Free COVID-19 Vaccine and Testing Update

On November 30, Moderna announced that it is seeking FDA authorization for its COVID-19 vaccine.  In addition, on November 17 the FDA issued an emergency use authorization for the first COVID-19 diagnostic test for self-testing at home.  With these recent developments, a COVID-19 update for health and welfare plans might be helpful.

• Free COVID-19 Vaccines – As reported in our April 1, 2020 SW Benefits Update: “The CARES Act – What Are the Health and Welfare Plan Issues to Consider?,” Section 3203 of the CARES Act requires group health plans and health insurance issuers to cover without cost-sharing any “qualifying coronavirus preventive service,” which includes an item, service, or vaccine that is intended to prevent or mitigate coronavirus that is:  (1) an evidence-based item or service with an A or B rating recommended by the U.S. Preventive Services Task Force; or (2) a vaccine that has in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.  This requirement takes effect 15 business days after the date on which the U.S. Preventive Services Task Force or Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention makes such a recommendation.  The 15-day time frame after which a group health plan must cover a qualifying coronavirus preventive service is significantly shorter than the timeframe for other preventive services under the ACA preventive care rules.  Accordingly, 15 days after a recommendation is provided for any vaccine, group health plans must start covering the approved COVID-19 vaccine free of charge, with no cost-sharing (i.e., no deductibles, co-pays, or co-insurance).  This is a permanent requirement and does not end when HHS determines that the public health emergency has expired.
• Free COVID-19 Testing Mandate Extended Again – As reported in our July 27, 2020 SW Benefits Update: “Free COVID-19 Testing Extended for Another 90 Days,” the free COVID-19 testing mandate was set to expire on October 23, 2020.  On October 2, HHS renewed the public health emergency declaration, effective October 23, 2020.  Public health emergencies generally last for 90 days, but can end sooner if HHS declares that the public health emergency no longer exists.  As a result of this latest extension, group health plans must continue to provide free COVID-19 testing until January 21, 2021 (unless the public health emergency ends sooner or is extended again).
• Free At-Home COVID-19 Testing – Q&A-4 of FAQ 43 clarifies that the free COVID-19 testing mandate also applies to at-home COVID-19 testing when the test is ordered by an attending health care provider who determines the test is medically appropriate.  In addition, the test must meet the other statutory requirements of Section 6001(a)(1) of the FFCRA.  For more information on free COVID-19 testing, including at-home testing, see our July 27, 2020 SW Benefits Update:  “Free COVID-19 Testing Extended for Another 90 Days.”

Employers need to make sure that their group health plans provide these free COVID-19 benefits when they take effect.  Participants should be notified regarding these COVID-19 benefits and plans may need to be amended to reflect these free benefits.