New Regulations for Coverage of COVID-19 Vaccines

On November 6, 2020, the Departments of Health and Human Services, Treasury, and Labor (the Departments) issued new regulations under the CARES Act regarding the obligation of group health plans to cover COVID-19 vaccines.

The regulation applies to qualified coronavirus preventive services.  This is defined as an immunization that has been approved for use by the Advisory Committee on Immunization Practices of the CDC (ACIP).

Under the regulation, non-grandfathered health insurance policies and group health plans (collectively, Plans) must provide coverage without cost sharing for a qualified coronavirus preventive service (QCPS) within 15 days after the service is approved by the ACIP and adopted by the Director of the CDC.

Plans must pay for services without cost-sharing for a QCPS even if the covered person receives it from an out-of-network provider.  The Plan is required to reimburse such providers by a reasonable amount as determined in accordance with market rates.  The Departments will consider the amount of payment to be reasonable if the Plan pays the provider the amount that would be paid under Medicare for the item or service.

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