Insurance carriers to waive all health plan cost-sharing associated with COVID-19 testing

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Dear Clients, Colleagues, Friends:

Carrier and Compliance Guides for Coronavirus (COVID-19)

We will continue to monitor the coronavirus (COVID-19) updates and important benefits changes. To help you and your employees keep informed, We have illustrated below the following carrier and compliance guides.

CARRIER GUIDE FOR BENEFITS CHANGES.

COMPLIANCE GUIDES

1. States Direct Insurers to Waive Cost-Sharing for COVID-19

Please see below for a Compliance Alert, which includes details on the States directing Insurers to waive cost-sharing for COVID-19. Please scroll down for the chart.

At least three states have now directed insurance carriers to waive all health plan cost-sharing associated with COVID-19 testing:

1. California

2. New York

3. Washington

For any fully-insured policy situated in one of those states, employees and family members will have COVID-19 testing covered in full by the plan as a free service not subject to any deductibles, copays, or coinsurance.

 What About Other State Policies?

More states are likely to follow in the coming weeks. Even for those states without a directive to waive COVID-19 testing cost-sharing, insurance carriers may move voluntarily to make such services available at no cost to employees and family members.

For example, Cigna announced yesterday that all fully insured policies (including fully-insured employer-sponsored group health plans) will make COVID-19 testing available at no cost as a free preventive service.

What About Self-Insured Plans?

Self-insured health plans are not subject to state insurance mandates, which means the new state cost-sharing directives for COVID-19 will not apply. 

Plan Sponsors desiring to waive COVID-19 cost-sharing in a similar manner with self-insured health plans should consult with their third-party administrator (TPA) and stop-loss provider to determine whether such measures are an option for the plan.

What About High Deductible Health Plan (HDHP) and Health Savings Account (HSA) Eligibility?

The general rule is that an individual must meet two primary requirements to be HSA-eligible (i.e., to be eligible to make or receive HSA contributions):

1) Be covered by an HDHP; and

2) Have no disqualifying coverage (generally any medical coverage that pays pre-deductible).

An HDHP cannot cover any non-preventive expenses before the minimum statutory deductible ($1,400 individual, $2,800 family) is satisfied.

At this point, it is not clear how these state directives will affect HSA eligibility. It seems likely that the IRS will eventually release guidance confirming that COVID-19 testing can qualify for first-dollar coverage as an HDHP preventive service. The IRS already issued guidance in 2019 (please see IRS Notice 2019-45) expanding the list of preventive services available to HDHPs.

Published: Wednesday, March 11, 2020

The Internal Revenue Service issued Notice 2020-15 advising that high-deductible health plans (HDHPs) can pay for 2019 Novel Coronavirus (COVID-19) related testing and treatment, without jeopardizing their status. This also means that an individual with an HDHP that covers these costs may continue to contribute to a health savings account (HSA).

Furthermore, the IRS stated that health plans that otherwise qualify as HDHPs will not lose that status merely because they cover the cost of testing for or treatment of COVID-19 before plan deductibles have been met. The IRS also noted that, as in the past, any vaccination costs continue to count as preventive care and can be paid for by an HDHP.

This IRS notice applies only to HSA-eligible HDHPs. Employees and other taxpayers in any other type of health plan with specific questions about their own plan and what it covers should contact their plan administrators.

2. DOL: Can an Employee Stay Home Under FMLA Leave to Avoid Getting Pandemic Influenza?

The FMLA protects eligible employees who are incapacitated by a serious health condition, as may be the case with the flu where complications arise, or who are needed to care for covered family members who are incapacitated by a serious health condition. 

Leave taken by an employee for the purpose of avoiding exposure to the flu would not be protected under FMLA

Employers should encourage employees who are ill with pandemic influenza or are exposed to ill family members to stay home and should consider flexible leave policies for their employees in these circumstances. 

https://www.dol.gov/agencies/whd/fmla/pandemic

We will continue to provide updates as information becomes available.

If you have any questions, please contact us at  questions@planprofessionals.com

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