FLASH: Update – Coverage for COVID-19 Testing
July 10, 2020The Federal Government recently released guidance about COVID-19 testing for employment and public surveillance purposes. We’re writing to inform you that following this guidance, beginning with dates of service on July 1:
- If a member gets tested for employment purposes or for public surveillance purposes, their plan will not cover the testing or testing related visit(s).*
- If a member gets tested for other non-clinical purposes (excluding employment and public surveillance purposes), their plan will cover the testing and testing related visits, but cost sharing will apply.* An example of this type of testing would be pre-operative COVID-19 testing before a medical procedure, when there is no other clinical indication.
We are basing this upon the June 23, 2020 FAQ document prepared jointly by the US Department of Labor, Department of Health and Human Services, and Department of the Treasury, to answer questions regarding the implementation of the Families First Coronavirus Response Act (FFCRA). Question 5 of this document reads: “testing conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance for SARS-CoV-2, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition is beyond the scope of section 6001 of the FFCRA.”
Members’ plans will continue to cover, with no member cost share, appropriate medically necessary diagnostic laboratory testing for COVID-19 when the test is ordered by a physician for clinical (i.e. medical) reasons (for example, if a member has symptoms or known exposure to the novel coronavirus). This also applies to serological (antibody) tests for COVID-19, as well as tests for other causes of respiratory illness, when an individual’s attending provider determines that these tests (such as influenza and blood tests, among others) are needed to help diagnose whether or not an individual has COVID-19. Cost sharing is also waived, in these above instances, for COVID-19 testing related visits, whether the visit is received in a healthcare provider’s office, an urgent care center, an emergency department or through telehealth.
These actions, guidelines and limits may change as the pandemic evolves. Members should call the number on the back of their ID card if they have any questions about their coverage.
*Please note that if an individual is on a self-funded plan administered by Health Alliance or Health Alliance Northwest, their coverage for COVID-19 testing (and testing related visits) that are for the purposes of employment, public surveillance and/or pre-operative and other non-clinical purposes may vary, based on the decisions of their employer / plan sponsor.
For more information about COVID-19, our response and questions about coverage, please visit HealthAlliance.org/Coronavirus.
If you have any questions, please contact your Provider Relations Specialist. And thanks, as always, for all you do for our members and our communities.