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2022 Year-End Plan Sponsor’s “To Do” List (Part 1) Health and Wellness | JD Supra

COVID-19 testing: Group health plans must cover (without cost-sharing, prior authorization, or medical management requirements) COVID-19 testing and items and services provided to an individual during visits to the health care provider’s office (including in-person and telemedicine visits), urgent care center visits and emergency department visits that result in an order or administration of a COVID-19 test or assessment of that person for the purpose of determining the need for such a test. For out-of-network providers, group health plans must reimburse either the cash price, as listed by the provider on a public website, or a lower negotiated rate.

Additionally, pursuant to Internal Revenue Service (“IRS”) Notice 2020-15, High Deductible Health Plans (“HDHP”) may waive minimum deductibles for COVID-19 testing without jeopardizing their status. HDHP.

For more information, check out our SW Benefits Update, “2021 Year-End Plan Sponsor To-Do List (Part 1) Health and Wellness.”

This requirement will expire at the end of the COVID-19 public health emergency.

Before the COVID-19 public health emergency ends, group health insurance plans could consider:

  • Continue to cover COVID-19 testing;
  • Should reasonable medical management techniques be mandated for COVID-19 testing?
  • Whether HDHP relief under IRS Notice 2020-15 may end when the COVID-19 public health emergency ends; and
  • How to notify plan members of applicable plan changes (e.g. plan amendment, SMM, etc.).
Over-the-counter (“OTC”) COVID-19 test: Group health plans must cover up to 8 FDA-approved OTC COVID-19 tests per month with no cost-sharing (i.e., deductibles, co-payments, or coinsurance), prior authorization, or other health care requirements. medical management. If a plan meets certain requirements, it can limit its reimbursement for OTC COVID-19 tests from non-preferred pharmacies and other retailers to the actual price or $12 per test (whichever is lower).

Additionally, per IRS Notice 2020-15, HDHPs can waive minimum deductibles for COVID-19 testing without compromising their HDHP status.

For more information, check out our SW Benefits Update, “Group Health Plans Must Provide Free Over-the-Counter COVID-19 Testing Starting January 15, 2022 – Six Takeaways *Updated*.”

This requirement will expire at the end of the COVID-19 public health emergency.

Before the COVID-19 public health emergency ends, group health insurance plans could consider:

  • Continue to cover OTC COVID-19 testing;
  • Should reasonable medical management techniques be imposed on OTC COVID-19 testing?
  • Whether HDHP relief under IRS Notice 2020-15 may end when the COVID-19 public health emergency ends; and
  • How to notify plan members of applicable plan changes (e.g. plan amendment, SMM, etc.).
Parity in mental health: The agencies provided limited enforcement relief under the MHPAEA by allowing plans to disregard free COVID-19 diagnostic tests and other services required to be covered under the section. 6001 of the Coronavirus Response Act First (“FFCRA”) to determine whether a financial requirement or quantitative treatment limitation (1) applies to “substantially all” medical/surgical benefits of a classification , or (2) is more restrictive than the “predominant” level applicable to medical/surgical benefits. For more information, check out our SW Benefits Update, “2021 Year-End Plan Sponsor To-Do List (Part 1) Health and Wellness.”
This relief will expire at the end of the COVID-19 public health emergency.

Until the COVID-19 public health emergency is over, group health insurance plans may want to consider whether continuing to provide COVID-19 benefits violates the requirements of the MHPAEA.

COVID-19 vaccination: Group health plans must cover, without cost sharing, any item, service, or vaccine intended to prevent or mitigate coronavirus if such item is appropriately recommended by the U.S. Preventive Services Task Force or Advisory Committee on immunization practices from the Centers for Disease Control and Prevention within 15 business days of such recommendation being made. For more information, check out our SW Benefits Update, “2021 Year-End Plan Sponsor To-Do List (Part 1) Health and Wellness.”
The obligation to cover vaccines provided by network providers continues beyond the COVID-19 public health emergency and the COVID-19 national emergency. However, the obligation to cover vaccines provided by out-of-network providers expires when the COVID-19 public health emergency ends.

Before the COVID-19 public health emergency ends, group health insurance plans could consider:

  • Continue to cover out-of-network COVID-19 vaccines free of charge;
  • Should reasonable medical management techniques be imposed on out-of-grid COVID-19 vaccines; and
  • How to notify plan members of applicable plan changes (e.g. plan amendment, SMM, etc.).

