The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies”) have issued Frequently Asked Questions #51 (“FAQs”) regarding implementation of the Families First Coronavirus Response Act, and the Coronavirus Aid, Relief, and Economic Security Act, which state that group health plans and health insurance issuers must cover over-the-counter (“OTC”) COVID-19 tests.
Plans and issuers must cover these OTC COVID-19 tests even though the tests are obtained without the involvement of a health care provider. This coverage must be provided without imposing any cost-sharing requirements, prior authorization, or other medical management requirements This rule does not require a plan or issuer to provide coverage by reimbursing sellers of OTC COVID-19 tests directly. A plan or issuer may instead require a participant, beneficiary, or enrollee who purchases an OTC COVID-19 test to submit a claim for reimbursement to the plan or issuer.
Plans or issuers that provide coverage through both their pharmacy network and a direct-to-consumer shipping program, may limit reimbursement for OTC COVID-19 tests from nonpreferred pharmacies or other retailers to $12 per test.
The plan or issuer may limit the number of OTC COVID-19 tests for each participant, beneficiary, or enrollee to 8 tests per 30-day period (or per calendar month). However, the Agencies note that this limit applies only with respect to the coverage of OTC COVID-19 tests that are administered without a provider’s involvement or prescription; “plans and issuers must continue to provide coverage for COVID-19 tests that are administered with a provider’s involvement or prescription.”
These rules apply to tests purchased on or after January 15, 2022.
The FAQs are available at: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf