Pension & Benefits News Group health plans must cover COVID-19 immunizations without cost sharing
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Tuesday, November 10, 2020

Group health plans must cover COVID-19 immunizations without cost sharing

By Pension and Benefits Editorial Staff

The Departments of the Treasury, Labor, and Health and Human Services (HHS) have issued interim regulations clarifying that plans and issuers must cover without cost-sharing qualifying coronavirus preventive services including immunizations. These changes apply as of November 2, 2020, until the end of the public health emergency (PHE) for COVID-19 as determined by the HHS Secretary.

No cost-sharing even if out-of-network. Under this emergency rule, plan enrollees can access qualifying coronavirus preventive services on the expedited basis. Furthermore, plans and issuers must cover without cost-sharing qualifying coronavirus preventive services, regardless of whether such services are delivered by an in-network or out-of-network provider.

This coverage is required to be provided within 15 business days after the date the United States Preventive Services Task Force (USPSTF) or the Advisory Committee on Immunization Practices of the CDC (ACIP) makes an applicable recommendation relating to a qualifying coronavirus preventive service.

Coronavirus preventive services. Qualifying coronavirus preventive services include items, services, or immunizations that prevent or mitigate coronavirus disease 2019 (COVID-19), and that is: (a) an evidence-based item or service that has in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force; or (b) an immunization that has in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (regardless of whether the immunization is recommended for routine use).

A recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention is considered in effect after it has been adopted by the Director of the Centers for Disease Control and Prevention.

Comment date. To be assured consideration, comments must be received no later than 5 p.m. on January 4, 2021. Refer to file code CMS-9912-IFC. Comments, including mass comment submissions, can be submitted electronically to http://www.regulations.gov; by regular mail to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9912-IFC, P.O. Box 8016, Baltimore, MD 21244-8016; or by express or overnight mail to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9912-IFC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

SOURCE: T.D. 9931, filed with the Federal Register on November 2, 2020.

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