Coverage for COVID-19 Testing and Treatment

Earlier this month, the administration announced that testing for COVID-19 was deemed an essential health benefit for coverage purposes. However, it is not considered preventive and is therefore subject to any deductible, copay or coinsurance applied to diagnostic testing under your plan. Testing and treatment provided at approved locations in accordance with CDC guidelines are also covered under the plan following the plan’s payment parameters.

If you sponsor a qualified HDHP, testing and treatment is covered after the plan’s deductible has been satisfied, subject to any coinsurance after the deductible. However, on March 11th the IRS released Notice 2020-15 which states that a plan may waive deductibles or implement a deductible lower than the minimum required in a qualified HDHP for the purposes of COVID-19 testing or treatment without disqualifying an eligible individual from making tax-favored contributions to a health savings account.

Ensuring Access to Care

Amending your Plan:

Most fully insured carriers have decided to waive member cost sharing, including copays, coinsurance and deductibles, for COVID-19 diagnostic testing and treatment. Some states are requiring fully-insured carriers to waive a member’s out-of-pocket for COVID-19 related expenses. As a self-funded plan, these state mandates are not applicable to your plan.

If, as a plan sponsor, you are considering amending your plan to include first dollar coverage for testing and treatment, please be aware that we will need to obtain prior approval from your stop loss carrier to ensure any related claims will be covered under stop loss should they exceed your stop loss deductible. Additionally, your plan will need a written and executed amendment to affect the change.

We will work closely with you and your carrier on these issues to safeguard your employees, their families and your plan.

Please contact your DG sales representative to discuss amending your plan to allow first dollar coverage of the testing, treatment or both. Your plan will continue to cover all medically necessary testing and treatment subject to the plan’s current deductible, copays and coinsurance in the meantime.

Working for you:

Diversified Group has plans and resources in place in our effort to protect our employees and continue to serve our clients. We have a business continuity plan to deal with any business disruption due to unforeseen circumstance. Our staff is prepared to handle a potentially large number of claims for members who may become ill and our systems are equipped to allow for telecommuting without service disruption.

COVID-19 Summary

For the most updated information about COVID-19, visit the CDC’s page at https://www.cdc.gov/coronavirus/2019-ncov/index.html or the World Health Organization at https://www.who.int/emergencies/diseases/novel-coronavirus-2019.