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Group Health Plans to Cover At-Home COVID-19 Tests

On December 2, 2021, President Biden released a nine-point action plan for COVID-19 (Plan). Part of the plan directs the Departments of Health and Human Services, Labor and the Treasury to issue regulations and guidance by January 15, 2022, requiring group health plans and insurers to cover or reimburse costs for over the counter (OTC) at-home rapid COVID-19 tests without requiring health plan participants to pay any of the amount.

Under existing guidance group health plans are required to cover the cost of at-home test but only when the test is ordered by an attending health care provider who has determined that the test is medically appropriate for the individual based on current accepted standards of medical practice and the test otherwise meets the statutory criteria in Section 6001(a)(1) of the Families First Coronavirus Response Act (FFCRA).

Under the Plan, individuals who purchase OTC COVID-19 diagnostic tests will be able to seek reimbursement from their group health plan or health insurance issuer and have insurance cover the cost during the public health emergency without necessitating that it be order by a health care provider.

Next Steps for Employers

Regulations and guidance will be released by the federal agencies charged with oversight of this part of the Plan. Once made available, employers are strongly encouraged to review the guidance to ensure their group health plan is in compliance.

HR Works will continue to monitor this topic and provide updated information as it becomes available.

HR Works, headquartered in Upstate New York, is a human resource management outsourcing and consulting firm serving clients throughout the United States for over thirty years. HR Works provides scalable strategic human resource management and consulting services, including: affirmative action programs; benefits administration outsourcing; HRIS self-service technology; full-time, part-time and interim on-site HR managers; HR audits; legally reviewed employee handbooks and supervisor manuals; talent management and recruiting services; and training of managers and HR professionals.