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Administration Clarifies Insurers Not Obligated to Cover “Back-to-Work” COVID-19 Tests

June 24, 2020

Based on guidance issued yesterday, insurers are not required to cover COVID-19 tests that employers may mandate as they bring employees back to work. The Families First Coronavirus Response Act (FFCRA) requires insurers to cover COVID-19 tests without patient cost-sharing, but yesterday’s guidance clarified that the law only applies to tests that are deemed “medically appropriate” by a healthcare provider. This requirement remains intact. According to the HHS, DOL and Department of the Treasury’s guidance:

“Q5.  Is COVID-19 testing for surveillance or employment purposes required to be covered under section 6001 of the FFCRA?  

 No.  Section 6001 of the FFCRA requires coverage of items and services only for diagnostic purposes as outlined in this guidance.  Clinical decisions about testing are made by the individual’s attending health care provider and may include testing of individuals with signs or symptoms compatible with COVID-19, as well as asymptomatic individuals with known or suspected recent exposure to SARS-CoV-2, that is determined to be medically appropriate by the individual’s health care provider, consulting CDC guidelines as appropriate.  However, testing conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance for SARS-CoV-2, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition is beyond the scope of section 6001 of the FFCRA.”

This latest guidance suggests that if an employer does mandate employees be COVID-19 tested as a requirement of returning to work, it is not required to be covered by insurance. An employer may of course work with their insurer or their self-funded plan to modify their plan to cover the cost of work-related testing. Alternatively, an employer could simply absorb testing costs directly.

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Employee Benefits