New Coronavirus Legislation Impacts Health Plans, Too.

As discussed in our other coronavirus related blog posts, new legislation intended to ease the economic consequences stemming from the novel coronavirus disease (COVID-19) outbreak by expanding FMLA and sick leave available to employees and providing tax credits to employers providing the leave has been passed. The legislation also affects employer-sponsored health plans.


Under these new provisions, private health plans (including insured, self-insured, and grandfathered) must provide coverage for COVID-19 testing and related services to employees and their covered dependents, without cost sharing (like deductibles, copayments and coinsurance) from the effective date of the Act (likely April 2) through the end of the national emergency period.


Covered services and related cost waivers apply to diagnostic testing, healthcare provider services, including telehealth, and facility costs (physician office, urgent care center, or ER) if the costs are related to determining the need for testing, conducting the testing, and COVID-19 diagnosis and treatment. In addition, health plans cannot require prior authorization or similar gate-keeping requirements on COVID-19 testing or services.


Fully-insured plan sponsors should review their plan’s language and contact their insurer to make sure they are able to implement these new coverage requirements. Self-insured plan sponsors will need to amend their plan documents to account for these changes.  Please contact any of Graydon’s Employee Benefits team if you have any questions.


We will continue to update you on these law changes as more information becomes available.