There’s a lot of uncertainty amid the ongoing COVID-19 pandemic. Many are questioning how long the pandemic will last and what the effects—both short-term and long-term—will be. While there is no way of knowing exactly what will happen in the months ahead, there are several changes happening now that Brokers and their Groups should be aware of, especially as it pertains to health insurance. Below, we provided insight into how COVID-19 is affecting Group health plans.
CARES Act: Changes to Group Health Plans
In response to the economic impact of the COVID-19 outbreak, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act into federal law on March 27, 2020. The CARES Act provides approximately $2 trillion in assistance to American households and businesses, which includes $100 billion in supplemental awards and grants for healthcare providers as they ramp up efforts to combat the outbreak. Here are several provisions included in the CARES Act that affect Employer-sponsored Group health plans:
The CARES Act expands upon some provisions within the Families First Coronavirus Response Act (FFCRA), which became effective on March 18, 2020. The FFCRA required Group health plans to cover FDA-approved products and services used in the testing and diagnosis of COVID-19. While the CARES Act expands on the types of COVID-19 testing that must be covered under insurance, it also provides additional guidance related to the amount that Group health plans must cover.
Under the CARES Act, insurance coverage for COVID-19 testing applies on a first-dollar basis to private insurance plans. “First dollar” means that coverage must be without any cost-sharing, including deductibles, copayments or coinsurance. Medicare and Medicaid beneficiaries can receive COVID-19 testing at no cost as well, and healthcare providers must publish their “cash price” for COVID-19 tests on a public website.
It’s also important to note that under Notice 2020-15, the Internal Revenue Service (IRS) also permits high-deductible health plans (HDHPs) to cover both COVID-19 testing and treatment on a first-dollar basis without making participants ineligible to make contributions to health savings accounts (HSAs).
Preventive Health Services
The CARES Act requires insurance coverage of preventative care intended to prevent or mitigate COVID-19. Currently, there are no preventative care options available. However, once COVID-19 preventative care, such as vaccines, becomes available, Group health plans must cover it on a first-dollar basis without any cost-sharing.
Over-the-Counter and Prescription Drugs
The CARES Act removes a restriction of the Affordable Care Act (ACA) for account-based plans, including flexible spending accounts (FSAs), HSAs and health reimbursement arrangements (HRAs). Under the CARES Act, these plans must reimburse the costs of over-the-counter medicines without a prescription.
The CARES Act also requires that Medicare prescription drug plans and Medicare Advantage Part D plans allow up to a 90-day supply of prescription drugs during the COVID-19 emergency period.
With social distancing measures in place and healthcare providers struggling to keep up with the influx of patients, many are turning to telehealth services. Through telehealth, patients are able to receive the care they need without having to physically go to a hospital or physician’s office. Due to the value of telehealth during this time, the CARES Act permits but does not require HDHPs with an HSA to waive cost-sharing for telehealth services prior to a patient reaching the deductible, without affecting the ability to make or receive HSA contributions.
Keep Your Wheels Turning Amid COVID-19
While a lot of uncertainty remains, it’s important for health insurance Brokers to stay abreast of the developing pandemic. From keeping you informed of these changes and regulations to providing the necessary resources to ensure your Groups have the health coverage they need, FormFire is here to help keep the wheels turning. With FormFire’s all-in-one digital platform, Brokers can quickly pull rates, build proposals and even renew health plans with just a few clicks. And because we’re completely digital, everything from completing our medical health questionnaire (MHQ) to signing insurance forms can be done online. Contact FormFire today to learn more or to request a free demo.