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Departments Issue Guidance on Coverage of OTC COVID Tests
In response to President Biden’s directive on December 2, 2021 that Americans with private insurance receive at-home COVID-19 tests reimbursed by their insurance, the Departments of Labor, Health and Human Services, and the Treasury (Departments) issued guidance in the form of Frequently Asked Questions (FAQs) that clarify how health plans and insurers must cover over-the-counter (OTC) COVID-19 diagnostic tests without an order or clinical assessment by a health care provider, and without cost-sharing, prior authorization, or other medical management requirements during the public health emergency. The FAQs also describe two safe harbors for meeting the direct coverage and monthly limitation requirements. The first set of FAQs were issued on January 10, 2022, followed by an additional set of FAQs on February 4, 2022, that modified and clarified certain aspects of the first set of FAQs. These FAQs also addressed a couple of non-related preventive care issues, the coverage of colonoscopies pursuant to USPSTF recommendations, including the coverage of follow-up colonoscopies and the coverage of FDA-approved contraceptive products.
2022 Health Plan Compliance Deadlines
Employers must comply with numerous reporting and disclosure requirements throughout the year in connection with their group health plans. The 2022 Compliance Overview explains key 2022 compliance deadlines for employer-sponsored group health plans. It also outlines group health plan notices that employers must provide each year.
Some of the compliance deadlines summarized are tied to a group health plan’s plan year. For these requirements, the chart shows the deadlines that apply to calendar year plans. For non-calendar year plans, these deadlines will need to be adjusted to reflect each plan’s specific plan year.
Read more here.
Medicare Part D Disclosures due by March 1, 2022, for Calendar Year Plans
Every year, group health plan sponsors are required to complete an online disclosure form with the Centers for Medicare & Medicaid Services (CMS) indicating whether the plan's prescription drug coverage is creditable or non-creditable. Prescription drug coverage is creditable “if the actuarial value of the coverage equals or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D, as demonstrated through the use of generally accepted actuarial principles and in accordance with CMS actuarial guidelines.”
This disclosure requirement applies when an employer-sponsored group health plan provides prescription drug coverage to individuals who are eligible for coverage under Medicare Part D. This disclosure is required regardless of whether the health plan’s coverage is primary or secondary to Medicare.
To determine whether the CMS reporting requirement applies, employers should verify whether their group health plans cover any Medicare-eligible individuals (including active employees, disabled employees, COBRA participants, retirees, and their covered spouses and dependents) at the start of each plan year. If an employer’s group health plan does not offer prescription drug benefits to any Medicare Part D eligible individuals as of the beginning of the plan year, the group health plan is not required to submit the online disclosure form to CMS for that plan year.
The plan sponsor must complete the online disclosure within 60 days after the beginning of the plan year. Thus, for calendar year health plans, the deadline for the annual online disclosure is March 1, 2022.
Annual CHIP Notice Disclosure
An employer who sponsors a group health plan in a state that offers a premium assistance subsidy must provide their employees with the CHIP (Children’s Health Insurance Program Reauthorization Act) notice annually. Employers can create their own notice or use the model notice the Department of Labor (DOL) releases bi-annually. The most recent notice was just released with state information current as of January 31, 2022. If the notice is created, it should include the state contact information for employees who reside in a state offering the premium assistance. Most employers furnish the notice with their annual open enrolment material or when benefits are offered to newly eligible employees.
Illinois’ Consumer Coverage Disclosure Act (CCEA)
The Consumer Coverage Disclosure Act (CCDA), which was signed into law on August 27, 2021, imposes new disclosure requirements on employers who provide group health insurance coverage to employees in Illinois. The CCDA applies to all Illinois employers, regardless of the type of insurance they provide, meaning that employers who provide self-insured plans and/or ERISA plans are subject to the new requirements.
Specifically, these employers must provide the following information to all employees upon hire, annually, and upon request:
- A list of essential health insurance benefits regulated by the State of Illinois; and
- A comparison of which of those benefits are and are not covered by their employer-provided group health insurance plan.
The method of disclosure can be either in written form, email, or posted on the intranet as long as the employee is able to regularly access it. Civil penalties may be assessed for noncompliance, taking into account the size of the employer, the good faith efforts made to comply and the gravity of the violation.
According to the Illinois Department of Labor, the CCDA does not impose coverage requirements on employers; it only requires certain disclosures to employees about the coverages the employer provides. The benefits that employers are required to cover may depend on plan type (e.g., self-funded or fully insured) and employer size.