Although previous guidance from the DOL stated that a group health plan cannot cover certain types of testing done solely to determine eligibility for work, case law and more recent DOL guidance suggest otherwise.įinally, some states may require that employers pay for tests that they require their employees to take. Nor does it suggest any means by which health plans can tell whether tests are taken for an employee to be able to travel, access entertainment venues, or for other “surveillance” purposes.įurther adding potential confusion in differentiating between “at home” tests required to be covered and those that are not, health plans typically do not process pharmacy claims for “over the counter” products.Įven apart from the regulations, the actual terms of an employer’s health plan could require coverage for tests taken for employment purposes. Indeed, the guidance suggests that health plans can rely only on participants’ attestations that their tests were not for employment purposes. Given the ease with which employees can identify various symptoms associated with Covid-19, their possible exposure to others suspected of having Covid-19, or their desire to check before visiting relatives-all generally regarded as an adequate basis for coverage-determining whether a test was solely for employment is a challenge.Įxacerbating this challenge, the regulations and guidance under the Family First/CARES Act generally prohibit health plans from using prior authorization, screening and other medical management techniques to find out.
Test results do not say why a test was taken.
In particular, employers that “self-fund” their employees’ health benefits may indirectly pay the cost of testing through their health plans.įirst, as a practical matter, it is not necessarily clear whether a test is for “diagnostic” or “surveillance” purposes. Some states and local authorities are also considering “vaccinate or test” mandates for employers.Īlthough the foregoing guidance and previous regulations under the Familes First/CARES Act do not require coverage for testing for these purposes, health plans should be aware that they could still be on the hook.
Relatedly, a Willis Towers Watson survey (pre-dating the Supreme Court’s OSHA ruling) reported that many employers plan to offer Covid-19 testing on a weekly basis. Supreme Court recently stopped the Occupational Safety and Health Administration from imposing a “vaccine or test” rule on companies with 100 or more employees, some employers are considering whether to require unvaccinated workers to test as a condition of continued employment. Testing for Continued Employmentĭemonstrating readiness for employment is one such “surveillance” purpose. Specifically, the regulations require coverage only of Covid-19 tests taken for “diagnostic”-not “surveillance”-purposes. Departments of Health and Human Services, Labor, and Treasury issued guidance expanding the scope of those regulations to include coverage for over-the-counter (OTC) Covid-19 tests.īy requiring coverage of “at home” tests, the guidance greatly improves access to testing, but like the previous regulations, it does not require coverage of all Covid-19 tests. Since the early days of the pandemic, the Families First and Coronavirus Aid, Relief, and Economic Security (CARES) Act, laws and regulations have required that group health plans provide first dollar coverage for Covid-19 tests administered under medical supervision. One factor they should consider is whether they will be obligated to pay the cost of such tests. Although employers are no longer subject to OSHA’s mandate requiring that their unvaccinated employees test for Covid-19, some may choose to require testing on their own.
0 kommentar(er)
