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FAQs Facilitate FFCRA & CARES Act Required COVID-19 Benefits Coverage Implementation

The Families First Coronavirus Response Act (“FFCRA”)

The FFCRA was enacted on March 18, 2020.  The FFCRA generally requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide benefits for certain items and services related to diagnostic testing for the detection of SARS-CoV-2 or the diagnosis of COVID-19 during the applicable emergency period.

 

The Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)

The CARES Act was enacted on March 27, 2020.  The CARES Act amended the FFCRA to include a broader range of diagnostic items and services that health plans and issuers must cover.

 

Departments Release Additional FAQs

On April 11, 2020, the Department of Labor (“DOL”), Health and Human Services (“HHS”), and the Treasury (collectively, “the Departments”) jointly issued additional FAQs to help individuals better understand the implementation of the laws and the intended benefits.

The FAQs indicate that the Departments’ approach to implementation “is and will continue to be marked by an emphasis on assisting (rather than imposing penalties on) group health plans, health insurance issuers, and other that are working diligently and in good faith to understand and come into compliance with the new law.”

The FAQs are available at: https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-42.pdf.[1]

Health insurance carriers will implement COVID-19 related benefits coverage for items and services for fully-insured group health plans.

Employers sponsoring self insured group health plans are responsible for implementation of COVID-19 testing and related services coverage.  Employers sponsoring self insured group health plans should carefully review the FAQs for assistance with implementation of COVID-19 testing and related services coverage.

Plan Sponsors of self insured group health plans should confirm with the plan’s third party administrator that the required COVID-19 testing and related services coverage is correctly administered, and confirm with any stop-loss carrier that COVID-19 testing and related services are covered claims under the terms of the stop-loss policy.

 

ERISA Plan Requirements

Plan Sponsors of group health plans subject to ERISA must also remember to complete ERISA disclosure requirements for plan participants and beneficiaries.  ERISA Plan Sponsors will need to notify plan participants of the added no-cost COVID-19 testing and related services by providing them with a summary of material modifications (“SMM”), or a revised Summary Plan Description (“SPD”).

Plan Sponsors will need to provide participants with an updated summary of benefits and coverage (“SBC”) to describe the impacted benefit changes, such as COVID-19 testing below the deductible.

Additional legislation and guidance are being issued on a daily basis to combat the COVID-19 epidemic.  This information is current as of the date it is issued; however, is subject to change due to legislative and regulatory action.

The content herein is provided for educational and informational purposes only and does not contain legal advice.  Please contact our office if you have any questions about compliance requirements applicable to your health and welfare plans due to COVID-19.

Dated:  April 27, 2020

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