Federal Law Requires Employer Plans to Cover Testing

2 min

Yesterday, the Senate passed and the president signed the Families First Coronavirus Response Act.  Effective immediately, and until the public health emergency is lifted, employer-sponsored group health plans are required to cover coronavirus testing without any cost-sharing by the covered person.  Specifically:

  • The plan must cover “in vitro diagnostic products” that detect SARS-CoV-2 or diagnose the virus that causes COVID-19, and the administration of those products.
  • The plan must cover “items and services” furnished during a visit with a healthcare provider, if the items and services relate to the testing or to determining whether testing is needed.  For these purposes, a healthcare provider visit includes not only in-person visits but also telehealth visits. 
  • The plan’s coverage must not require any cost-sharing on the part of the individual.  This means that any plan provisions regarding the deductible, copayments, and co-insurance do not apply.  As we previously reported, the no-cost-sharing requirement will not affect an individual’s eligibility for a health savings account.

These requirements apply to both fully insured and self-funded plans, and to both grandfathered and non-grandfathered plans.

The Act does not require employer-sponsored plans to cover the cost of treatment for coronavirus. Additional legislation is being prepared, but we do not know whether that issue will be addressed.

The Act includes significant provisions regarding paid sick leave.  Those are the subject of a separate alert, available here.

Additional Information

If you have any questions regarding this client alert, or if you would like assistance with any of the requirements described here, please contact a member of Venable’s Employee Benefits and Executive Compensation Practice Group.