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On Jan. 10, 2022, the Depts. of Labor, Health and Human Services (HHS), and the Treasury issued FAQ guidance regarding the requirements for group health plans and health insurance issuers to cover over-the-counter (OTC) COVID-19 diagnostic tests.
Legal RequirementsPlans and issuers must cover the costs of COVID-19 tests during the COVID-19 public health emergency without imposing any cost-sharing requirements, prior authorization, or other medical management requirements.
Under guidance issued in June 2020, at-home COVID-19 tests had to be covered only if they were ordered by a health care provider who determined that the test was medically appropriate for the individual. At that time, the FDA had not yet authorized any at-home COVID-19 diagnostic tests. Since then, several types of OTC at-home tests have been approved.
As of Jan. 15, 2022, the cost of these tests must be covered, even if they are obtained without the involvement of a health care provider. However, the FAQs do not require tests to be covered if they are not for individualized diagnosis (such as tests for employment purposes).
Plan OptionsPlans and insurance issuers may place some limits on coverage, such as:
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Important Dates
Dec. 2, 2021 President Biden announced that guidance would be issued clarifying coverage of OTC COVID-19 tests.
Jan. 10, 2022 Federal agencies issued the guidance implementing the requirements for coverage of OTC COVID-19 tests.
Jan. 15, 2022 Deadline for plans and issuers to provide coverage for OTC COVID-19 tests available without a health care provider order or assessment.
At-home COVID-19 tests must be covered even if they are obtained without the involvement of a health care provider. |
