COVID-19 – Federal Laws Affecting Health Care

The Families First Coronavirus Response Act (FFCRA or Act)

Effective March 18, 2020, the Families First Coronavirus Response Act (FFCRA) requires group health plans and health insurance issuers to cover COVID-19 testing without imposing any cost sharing (such as deductibles, copayments or coinsurance) or prior authorization or other medical management requirements.

This coverage mandate applies to the following health plans and issuers, regardless of grandfathered status under the Affordable Care Act (ACA):

  • All fully insured group health plans
  • All self-insured group health plans
  • Health insurance issuers offering group or individual coverage

During the COVID-19 public health emergency, health plans and issuers must cover FDA-approved diagnostic testing products for COVID-19, including any items or services provided during a visit to a provider (in-person or telehealth), urgent care center or emergency room that relate to COVID-19 testing.

Coronavirus Aid, Relief, and Economic Security (CARES) Act

Effective March 27, 2020, the CARES Act expands this coverage mandate to include COVID-19 tests provided on an emergency basis, state-developed tests and any other tests approved by the U.S. Department of Health and Human Services.

The CARES Act makes a variety of changes affecting health plans.

  • Expanding the types of coronavirus testing that all health plans and health insurance issuers must cover without cost-sharing (such as deductibles, copayments or coinsurance) or prior authorization.
  • Accelerating the process that will require health plans and issuers to cover preventive services and vaccines related to COVID-19.
  • Allowing telehealth and other remote care services to be covered under a high deductible health plan (HDHP) before the deductible is met, without affecting the HDHP’s compatibility with health savings accounts (HSAs) (applicable for HDHP plan years beginning on or before Dec. 31, 2021).

In addition, the bill:

  • funds various loans, grants, and other forms of assistance for businesses, industries, states, local governments, and hospitals;
  • provides tax rebates of up to $1,200 per individual and an additional $500 per child, subject to limits based on adjusted gross income;
  • temporarily expands unemployment benefits; and
  • suspends payments and interest on federal student loans.

Effective April 1, 2020, the Families First Coronavirus Response Act (Act) will assist reimbursing American private employers that have fewer than 500 employees with tax credits for the cost of providing employees with paid sick or expanded family and medical leave taken for specified reasons related to COVID-19.

Paid Leave Entitlements for employers covered under the Act that must provide employees:

Up to two weeks (80 hours, or a part-time employee’s two-week equivalent) of paid sick leave based on the higher of their regular rate of pay, or the applicable state or Federal minimum wage, paid at:

  • 100% for qualifying reasons #1-3 below, up to $511 daily and $5,110 total;
  • 2/3 for qualifying reasons #4 and 6 below, up to $200 daily and $2,000 total; and
  • Up to 12 weeks of paid sick leave and expanded family and medical leave paid at 2/3 for qualifying reason #5 below for up to $200 daily and $12,000 total.

A part-time employee is eligible for leave for the number of hours that the employee is normally scheduled to workover that period.

Qualifying reasons for leave related to COVID-19:

An employee is entitled to take leave related to COVID-19 if the employee is unable to work, including unable to telework, because the employee:

  1. is subject to a Federal, State, or local quarantine or isolation order related to COVID-19;
  2. has been advised by a health care provider to self-quarantine related to COVID-19;
  3. is experiencing COVID-19 symptoms and is seeking a medical diagnosis;
  4. is caring for an individual subject to an order described in (1) or self-quarantine as described in (2);
  5. is caring for his or her child whose school or place of care is closed (or child care provider is unavailable) due to COVID-19 related reasons; or
  6. is experiencing any other substantially-similar condition specified by the U.S. Department of Health and Human Services.

Please visit us at www.ciainsurance.com/covid-19 for up-to-date information on how businesses are affected by the worldwide response to the novel Coronavirus.

Post written by Janelle Morck, Vice President | Employee Benefits Risk Management (ERM)

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