Effective January 15, 2022, medical plans (both insured and self-insured) will be required to cover over-the-counter or at-home COVID-19 tests (“OTC COVID-19 Tests”) without imposing cost-sharing requirements. This requirement for medical plans to cover OTC COVID-19 Tests was contained in guidance issued on January 10, 2022 by the Departments of Labor, Health and Human Services, and the Treasury, and expands on the existing requirements under Section 6001 of the Families First Coronavirus Response Act (“FFCRA”) that medical plans provide coverage for certain items and services related to COVID-19 testing without imposing any cost-sharing requirements.
This new guidance provides for the following:
Medical plans are required to reimburse participants for OTC COVID-19 Tests without imposing any cost-sharing requirements, prior authorizations, or other medical management requirements. For example, the coverage of OTC COVID-19 Tests may not be limited to situations in which the individual has an order or individualized clinical assessment from a health care provider. However, OTC COVID-19 Tests not primarily intended for individualized diagnosis or treatment of COVID-19, such as testing required for employment purposes, are not covered;
Medical plans are strongly encouraged, but not required, to directly reimburse sellers of OTC COVID-19 Tests (known as “Direct Coverage”). Medical plans may also require the participant to submit a claim for reimbursement for the purchase of...
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