Health Plans Must Cover COVID-19 Vaccine Without Cost Sharing

On November 6, 2020, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) published an interim final rule requiring Medicare, Medicaid and private insurers to cover a COVID-19 vaccine without any cost sharing.  The interim final rule implements the requirement in the Coronavirus Aid, Relief and Economic Security (CARES) Act that group health plans and health insurance issuers offering group or individual health insurance coverage provide coverage, without cost sharing, for qualifying COVID-19 preventive services, which includes COVID-19 immunizations.

In anticipation of when a COVID-19 vaccine is available:

  • The interim final rule requires Medicare, Medicaid and private insurers to cover the vaccine without cost sharing.
  • Coverage of qualifying COVID-19 preventive services must be provided within 15 business days after the recommendation is made.

During the COVID-19 public health emergency, this coverage must be provided for both in-network and out-of-network providers.

COVID-19 vaccines will be considered preventative care under the Affordable Care Act once the US Preventative Services Task Force rates them at an ‘A’ or ‘B’. At that time, these vaccines will be covered as preventive services at no cost to employees under most health plans. As subsequent vaccines hit the marketplace, the cost will shift to insurance carriers (including self-funded health plans).

EEOC Issues FAQs on Mandatory Vaccinations for COVID-19

On Dec. 16, 2020, the Equal Employment Opportunity Commission (EEOC) issued additional answers to frequently asked questions (FAQs) about how employers should comply with the Americans with Disabilities Act (ADA) and other federal fair employment laws while also observing all applicable emergency workplace safety guidelines during the coronavirus pandemic. The new FAQs address whether employers may require employees to receive COVID-19 vaccinations. They were added to guidance that the EEOC first issued on March 18, 2020, and then updated several times.

The EEOC’s pandemic guidance clarifies that employers may:

  • Require employees to receive COVID-19 vaccinations (but may need to accommodate certain refusals);
  • Ask employees if they have COVID-19 or its symptoms;
  • Require employees to stay home (and to provide medical notes before returning to work) if they have COVID-19 or its symptoms; and
  • Screen applicants for COVID19 symptoms after making conditional job offers.

IRS Circular 230 disclosure: To ensure compliance with requirements imposed by the IRS, we inform you that any tax advice contained in this communication, unless expressly stated otherwise, was not intended or written to be used, and cannot be used, for the purpose of (i) avoiding tax-related penalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any tax-related matter(s) addressed herein.

Heffernan Employee Benefits Health Care Reform, ERISA, and HR Alerts are published as an information source for our clients and colleagues. It is general in its nature and is not intended to be and should not be used as a substitute for specific legal advice.

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