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.

Coverage of COVID-19 Diagnostic Testing

Health plans and issuers must cover COVID-19 diagnostic items and services without cost-sharing. 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.

Other Guidance

These FAQs also provide guidance regarding:

  • Coverage of COVID-19 vaccines and other preventive care services;
  • Notice requirements for plans and issuers regarding coverage of preventive care services; and
  • Requirements for employee assistance programs (EAPs) and on-site medical clinics that administer COVID-19 vaccines to be considered excepted benefits.

For a copy of this legal update, visit this link: Agency FAQs Clarify COVID-19 Testing and Vaccine Coverage.

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