Archived Insight | June 24, 2020
On June 23, 2020, the Departments of Labor, Treasury, and Health and Human Services released new answers to frequently asked questions (FAQs) that clarify key issues for health plan sponsors working to implement requirements related to COVID-19 under the Families First Coronavirus Response Act and the CARES Act.
The FAQ answers clarify that:
The FAQ answers provide additional information about payment for tests in an emergency room setting. They also note that the Cares Act does not permit balance billing for tests, but does not address balance billing for items and services other than the test.
Rules applicable to the ACA-required Summary of Benefits and Coverage (SBC) generally require 60-day advance notice of a material plan change that takes place mid-year and that affects the content of the SBC. Answers to earlier FAQs announced an enforcement safe harbor for COVID-19-related benefit enhancements during the public health emergency or the national emergency declaration period. Plan sponsors only needed to provide reasonable notice of the benefit enhancements.
This latest set of FAQs clarifies that:
For the duration of any plan year that begins before the end of the public health emergency, large employers may offer telehealth and other remote-care services to employees (and their dependents) who are not eligible for the employer’s group health plan. Such an arrangement would not be subject to most of the group market reforms otherwise applicable to a group health plan. Requirements that continue to apply include protections against discrimination based on health status, the Mental Health Parity and Addiction Equity Act, and the prohibition on retroactive termination of coverage (i.e., rescissions).
Plan sponsors assessing their compliance with MHPAEA must meet specific mathematical tests to determine what cost-sharing requirements may be applied to mental health and substance use disorder benefits. Waiving cost sharing applicable to certain medical benefits within a classification (such as in-network outpatient services) could have an impact on these calculations.
An answer to a new FAQ announces that the departments will allow plan sponsors to disregard temporary cost-sharing waivers required by the Families First Coronavirus Response Act in determining compliance with MHPAEA’s mathematical tests.
Some plan sponsors have recognized that the public health emergency has made it difficult for participants and family members to meet the requirements for earning a reward under a health-contingent wellness program. One FAQ answer confirms that plans may waive requirements for obtaining a reward under such a wellness program as long as the waiver is offered to all “similarly situated” individuals.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.
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