We’ve Got You Covered; Free At-Home COVID Tests Coming Soon
Following the emergence of the COVID-19 Omicron variant, President Biden posted a nine-point action plan (the “Winter Plan”) to combat the Delta and Omicron variants. Of particular interest to employers is the expanded requirement for group health plans and insurers to cover or reimburse at-home rapid, over-the-counter (OTC) COVID-19 tests without participant cost-sharing during the ongoing public health emergency (PHE). As background, that the PHE has been renewed every 3 months by the HHS Secretary since January 2020. Currently, the PHE expires on January 15, 2022, but we expect it to be extended well beyond that date. This new mandate likely won’t take effect until the Departments of Health and Human Services (HHS), Labor and the Treasury “clarify” the requirement, which they’re directed to do by January 15, 2022.
Under existing guidance (see FAQ Part 43, Q/A-4), at-home COVID tests must be covered without participant cost-sharing, but only when ordered by an attending health care provider who has determined the test is medically appropriate based on current accepted standards of medical practice. As a side note, group health plans and insurers currently may (but are not required to) provide coverage of at-home tests without participant cost-sharing even absent a health care provider’s determination of medical necessity. While we await important details, it seems quite possible that forthcoming guidance will significantly expand the scope of required coverage of at-home COVID testing without participant cost-sharing, in short, by eliminating the need to involve a health care provider.
The Winter Plan states that “[w]orkplace screening would remain consistent with current guidance.” This may signal that coverage for at-home COVID testing without participant cost-sharing will still not be required if the test’s purpose is to allow employees to return to the workplace in accordance with an employer’s policy and/or OSHA’s vaccination or testing Emergency Temporary Standard (ETS) for employers with 100+ employees. This ETS is now halted pending ongoing litigation. Recall that under current federal testing guidelines (see FAQ Part 43, Q/A-5), coverage for COVID testing without participant cost-sharing is not required if the purpose is general workplace health and safety (such as return-to-work programs), public health surveillance, or any other employment-related reason not primarily intended for individualized diagnosis or treatment of COVID-19.
President Biden’s Winter Plan has prompted a lot of questions that the forthcoming guidance should answer, including:
- May group health plans impose limitations (such as number, frequency, dollar amount caps) on coverage / reimbursement of at-home tests without participant cost-sharing?
- Will the at-home test need to be proctored by a health professional to be eligible for coverage without participant cost-sharing?
- Will the at-home test be fully covered at point-of-sale, or will participants need pay upfront and then submit claims for reimbursement?
- Does the statement that “[w]orkplace screening would remain consistent with current guidance” mean that group health plans need not cover at-home tests without participant cost-sharing if the purpose is return to the workplace? And if so, how will this be monitored from a practical standpoint?
We will keep you informed of further developments.