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Coronavirus Relief Expands Coverage Under Group Health Plans

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Just when you thought you were getting your arms around administering your group health plans in accordance with the Affordable Care Act, a global pandemic has us all on our toes again. Congress acted quickly to pass the Coronavirus Family Relief Act with little time to contemplate the downstream effects. But, a little time and patience will provide more clarity.

One of the changes in this new legislation directly impacts private employer-sponsored group health plans (including insured, self-insured, and grandfathered).  The new provision requires that plans must provide coverage for COVID-19 testing and related services to employees and their covered dependents, without cost sharing (like deductibles, copayments and coinsurance) and that plans must do so without other medical management criteria like prior authorization.   

Covered services and related cost waivers apply to diagnostic testing, healthcare provider services, including telehealth, and facility costs (physician office, urgent care center, or ER) if the costs are related to determining the need for testing, conducting the testing, and COVID-19 diagnosis and treatment.

Plan sponsors should review their plan’s language for compliance.  Fully-insured plan sponsors should contact their insurer to make sure they are able to implement these new coverage requirements. Self-insured plan sponsors need to amend their plan documents to account for these changes through a Summary of Material Modification. 

These changes are required to take effect as of the date of the Act (likely April 2) through the end of the national emergency period.

We will continue to update you on these law changes as more information becomes available.

Please contact your HORAN representative with any questions.