EBSA Addresses COVID-19 Testing and Preventive Service Coverage Questions

On January 10, 2022, the Department of Labor’s Employee Benefits Security Administration, issued a new set of FAQs. This latest set of FAQs address questions relating to COVID-19 testing and diagnosis that must be covered by group health plans and health insurance issuers without cost sharing pursuant to the Families First Coronavirus Response Act (FFCRA). The FAQs require group health plans (GHPs) and health insurance issuers (issuers) to reimburse a participant or direct pay a provider for the cost of over-the-counter COVID-19 tests beginning January 15, 2022. The FAQs also provide the following information.

  • GHPs and issuers must provide information to participants relating to availability and coverage of tests;
  • GHPs and issuers must cover the cost of COVID-19 tests that do not involve a health care provider;
  • GHPs and issuers may require a participant to submit a reimbursement request, including related attestation to prevent fraud and abuse, and other documentation necessary to determine the cost;
  • GHPs and issuers may not limit reimbursements to preferred retailers or pharmacies;
  • GHPs and issuers may limit reimbursement to nonpreferred retailers or pharmacies, but may not impose a limit of less than $12 per test or the actual price (whichever is lower);
  • GHPs and issuers may limit the number and frequency of over-the-counter COVID-19 tests, but may not impose a limit of less than 8 tests per 30-day period or per calendar month;

The FAQs also clarify that GHPs and issuers must take into account the number of tests contained in a multi-pack kit; and provide additional information—including the coverage of colonoscopies and related services without cost-sharing and coverage of contraceptive services.