Q: Do Health Insurance Plans Cover COVID-19 Testing?

If you are covered by a health insurance plan—either individual or a group plan—the Families First Coronavirus Response Act (FFCRA) generally requires insurers to provide you with testing for or related to COVID-19 without paying out of pocket expenses.

Eligible coronavirus tests (covered by FFCRA) are any tests approved by the Food and Drug Administration (FDA), developed by states, requested by the developers for authorization from the FDA, or deemed appropriate for COVID-19 diagnosis by the secretary of Health and Human Services (HHS).

When did the covered COVID-19 testing go into effect? 

The FFCRA went into effect on March 18, 2020. It says that insurance carriers must cover certain items and services related to diagnostic testing for COVID-19. They also generally can’t require you to pay out-of-pocket expenses, such as deductibles, copayments, and coinsurance. If you were tested for COVID-19 before March 18, 2020, the costs likely won’t be covered, but you should check with your insurance carrier to confirm.

What steps should I take to ensure my tests are covered by my insurance?

FFCRA says that states can require carriers to cover more COVID-19 tests than required at the federal level, so check with your insurance carrier to confirm what’s covered. You can confirm what is being covered specifically by checking your carrier’s COVID-19 bulletin online or by calling them directly.

If you’ve already received diagnostic tests to detect SARS-CoV-2 or the diagnosis of COVID-19 and believe you were unfairly charged, be sure to contact your carrier to appeal the claim. Services provided during this visit that are not related to the diagnosis of COVID-19, however, will still be charged to you by your insurance provider according to your plan’s terms.

Do I have to use an in-network provider?

Using an in-network provider means insurance carriers reimburse expenses based on the in-network rate—which means COVID-19 diagnostic testing should be free for you. For out-of-network providers, you could incur a fee that your carrier may refuse to pay. It’s typically a good idea to stay in-network to reduce the chances of paying out-of-pocket. You can usually  find an in-network provider by calling the number on the back of your insurance card or visiting your carrier’s website and using the “find a provider” tool. 

Are health insurance carriers covering any other COVID-19 related costs? 

COVID-19 preventive services generally have to be covered without charging you for out-of-pocket costs. This would include any item, service, or immunization that prevents or mitigates the disease. Once these preventive measures are recommended by the government, insurers will have 15 business days to provide them without cost sharing.

Quick note: This is not to be taken as legal or HR advice. Since employment laws change over time and can vary by location and industry, consult a lawyer or HR expert for specific guidance. This is also not medical advice, and employers dealing with issues related to coronavirus should be reminded to adhere to employee privacy laws and best practices.

Our COVID-19 Small Business Resource Hub has legislation updates, advice, and support.

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