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Health Insurers Cover Home COVID-19 Tests

Health Insurers Cover Home COVID-19 Tests

by | Jan 18, 2022 | COVID-19, healthcare

Starting January 15 at-home CIOVID-19 tests will be free of charge. This order was issued last week Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests.

Free At-Home COVID-19 Test available via USPS. On Jan. 18, every home in the United States can order up to four free COVID-19 tests. January 19, Americans will be able to order free at-home rapid COVID tests from the government at COVIDTests.gov.

The federal guidance requires commercial insurers and group health plans (both fully insured and self-insured) to reimburse consumers for the cost of Over-the-Counter (OTC) COVID-19 diagnostic tests, with or without an order or clinical assessment by a healthcare provider.

Types of COVID Tests:

  • Antigen tests, which test for an active infection by detecting specific virus proteins. Most at-home tests and “rapid tests” performed by healthcare providers fall in this category.
  • Molecular tests, which test for an active infection by amplifying genetic material from the virus. These are considered the “gold standard” for diagnosing COVID, as they are generally more accurate than antigen tests. The most familiar test from this category is the polymerase chain reaction (or PCR) test, which requires lab processing. 
  • Antibody tests, which are blood tests that determine if the body has had an immune response to the virus. These tests are not used for diagnosing an active infection.

How Will this work with your Insurer?

Consistent with the guidance Insurers will utilize existing member claims submission procedures to provide benefits without cost-share for OTC COVID-19 tests that members purchase, either online or through other retailers. In addition to the member demographic information that is normally filed with member-submitted claims, the members will be required to certify that the test was purchased for personal use and not for employment purposes.

Customers may receive reimbursement for up to 8 COVID-19 OTC tests per covered individual per calendar month without a health care provider prescription or individualized clinical assessment. For a family of four covered individuals, that equates to 32 tests per month.

Members with Empire Blue Cross, for example, will utilize A.I. apps such as Sydney App or online.  Separately, Insurers such as UnitedHealthcare will initially offer for at-home COVID-19 tests are Walmart Pharmacy and Rite Aid Pharmacy. When using Walmart or Rite-Aid there will be no up-front cost and you will not have to submit a form for reimbursement. Note, you may be required to go to the pharmacy counter to obtain the test kits at no cost.

Note, only tests that are FDA approved and sold by an authorized reseller are eligible for reimbursement. For updates, go to Approved COVID-19 Home Tests | NC COVID-19 (ncdhhs.gov).

Insurance Resources:

Aetna

CIGNA

Empire BlueCross / Anthem

Halthfirst

Horizon Healthcare NJ

Oxford/Unitedhealthcare

If you’re interested in hearing more about the advantages of partnering with a PEO, we’d love to talk to you. Fill out the form below or email info@medicalsolutionscorp.com for a FREE Consultation Today!

The information provided on this website is intended for informational purposes only.  Millennium Medical Solutions Corp. does not offer legal or medical guidance.  Those with legal or medical questions should seek appropriate assistance from a licensed professional.  Stay up to date by signing up for Newsletter and Coronavirus Dashboard below.

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Winter Action Plan to Battle COVID-19

Winter Action Plan to Battle COVID-19

by | Dec 11, 2021 | COVID-19, healthcare

On December 2, 2021, the Biden administration issued a nine-pronged plan to combat COVID-19 as the winter months approach and the new Omicron variant poses risk of new infections. The plan covers:

1. Boosters for adults

2. Vaccinations to protect children and keep schools open

3. Expanded free at-home testing

4. International travel protections

5. Workplace protections

6. Rapid response teams to battle rising cases

7. Supplying treatment pills to help prevent

hospitalizations and death

8. Continued commitment to global vaccination efforts

9. Steps to ensure preparation for all scenarios

Aspects of this plan will affect employers and group health plans, as follows:

Expanded free at-home testing. The Departments of Labor, Health and Human Services, and the Treasury (collectively, the “Departments”) are directed to issue guidance by January 15, 2022, to clarify that individuals who purchase over-the-counter (“OTC”) COVID-19 diagnostic tests can seek reimbursement from their group health plan or health insurance issuer to cover the cost of the OTC test during the public health emergency.

The plan notes that consistent with current guidance, group health plans are not required to cover testing for public health surveillance or employment purposes.

PTO for booster shots. While all federal employees currently receive paid time off to get booster shots,  employers are called upon to provide the same paid time off for their employees, if they are not doing so already, including paid time off for family members getting their first, second, or booster shots.

