President Biden announced on January 10and that the Biden-Harris administration is requiring insurance companies and group health plans to cover the cost of at-home over-the-counter (OTC) COVID-19 tests. As of January 15, 2022, individuals with private health insurance or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the Food and Drug Administration (FDA) from the United States will be able to have these testing costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter tests at home per person covered per month.
In the Department of Labor (DOL) FAQ published on January 10, 2022, Q1 states: “This FAQ does not modify the previous guidelines** dealing with coverage for purposes that are not primarily intended for the diagnosis or individualized treatment of the COVID-19, including guidance that states that plans and issuers are not required to provide testing coverage (including an OTC COVID-19 test) for employment purposes.
Additionally, Q4 provides that schemes and issuers may take reasonable steps to ensure that an OTC COVID-19 test has been purchased for the individual’s personal use, including requiring certification that the test has was purchased for personal use and not for professional use.
**Previous guidelines referenced above are DOL FAQs published in February 2021 which state that plans and issuers are required to cover COVID-19 diagnostic testing of asymptomatic individuals when the purpose of the test is diagnosis or treatment of COVID-19, but not for public health surveillance or employment purposes.
The essential: While waiting to hear how insurance companies will handle this, we expect them to take action to exclude employment testing now, even if they have not done so so far. Unfortunately, employers shouldn’t rely on this to help pay for testing costs.