Part I: COVID-19 Diagnostic Testing Coverage

On January 30, 2023, the Biden Administration introduced that it intends for the National Emergency (NE) referring to the COVID-19 pandemic to finish on May 11, 2023. Shortly after, the Department of Health and Human Services introduced the intent to finish the Public Health Emergency (PHE) on the identical day. The finish of the NE and PHE can have important impacts on group well being plans. In the approaching weeks, Stinson’s Employee Benefits Practice Group can be issuing a number of alerts describing these impacts and outlining issues and motion objects for plan sponsors to take earlier than the tip of the PHE and NE. This is the primary within the sequence of alerts.

During the PHE, most group well being plans are required to cowl sure objects and companies associated to diagnostic testing for COVID-19 with out cost-sharing (together with deductibles and copays or coinsurance), prior authorization, or different medical administration necessities. In January 2022, the Departments of Labor, Health and Human Services, and Treasury (the Agencies) issued steerage increasing this required protection to over-the-counter COVID-19 exams.

The COVID-19 diagnostic testing protection mandate ends with the expiration of the PHE. Group well being plan sponsors might want to take into account the next:

• Whether the group well being plan will proceed to cowl all COVID-19 diagnostic testing and—if that’s the case—whether or not cost-sharing necessities will apply. The Agencies issued guidance on March 29, 2023, encouraging plans and issuers to proceed offering protection of COVID-19 testing, with out cost-sharing after the PHE ends. Insured plans ought to attain out to their insurers to verify what the insurer has determined to cowl. Self-insured plans ought to work with their third-party directors to find out what protection choices can be found after the tip of the PHE.
• Whether a plan modification or participant discover is required. Plan sponsors might want to guarantee plan paperwork, abstract plan descriptions and different participant communications precisely replicate whether or not COVID-19 diagnostic testing protection will proceed. Group well being plans could should be amended, relying on the language used within the plan and whether or not protection will proceed. Similarly, participant discover might also be required, relying on language used to inform the participant of the change in protection.

The March 29 steerage encourages plans to inform individuals about key data referring to COVID-19 prognosis and therapy protection, such because the date protection will finish or the date cost-sharing can be imposed, as relevant. Accordingly, even when individuals had been beforehand supplied discover, plan sponsors ought to take into account speaking any modifications to individuals, who might not be conscious that the PHE is ending.