DOL issues new guidance for health plans to pay for COVID-19 test kits
By Katie Tranter, DBL Law
The US Department of Labor (DOL) issued a new set of frequently asked questions to implement President Biden’s order that, starting 15 January, health plans and insurance issuers must cover or reimburse costs for over-the-counter (OTC) COVID-19 tests without imposing any cost-sharing requirements, prior authorisation, or other medical management requirements. Employees and dependents covered by an employer-sponsored health plan may purchase tests online or in bricks-and-mortar retail locations.
The tests may be paid for upfront by an individual’s health plan or individuals may be reimbursed by submitting a claim. Employers may, but are not required to, provide coverage for OTC COVID-19 tests purchased before 15 January.
Providing coverage: Direct or reimbursement
A health plan or insurance issuer may provide coverage either directly or through reimbursement. If a plan or issuer provides direct coverage of OTC COVID-19 tests, it may not limit coverage to tests that are only provided through preferred pharmacies or retailers. Employees and dependents may also be reimbursed by submitting a claim to their plan after purchasing an OTC COVID-19 test. However, plans and issuers are strongly encouraged to provide direct coverage for OTC COVID-19 tests by reimbursing sellers directly and without requiring participants, beneficiaries, or enrolees to provide upfront payment and seek reimbursement.
Physician’s authorisation not required
The updated guidance requires coverage without a doctor’s order or individualised clinical assessment from a health care provider. The coverage also must be provided without imposing any cost-sharing requirements such as deductibles, co-payments, or coinsurance, prior authorisation, or other medical management requirements.
Limit on number of tests
The DOL guidance states that plans and issuers may “limit” the number of OTC COVID-19 tests covered for each participant, beneficiary, or enrolee to eight tests per 30-day period (or per calendar month). This limit only applies with respect to the coverage of OTC COVID-19 tests that are administered without a doctor’s authorisation; health plans and insurance issuers must continue to provide coverage for all COVID-19 tests that are administered with a provider’s involvement or prescription.
Katie TranterGGI member firm
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Dressman, Benzinger LaVelle psc (DBL Law) provides a complete range of services to meet legal needs in a wide variety of industries. With cross-industry collaboration, DBL Law attorneys offer comprehensive service on complex matters that transcend simple categorisation in many areas of law.
Katie Tranter's law practice includes advising clients on compliance with various employment laws and regulations and providing in-house training on such issues. She has experience drafting employee policies and procedures, as well as employment agreements. She has handled cases involving the Equal Employment Opportunity Commission, Department of Labor, Kentucky Labor Cabinet, and the Ohio Civil Rights Commission. She litigates cases in state and federal court.
Published: Employment Law Newsletter, No.12, Summer 2022l Photo: ekkaphan - stock.adobe.com