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What medical services must be provided under the CARES Act and the FFCRA without imposing any cost sharing?

Posted by Bonita Hatchett-Bodle

May 1, 2020 2:17:28 PM

Under the Families First Coronavirus Response Act (FFCRA) and as amended by the Coronavirus Aid, Relief, and. Economic Security Act (CARES Act), health plans must provide coverage and not impose any cost sharing (including deductibles, copayments, and coinsurance), prior authorization, or medical management requirements for the following services during the public health emergency due to COVID-19:

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Topics: FFCRA, CARES Act, COVID-19 medical services

What is the definition of “health plan” for purposes of complying with the requirement that COVID-19 related services be provided without cost sharing?

Posted by Bonita Hatchett-Bodle

May 1, 2020 2:13:31 PM

Health plans include group health plans and health insurance issuers offering group or individual health insurance coverage (including grandfathered health plans). Group health plans means insured and self-insured group health plans, including private employer group health plans, non-federal governmental plans (such as plans sponsored by states and local governments), and church plans.

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Topics: health plans, FFCRA, CARES Act, COVID-19 medical services

Which tests fall within the definition of “in vitro diagnostic tests” which must be provided without cost sharing under the CARES Act and the FFCRA?

Posted by Bonita Hatchett-Bodle

May 1, 2020 2:11:26 PM

In vitro diagnostic tests include serological tests for COVID-19 that are used to detect antibodies against the SARS-CoV-2 virus, and are intended for use in the diagnosis of the disease or condition of having current or past infection with SARS-CoV-2, the virus which causes COVID-19. If such other testing results in an order for, or administration of COVID-19 diagnostic testing, a health plan must provide coverage for the tests without cost sharing and without imposing prior authorization or other medical management requirements.

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Topics: health plans, FFCRA, CARES Act, COVID-19 medical services

Has the DOL and IRS waived the requirement that summaries of material modification be issued within 60 days?

Posted by Bonita Hatchett-Bodle

May 1, 2020 2:09:04 PM

Yes. Under the Public Health Services Act (PHSA), if a plan makes a material modification, as defined under ERISA, in any of the terms of the plan or coverage that would affect the content of the Summary of Benefits and Coverage (SBC) that is not reflected in the most recently provided SBC, and that occurs other than in connection with a renewal or reissuance of coverage, the plan or issuer must provide notice of the modification to enrollees not later than 60 days prior to the date on which the modification will become effective.

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Topics: Summary of Material Modifications, FFCRA, CARES Act

Are paid sick leave and expanded family and medical leave requirements retroactive?

Posted by Bonita Hatchett-Bodle

Apr 8, 2020 3:24:19 PM

No. The paid leave provisions of the Families First Coronavirus Response Act (FFCRA) only apply to leaves taken on or after April 1, 2020.

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Topics: Coronavirus, paid leave, FFCRA

What are the tax credits under the Families First Coronavirus Response Act (FFCRA)?

Posted by Bonita Hatchett-Bodle

Apr 8, 2020 12:33:07 PM

Tax credits are available to employers between April 1, 2020, and December 31, 2020, for qualifying paid sick leave and expanded medical leave under the FFCRA. The credits are equal to 100% of the stated limit for the types of leave described below. The purpose of the tax credit is to enable employers to provide this paid leave without the additional financial burden during these difficult times.

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Topics: COVID-19, Families First Coronavirus Response Act, EPSLA, EFMLEA, FFCRA

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