Effective October 13, 2022, the COVID-19 public health emergency once again was extended through January 11, 2023 by the Department of Health and Human Services (HHS), as anticipated. Importantly, this extension impacts group health plan coverage requirements related to COVID-19 testing and related services, explained further below.

Background

The Families First Coronavirus Response Act (FFCRA) generally requires group health plans (including fully insured, self-insured, and level funded plans) and health insurance issuers to provide benefits for items and services related to the testing and diagnosis of COVID-19 as of March 18, 2020 and through the end of the public health emergency period declared by HHS. This coverage must be provided without cost-sharing requirements (including deductibles, copayments, and coinsurance), prior authorization, or other medical management techniques.

In addition, the Coronavirus Aid, Relief, and Economic Security (CARES) Act amended the FFCRA to include a broader range of items and services that must be covered, including coverage for approved COVID-19 vaccines. Per the CARES Act, coverage for the COVID-19 vaccine must be provided by non-grandfathered group health plans without cost sharing, regardless of whether the vaccine is administered by an in- or out-of-network provider. However, once the public health emergency ends, the COVID-19 preventive-services coverage mandate will continue to apply, but only on an “in-network” basis.

Group Health Plan Impact

With the public health emergency still effective, group health plans must continue to provide coverage related to the testing (including certain over-the-counter tests) and diagnosis of COVID-19 without cost-sharing requirements, as described above. Similarly, coverage for the COVID-19 vaccine must be provided (by non-grandfathered group health plans) without cost sharing for both in- and out-of-network providers.

Note that the public health emergency is separate from the national emergency (also still effective), which provides an extension of certain deadlines impacting group health plan administration as explained further in our blog COVID-19 Health & Welfare Deadline Relief Further Extended.

Employer Action

While there is no immediate action at this time, employers should be aware of these developments. Sequoia will continue to monitor and communicate updates, as applicable.

Additional Resources

DISCLAIMER: This communication is intended for information purposes only and should not be construed as legal or tax advice. It provides general information and is not intended to encompass all compliance and legal obligations that may be applicable to your situation. This information and any questions as to your specific circumstances should be reviewed with legal counsel and/or a tax professional.  

Diane Cross — Diane is a Client Compliance Consultant for Sequoia, where she works with our clients to optimize and streamline benefits compliance. In her free time, Diane enjoys spending time with her family, live music, and cycling.