Additional Guidance on COVID-19 Testing Coverage Mandate

On June 23, the Departments of Labor, Health and Human Services, and the Treasury issued guidance on the COVID-19 diagnostic testing mandate for group health plan sponsors.  This guidance, in the form of frequently asked questions, supplements the Families First Coronavirus Response Act, as amended by the Coronavirus Aid, Relief, and Economic Security Act (the “Acts”).  Here are the important takeaways:

  • Most self-funded group health plans are subject to the mandate, including grandfathered plans under the ACA, non-federal governmental plans, and church plans. Retiree-only plans and excepted-benefit plans (such as dental- or vision-only plans) are not subject to the mandate.
  • The Food and Drug Administration (FDA) Website contains information on tests that satisfy the criteria under the Acts: authorized by the FDA, under review by the FDA, developed and authorized by a state, or determined appropriate by the Secretary of Health and Human Services.
  • At-home tests meeting one of the criteria above must be covered if ordered by the attending health-care provider, meaning an individual who is licensed or otherwise authorized under applicable law, acting within the scope of his/her license or authorization, and responsible for providing care to the patient.
  • Testing performed to screen for general workplace health and safety, for public health surveillance, or for any other purpose not primarily intended for individual diagnosis or treatment is not subject to the mandate.
  • A plan may be required to cover multiple diagnostic tests for the same individual if medically appropriate as determined by the attending health-care provider.
  • A facility fee charged for an office visit resulting in an order for or administration of the test must be covered without cost sharing, prior authorization, or other medical-management requirements.

If you have questions on COVID-19 testing, call ASR Health Benefits at (616) 957-1751 or (800) 968-2449.