Targeting outreach to Medicare beneficiaries. CMS  is launching an initiative to get Medicare beneficiaries booster shots. CMS will be sending all Medicare beneficiaries a notice providing information on access to booster shots in their community as well as emails.

• Protecting Workplaces to Keep Businesses  Open. The administration is calling on businesses to move forward with requiring their workers to get vaccinated or be tested weekly. No new guidelines or requirements are part of this provision. The emphasis on encouragement is likely in response to the ongoing legal challenges to the federal vaccine mandates.

Currently, the courts have issued an enforcement stay with respect to the OSHA Emergency Temporary  Standard (“ETS”), applicable to private employers, and a nationwide preliminary injunction with respect to both the CMS interim final rule applicable to health care workers and the federal contractor mandate.

Future guidance is expected to clarify and implement the provisions outlined in this plan. We are monitoring this information and will report on developments.

 

For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

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OSHA Issued COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS)

OSHA Issued COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS)

by | Nov 5, 2021 | COVID-19, healthcare

CMS and OSHA released interim final rules this week detailing the implementation of national vaccine requirements established by President Biden’s executive order in September.Yesterday, the Department of Labor released an unpublished version of the OSHA Emergency Temporary Standard (ETS).

 The ETS is effective immediately and will cover 2/3rds of private employers. The OSHA ETS puts into effect the Biden Executive Order mandating all private employers with 100 or more employees ensure their employees are vaccinated against COVID-19, or submit negative weekly tests.

KEY Summary:

Covered Employers

    • Private employers with 100 or more employees enterprise-wide (across US locations) at the time these rules become effective
      • Independent contractors not included
      • Special franchisee, construction and staffing agency rules
      • Companies who grow will move into the covered group
    • State/local governments, including schools
    • Only state/local ordinances/laws that are not conflicting will have effect (i.e., if the state law prohibits vaccine mandates, OSHA ETS will supersede state law. OSHA ETS will be mandated.)
      • States with state OSHA plans may adopt these federal rules or similar rules. Some states are threatened with removal of state plan authority for failure to comply with laws as stringent as federal (e.g., UT & AZ)

Compliance Deadline

    • Within 30 days of publication (December 5)
    • Testing requirements within 60 days (January 4)

Mandate

    • Determine vaccination status of each employee
      • Obtain acceptable proof –
      • Maintain records/roster
    • Unvaccinated must test negative weekly if worker in workplace at least once a week or within 7 days before returning to work if worker is away from workplace a week or longer
      • Must wear face covering indoors or in occupied vehicle for work
      • Employer not required to pay for testing unless required by law or collective bargaining agreement
      • Employer not required to pay for face coverings
    • Notice
      • Employee must promptly notify of positive COVID test or receive diagnosis
        • Employer must remove employee from workplace, regardless of vaccination status
        • May not return to work until meeting criteria
    • Must provide paid time off for vaccination and recovery from side effects

OSHA is offering robust compliance assistance to help businesses implement the standard, including a webinar, frequently asked questions and other compliance materials.  

 

Conclusion

In conclusion, employers subject to the ETS must determine whether they will take a vaccine-only or combined vaccine and testing/face covering approach to compliance and must develop the required written policies and communicate those policies to employees so they have ample time to receive their COVID-19 vaccines.  Employers should work with legal counsel to develop their written policies and to address any reasonable accommodation requests received by employees.

If needing employment law assistance in implementing these new rules, contact your World Insurance Associates representative so that they can connect you a Jackson Lewis P.C. council in order to receive the WIA arrangement. For our PEO clients, please speak with in-house council and HR. 

 

 

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers, or our clients.  This is not legal advice. Rather, the content is intended as a general overview of the subject matter covered.  

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PPE Expenses May Be Reimbursable Under HSA

PPE Expenses May Be Reimbursable Under HSA

by | May 3, 2021 | COVID-19, healthcare, HSA

PPE Expenses May Be Reimbursable Under Health Spending Accounts – Video

During the COVID-19 pandemic, you may have purchased masks or PPE for the purpose of preventing the spread of the COVID-19. Now, according to a recent announcement from the IRS, those purchases may be deductible from your income for tax purposes and eligible to be paid or reimbursed under certain savings accounts. This video explains further:

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American Rescue Plan Act

American Rescue Plan Act

by | Mar 17, 2021 | ARPA, COBRA, COVID-19, healthcare

American Rescue Plan Act – Extension of EPSL and EFMLA and New COBRA Subsidies

The American Rescue Plan Act (ARPA), which is the latest bill to address the ongoing economic impacts of COVID-19, has been signed into law. We’ve outlined the key provisions of this new legislation that directly affect employers and employees – the optional extension of sick and family leave and the establishment of COBRA subsidies. 

