Update on 4/11/2023: On January 30, 2023, the Biden Administration released a Statement of Administration Policy announcing their plan to expire the public health emergency on May 11, 2023. See our blog, COVID-19 Emergency Declarations Anticipated to Expire: Impact to Group Health Plans, for further information.
Update on 1/19/2023: On January 11, 2023, the public health emergency was extended once again and is now effective through April 11, 2023. The continued impact to group health plans is explained further below.
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
- Statement of Administration Policy
- HHS 1/11/2023 Renewal Announcement
- HHS 10/13/2022 Renewal Announcement
- Sequoia Foreword: COVID-19 Health & Welfare Deadline Relief Further Extended
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.
