Health Benefits and the Families First Coronavirus Response Act

By: Wendy Pongracz, James Beall, Susan Bahme Blumenfeld, Kelly A. Brogan

The newly enacted Families First Coronavirus Response Act (FFCRA) provides that group health plans (including self-insured and insured plans, as well as Medicare, Medicaid and CHIP plans and programs) must provide certain benefits for COVID-19 testing.

What COVID-19 benefits must group health plans provide?

Effective, March 18, 2020, group health plans must provide benefits for the following items and services with no cost-sharing (including copayments, deductibles and coinsurance) and no prior authorization or other medical management requirements:

1.Diagnostic products for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 that are FDA-approved, as well as the administration of such products; and

2.Items and services furnished to an individual during health care provider office visits, urgent care center visits, and emergency room visits that result in an order for or administration of a diagnostic product described above, but only to the extent such items and services are related to furnishing or administering such product or to the evaluation of such individual for purposes of determining the need of such individual for such product.

NOTE: The requirement that these items and services be provided with no patient cost-sharing applies to both grandfathered and non-grandfathered group health plans.

These requirements will be in effect for the period of the public health emergency declared by the Secretary of the United States Department of Health and Human Services as a result of the 2019 Novel Coronavirus (2019-nCOv).

I have been laid off from my job and my benefits were terminated. Where can I get health benefits now?

You may be able continue your health benefits coverage through the COBRA continuation coverage provisions under your group health plan. If you worked for an employer that is not required to offer COBRA coverage, continuation coverage may still be available under state laws for small employers.

Before enrolling in COBRA or other continuation coverage through your employer, you may want to explore the Marketplace coverage options that are available to you at www.HealthCare.gov. The Marketplace coverage may be more affordable than your employer’s continuation coverage, and you may be able to purchase coverage tailored to your family’s needs.

Although the general open enrollment period for Marketplace coverage is closed for 2020, you may be able to enroll under the “special enrollment” rules. When you log onto www.HealthCare.gov, click on the “See if I can enroll” button. You will then be asked to enter your ZIP code and respond to “What do you want to do first.” Click the button that says, “See if you qualify for a Special Enrollment Period,” hit “continue” and answer the questions.If you qualify, you can enroll in a plan or change plans for the rest of 2020. You can then create an account and shop for coverage. You may also wish to explore options on the websites of the health insurance carriers in your area that offer coverage independent of www.HealthCare.gov.

For additional information on other provisions of FFCRA relating to paid sick leave, paid family and medical leave and the additional federal funding to states for unemployment insurance, see: https://www.wwdlaw.com/resources/#collectively-the-blog