Click here for a complete overview of these new provisions and how they affect employers and employees. 

Pertaining to the COBRA premium subsidy it is important to note:

  • ARPA provides a 100% COBRA subsidy if the employee’s work reduction or termination was involuntary. The subsidy applies for up to six months of coverage from April 2021 through September 2021 (unless the individual’s maximum COBRA period expires earlier).
  • For group plans subject to the federal COBRA rules, the employer will be required to pay the COBRA premium but then will be reimbursed through a refundable payroll tax credit.
  • Employers with fewer than 20 workers usually are exempt from the federal COBRA rules, but their group medical insurance plans may be subject to a state’s mini-COBRA law. In that case, it appears the subsidy will be administered by the carrier. The carrier will pay the premium and then be reimbursed by the government.
    Note: the premium subsidy will apply to NY continuation.
  • Although it takes effect April 1, 2021, employees who were terminated earlier but are still in their COBRA election window also are included.
  • Federal guidance is expected to be released by April 10, including model notices that
    plans can tailor for their use.

As this legislation is very new and vague in certain areas, we will keep you updated as more information and additional clarification becomes available. 

For more details visit  Understanding the $1.9 Trillion American Rescue Plan 

 

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How PEO Clients Fared During COVID-19 Study

How PEO Clients Fared During COVID-19 Study

by | Dec 7, 2020 | COVID-19, healthcare, PEO, Small Business Group Health

The 2020 COVID-19 pandemic has created unprecedented economic challenges for almost all employers, with small businesses hit especially hard.  But how have PEO clients faired during this historic time?  While there have been articles such as 6 Advantages of a PEO during COVID-19  explaining the positive advantages we now how  the data and analytics published by NAPEO  – White Paper on How PEO Clients Fared in the First Months of the COVID-19 Pandemic: A Comparative Analysis.

PEO clients were 119% more likely to have received PPP loans.

It turns out that PEOs have been very successful at helping their clients through this period of extreme difficulty. One of the most apparent ways is by helping clients to apply for and claim emergency funds available through the Paycheck Protection Program (PPP)

These funds were designed to help businesses navigate the economic disruption without downsizing. However, the PPP program turned out to be challenging to apply for and receive funds. PEOs have proved to be a major help in this regard. One PEO client told NAPEO: “I sat down at my computer one morning to request what I would need to get a PPP loan and it was already in my inbox (from my PEO), even before banks were allowed to accept applications… As a result of their service, I could focus on serving my clients.”

Specifically, only an average of 30.1% of small businesses nationwide received PPP loans, while fully two-thirds (65.9%) of comparable PEO clients received PPP loans.

PEO clients were 60% less likely to have permanently closed.

The effects of COVID-19 have proven so destructive that many businesses have permanently shuttered. While noting that it is too early to determine final survival rates, NAPEO’s survey did find that as of July 31, 2020, only 0.6% of PEO clients had permanently closed, compared to an average of 1.5% for all small businesses nationwide. There’s a similarly dramatic difference in temporary closures as well: only an average of 1.3% of PEO clients was still temporarily closed compared to 14% of all small businesses.

The NAPEO report suggests that PEO’s ability to help clients maneuver through new regulations and figure out ways to reopen safely played a role. As one of NAPEO’s member PEOs said, “We’ve helped our clients in a variety of new ways, with everything from return-to-work procedures and securing personal protective equipment to introducing solutions via mobile applications for contact tracing and office reopening management.”

Final Summary

So, from a percentage standpoint, compared to other small businesses, PEO clients are:

  • 119% more likely to have received PPP loans.
  • 72% more likely to have received their PPP funding in Round 1.
  • 91% less likely to still be temporarily closed.
  • 60% less likely to be permanently closed.

While the first wave of urgent needs from small and mid-sized businesses is behind us, smaller businesses will continue to face challenges as the recession and COVID-19’s impact continue. As the research shows, PEOs will provide unmatched support as these smaller companies anticipate and respond to the new normal.

360PEO is also here for you during this time. For more information on how a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

 

Infographic How PEO Faired DuringC

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