Federal Agencies Issue Guidance Requiring Coverage of Over-the-Counter COVID-19 Tests

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Attorneys & Professionals

On January 10, 2022, the Departments of Labor, the Treasury and Health and Human Services (the Tri-Agencies) released new guidance that requires group health plans to cover certain authorized over-the-counter COVID-19 tests (OTC Tests) purchased on and after January 15, 2022 without cost sharing, prior authorization, or other medical management requirements. This requirement applies to both fully insured and self-insured group health plans, including grandfathered group health plans.

As background, the Families First Coronavirus Response Act currently requires group health plans and health insurance issuers to cover certain diagnostic COVID-19 tests without cost sharing. However, under previous Tri-Agency guidance, group health plans were only required to cover OTC Tests without cost sharing when those tests were ordered by a health care provider as medically necessary. This new guidance overrules that prior guidance. A group health plan is now required to cover OTC Tests without cost sharing, regardless of whether those tests are ordered by a health care provider or determined to be medically necessary.

The main elements of this new guidance are as follows:

Next steps for plan sponsors:

Fully-insured plans

Self-insured plans

If you have questions about this new guidance, please contact your Vorys attorney.



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