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Must Local Government Plans Comply with COVID-19 Mandates?

Governmental plans often enjoy exemptions from certain federal employee benefits requirements. As guidance has been issued throughout 2020 to address the COVID-19 pandemic, questions have arisen about which of these requirements, if any, apply to governmental plans.

In June 2020, the Center for Medicare and Medicaid Services (CMS) issued guidance on the application of COVID-19 mandates, such as the FFCRA, CARES Act, and telehealth requirements, to non-federal governmental plan sponsors.

COVID-19 Mandate

Application to Non-Federal Governmental Plans

CARES Act Testing Requirements:

Requires group health plans and health insurance issuers offering group or individual health insurance to cover (without cost-sharing) any qualifying coronavirus preventive service and shall take effect 15 business days after the date on which the recommendation is made relating to the "qualifying coronavirus preventive service."

Required for state and local government plans.
FFCRA Testing Requirements:

Requires group health plans and a health insurance issuers offering group or individual health insurance coverage, including grandfathered plans, to provide coverage, with no cost-sharing, for in vitro diagnostic products and items and services furnished to an individual during health care provider office visits (includes in-person and telehealth), urgent care center visits, and emergency room visits related to in vitro diagnosis.

Requires the waiver of cost-sharing for COVID-19 testing and office visits under Medicare and Medicare Advantage, Medicaid, CHIP, Tricare, coverage for veterans and federal civilians, and Indians covered through the Indian Health Services.

Required for state and local government plans.
Extended Notice Requirements:

Provides relief via deadline extensions for HIPAA special enrollment, COBRA, claims procedures, external review process, and furnishing ERISA required notices.

Optional for state and local government plans.
Telehealth Requirements:

Telehealth and other remote care services without a deductible or with a deductible below the minimum annual deductible will not disqualify an individual from contributing to an HSA for plans beginning on or before December 31, 2021. This is not limited to coverage for COVID-19 related services.

Optional for state and local government plans.

Never miss an update: visit OneDigital’s Compliance Confidence Page for the latest developments and the impact on your business.

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