February Compliance Newsletter

Federal Government Issues FAQs on Over-the-Counter COVID-19 Tests

As follow up to our January newsletter, on February 4, 2022, federal agencies issued additional FAQs regarding coverage of over-the-counter (OTC) COVID-19 tests.

These FAQs modify and clarify the guidance in the first round of FAQs which specified that plans and issuers must cover OTC COVID-19 tests available without an order or individualized clinical assessment by a health care provider.

The new FAQs include the following guidance:

• Plans and issuers have flexibility in how they establish a direct-to-consumer shipping program and direct coverage through an in-person network in order to qualify for the safe harbor.
• The Departments will not take enforcement action against a plan or issuer that is temporarily unable to provide adequate access to OTC COVID-19 tests through its direct coverage program due to a supply shortage.
• Plans and issuers are permitted to take reasonable steps to prevent, detect and address fraud and abuse.
• The OTC test coverage requirements do not apply to tests that use a self-collected sample but require processing by a laboratory or other health care provider to return results.

The FAQs also address how a plan’s or issuer’s coverage of OTC COVID-19 tests impacts health flexible spending arrangements (FSAs) and similar account-based plans.

For more information on how health insurance plans and third-party administrators are reimbursing for the tests, visit our website’s COVID-19 response page.

Annual CHIP Notice Disclosure

An employer who sponsors a group health plan in a state that offers a premium assistance subsidy must provide their employees with the CHIP (Children’s Health Insurance Program Reauthorization Act) notice annually.  Employers can create their own notice or use the model notice the Department of Labor (DOL) releases bi-annually.  The most recent notice was just released with state information current as of January 31, 2022.  If a notice is created, it should include the state contact information for employees who reside in state offering the premium assistance.   Most employers furnish the notice with their annual open enrolment material or when benefits are offered to newly eligible employees. 

Click here for the most recently released model Employer CHIP Notice