As a result, group health plans periodically may consider:

  • Whether to cover COVID-19 treatment for free;
  • Whether HDHP relief under IRS Notice 2020-15 may end when the COVID-19 public health emergency ends; and
  • How to notify plan members of applicable plan changes (e.g. plan amendment, SMM, etc.).
This relief will expire at the end of the last of the COVID-19 public health emergency and the national COVID-19 emergency for EAPs. However, the guidelines suggest that on-site medical clinics are still excluded benefits and therefore benefits for COVID-19 diagnosis, testing and vaccinations do not compromise this status.

Prior to the end of the COVID-19 public health emergency and the COVID-19 national emergency, group health insurance plans may consider continuing to provide benefits for COVID-19 diagnosis, testing and vaccinations. 19 as part of an EAP and/or on-site medical clinic and how to notify participants of applicable changes.

Telemedecine : HDHPs may, but are not required to, provide telemedicine and other remote care services free of charge until the required deductible is reached for services provided on or after January 1, 2020 for plan years commencing on or before December 31, 2021 and for months beginning after March 31, 2022 and before January 1, 2023. For more information, see our SW Benefits blog, “HDHP Telehealth Relief extended for remainder of 2022, but beware of 3-month relief gap.”

As a result, effective January 1, 2023, HDHPs should no longer do so to avoid tainting their HDHP status and rendering HSA participants ineligible. HDHPs must also notify plan participants of this change.

Extension of COVID-19 deadlines: ERISA health and wellness plans must extend various deadlines during the “epidemic period” related to the Consolidated Fiscal Reconciliation Act (“COBRA”), special enrollment, claims and appeals, including including external review procedures. For more information, check out our SW Benefits Update, “2021 Year-End Plan Sponsor To-Do List (Part 1) Health and Wellness.”
The “outbreak period” ends at the earliest of (1) one year from the date a person is first eligible for assistance, or (2) 60 days after the announced end of the outbreak. national COVID-19 emergency. This leads to individual one-year extensions of the deadlines mentioned above while the national COVID-19 emergency is ongoing.

At the end of the national COVID-19 emergency, group health plans may consider notifying plan members of the end of time extensions.

Changes to the cafeteria layout: According to the CAA, IRS Notice 2021-15, and American Rescue Plan Act of 2021 (“ARPA”), employers may make various temporary changes to their cafeteria plans, including, but not limited to, the deferral of the Flexible Health Spending Account (“ FSA Santé”) and the Dependent Assistance Plan (“DCAP”). relief and health FSA and DCAP grace period relief. For more information, check out our SW Benefits Update, “2021 Year-End Plan Sponsor To-Do List (Part 1) Health and Wellness.”

Although most of the temporary changes to cafeteria plans are no longer applicable, group health plans that have adopted one of these changes should ensure that they adopt a modification before the end of the first calendar year beginning after the end of the plan year in which the amendment is effective. For example, an employer with a calendar year plan that allowed participants to carry forward unused amounts remaining in their health FSA and/or DCAP from plan year 2021 to plan year 2022, must modify their cafeteria to reflect this change by December 31, 2022. .

Inclusion of COVID-19 Personal Protective Equipment (“PPE”): In accordance with IRS Announcement 2021-7, Health Savings Accounts (“HSAs”), Archer Medical Savings Accounts, Health FSAs, and Health Reimbursement Agreements (“HRAs”) may reimburse amounts paid for PPE for the primary purpose of prevent the spread of COVID-19, including masks, hand sanitizer, and disinfectant wipes, effective January 1, 2020.
These changes appear to be permanent and therefore employers wishing to allow reimbursement for these items should consider modifying their plans accordingly.

In accordance with IRS Announcement 2021-7, an employer may adopt an amendment no later than the last day of the first calendar year beginning after the end of the plan year in which the amendment takes effect. However, an amendment with retroactive effect cannot be adopted after December 31, 2022.

Long COVID-19 as a disability: On July 26, 2021, HHS and the Department of Justice released tips confirming that “Long COVID” is a condition that may be considered a disability under the Americans with Disabilities Act (“ADA”) and the ACA if the condition is a physical or mental impairment that significantly limits one or many major life activities. The guidelines note that long COVID is not always a disability and that employers should assess each individual to determine if the person’s long COVID condition meets the requirements. These guidelines have the potential to provide federal protection to a large group of COVID-19 “long haulers” from discrimination.

These changes seem permanent. Employers must ensure their benefit plans and wellness programs do not discriminate against employees with COVID-19-related disabilities

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