23 March 2020

No Cost-sharing for Coronavirus Testing

***Information and guidance in client updates was up to date at time of publication. During the pandemic, information and guidance has been changing rapidly. If you have any questions about the information contained in a client update, please contact the author(s) or your Miller Johnson attorney.***

As the coronavirus spreads and more individuals are tested for COVID-19, the federal government has made it clear that group health plans and insurers must cover testing without participant cost-sharing (i.e. deductibles, copayments, and coinsurance).

The Families First Coronavirus Response Act (“FFCRA”), signed into law on March 18, 2020, requires a group health plan to provide the following items and services with respect to COVID-19 testing without participant cost-sharing or medical management techniques (such as prior authorization or utilization review):

  1. COVID-19 testing.  Specifically, this requirement includes “in vitro diagnostic products” for the detection of SARS-CoV-2 (which is the virus that causes the disease, Coronavirus) that are approved, cleared or authorized under the Federal Food, Drug and Cosmetic Act.  This requirement includes the cost of the in vitro diagnostic products and the cost of the administration of those products.
  2. Certain items or services that are furnished to a participant during a health care visit that results in an order for covered COVID-19 testing.  Please note the following about this requirement:
    1. The health care visit could take the form of an in-person office visit, a telehealth visit, an urgent care center visit, or an emergency room visit.
    2. The covered items or services under this requirement only include items or services that relate to: (i) the furnishing or administering of the COVID-19 test; or (ii) the evaluation of the individual to determine whether a COVID-19 test is needed.

The bottom line is COVID-19 testing must be covered in most settings with no participant cost-sharing.  This includes the items and services used in the evaluation of determining whether the COVID-19 test is needed.  Not all evaluations will result in an actual COVID-19 test.  Nonetheless, it appears that an evaluation to determine the necessity of a COVID-19 test must be covered with no participant cost-share, even if the determination is that no test is needed.  It is unclear, however, if this requirement applies to these services provided out-of-network.

For more information or if you have any questions, please contact a  Miller Johnson employee benefits attorney.