Compliance Corner

Federal Updates

DOL, HHS and the Treasury Issue Joint FFCRA and CARES Guidance

April 14, 2020

On April 11, 2020, the DOL, HHS and the Treasury issued joint guidance on the FFCRA and CARES Act. Specifically, the 14 frequently asked questions provide additional guidance for plans implementing the requirement to provide coverage of COVID-19 testing to participants with no cost sharing.

The guidance includes clarifications of the following:

  • The requirement for health plans to provide benefits for COVID-19 testing applies to both individual and group health plans. This includes self-insured, fully insured, church, non-federal governmental, ERISA and grandfathered plans. It does not apply to short-term, limited duration, excepted benefit or retiree plans.
  • Plans must provide the coverage of COVID-19 testing without participant cost sharing, effective for expenses incurred on or after March 18, 2020, and continued through the public health emergency related to COVID-19.
  • Plans must provide coverage for all items and services provided to the insured during the visit that resulted in the COVID-19 testing. For example, if the health care provider also administered a flu or blood test to determine the necessity of the COVID-19 testing, the flu and blood test would also be covered with no cost sharing.
  • In addition to the cost-sharing requirements, the coverage must also not be subject to prior authorization or medical management requirements.
  • The departments will not take enforcement action against any plan that fails to comply with the 60-day advance notice requirement to revise and distribute an SBC to reflect modifications to coverage related to COVID-19 testing or treatment or telehealth services. This relief is only applicable to advance notice requirements. The plans must provide notice as soon as reasonably practicable. Plans are still expected to revise plan documents as necessary to reflect any changes to the plan design due to COVID-19.
  • An EAP will not lose its status as an excepted benefit solely because it provides benefits for COVID-19 diagnosis and testing during the public health emergency.

DOL, HHS and the Treasury FFCRA and CARES Act FAQs ยป