In preparation for the widespread and rapid introduction of COVID-19 immunizations and other coronavirus preventive services, the Tri-Agencies (Internal Revenue Service, Department of Labor, and Health and Human Services) have issued interim Final Regulations updating and revising the requirements that group health plans cover COVID-19 vaccines, testing, and other preventive services. The regulation outlines a “comprehensive plan with proactive measures to remove regulatory barriers and ensure consistent coverage and payment for the administration of an eventual vaccine for millions of Americans.”
In addition to regulations designed to expedite and increase access to providers for COVID-19 testing and treatment, the Final Regulations modify the requirements for non-grandfathered group health plans to cover COVID-19 immunizations and preventive services previously described in the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) which became law earlier this year. The final regulations are effective immediately but will sunset at the end of the COVID-19 public health emergency – a period of time defined by the Secretary of the Department of Health and Human Services.
The following provisions apply to non-grandfathered group health plans immediately:
Qualifying Coronavirus Preventive Services
- The regulations implement the CARES Act requirement that group health plans cover, without cost-sharing, qualifying coronavirus preventive services, including immunizations, as recommended by the United States Preventive Services Task Force (USPSTF) and the Center for Disease Control’s Advisory Committee on Immunization Practices (ACIP).
- Coverage for COVID-19 preventive services and immunizations furnished during the COVID-19 public health emergency must be covered by group health plans by the date which is 15 business days after any such recommendation is made, regardless of whether the service or immunization is recommended for routine use.
- COVID-19 immunizations and preventive services furnished during the COVD-19 public health emergency must be covered without cost-sharing when provided by either an in-network or an out-of-network provider.
- Group health plans must cover the cost of a vaccine’s administration, even if the cost of the vaccine itself is paid by a third party such as the federal government. Group health plans may impose cost-sharing for office visits that are billed separately, but office visits not billed separately must be covered without cost-sharing if the primary purpose of the visit is for the administration of the vaccine.
- While grandfathered group health plans and plans providing excepted benefits or short-term, limited-duration coverage are not required to comply with these rules, the regulation encourages them to do so.
- At this time, the public health emergency has been extended by the Secretary of Health and Human Services through January 21, 2021. The public health emergency is extended for a period of 90 days at a time and is likely to be extended again from January 21, 2021 to April 21, 2021.
MedBen is quickly working on an updated amendments to our client’s group health plans and will make those available before the end of the year. If you have any questions regarding these requirements, please contact Senior Vice President Caroline Fraker (800-851-0907 or firstname.lastname@example.org), Director of Compliance and Medical Management Erin Kelly (740-522-7368 or email@example.com), or your Account Manager.