, 2021, the Departments of Labor, Health and Human Services (HHS), and the Treasury issued FAQ guidance to clarify health coverage requirements related to COVID-19 diagnostic testing and vaccinations.

The FAQs explain that plans and issuers:

  • May not use medical screening criteria to deny (or impose cost sharing on) a claim for COVID-19 diagnostic testing for an asymptomatic person with no known or suspected exposure to COVID-19.
  • May distinguish between COVID-19 diagnostic testing of asymptomatic people that must be covered, and testing for general workplace health and safety or other purposes not primarily intended for individualized diagnosis or treatment of COVID-19.
  • Must assume that a test is for individualized clinical assessment if it is provided by a licensed or authorized provider, including at a state- or locality-administered site, a drive-through site or a site that does not require appointments.
    These FAQs also provide guidance regarding: (1) coverage of COVID-19 vaccines and other preventive care services; (2) notice requirements for plans and issuers regarding coverage of preventive care services; and (3) requirements for employee assistance programs (EAPs) and on-site medical clinics that administer COVID-19 vaccines to be considered excepted benefits.

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