FAQs Clarify COVID-19 Testing and Vaccine Coverage

From: COVID-19

FAQs Clarify COVID-19 Testing and Vaccine Coverage


Legal Update

FAQs Clarify COVID-19 Testing and Vaccine Coverage

On Feb. 26, 2021 federal agencies issued FAQs to clarify health coverage requirements for COVID-19 diagnostic testing and vaccinations. Health plans and issuers generally must cover COVID-19 diagnostic items and services without cost sharing.

The FAQs explain that plans and issuers may not use medical screening criteria to deny (or impose cost sharing on) a claim for COVID-19 diagnostic testing for an asymptomatic person with no known or suspected exposure to COVID-19

However, plans and issuers may distinguish between COVID-19 testing of asymptomatic people that must be covered, and testing for general workplace health and safety or other purposes not intended for individualized COVID-19 diagnosis or treatment.

The FAQs also provide guidance on coverage of COVID-19 vaccines and other preventive services, certain notice requirements, and rules for EAPs and on-site medical clinics that administer COVID-19 vaccines to be considered excepted benefits.

Plans and issuers are encouraged to ensure communications about the circumstances in which testing is covered are clean. Plans and issuers must provide any required notice of the preventive care coverage changes as soon as reasonably practicable.

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