New HHS Guidance Expands Telehealth Benefits, Clarifies Insurers Not Required to Cover Return to Work COVID-19 Testing

June 26, 2020

The Trump administration released guidance enabling large employers to offer telehealth benefits to employees who are not eligible for any other health plan and stating insurers are not required to cover COVID-19 tests when employers require them as part of their return to work policies.

According to the guidance, in light of the critical need to minimize the risk of exposure to and community spread of COVID-19, for the duration of any plan year beginning before the end of the public health emergency, large employers are allowed to offer telehealth or other remote care services to employees who are not eligible for any other health plan offered by the employer.  

The guidance also clarified that the Families First Coronavirus Response Act (FFCRA) only applies to tests that are deemed “medically appropriate” by a health care provider and does not apply to “testing conducted to screen for general workplace health and safety (such as employee ‘return to work’ programs), for public health surveillance for SARS-CoV-2, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19.”

Who pays for the tests then?  Both the FFCRA and the CARES Act included provisions on cost-sharing for COVID-19 testing and treatment, including a requirement that insurers cover the cost of testing when ordered by a health care provider.  For employers requiring COVID-19 tests before returning to work, if insurers do not pick up the cost, it appears the employer is responsible for the testing costs.

Federal funding could help offset the cost:  Self-insured and fully-insured employers have already been picking up the cost of tests for diagnostic testing.  An America's Health Insurance Plans study found that diagnostic testing for medically necessary and public health surveillance purposes would cost between $6 billion and $25 billion a year.  Public health officials have stated large-scale testing is needed to effectively combat the spread of the virus, but the role of employers in providing that testing has been unclear.

Outlook: Many employers want to use testing to ensure a safe workspace as well as ease anxiety among workers when returning to office or facility environments.  However, without clear guidance on how often employees should be tested, employers are left asking how much will testing cost and does it really ensure a safe work environment?

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