Expansion of “Free At-Home Testing for Americans”

On December 21, 2021, President Biden announced a plan to further battle the ongoing COVID-19 pandemic. Among the items listed as the expansion of free at-home testing. On January 10, agencies issued FAQs clarifying that group health plans and issuers must provide coverage of over-the-counter home COVID-19 tests without participant cost-sharing, preauthorization, or medical management. Currently, the cost for diagnosing COVID-19 through home testing is an eligible medical expense that may be paid or reimbursed under healthcare Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs). In the case of health FSAs and HRAs, the plan document must permit the reimbursement. Plans with provisions allowing reimbursement of any expense that qualifies as a medical expense under the Internal Revenue Code and applicable regulations will automatically permit reimbursement of home COVID-19 tests. However, plan sponsors are encouraged to review their plan documents to determine if additional plan amendments are needed if they wish to permit such reimbursements.  

HealthEquity has put together a general summary of the potential effects of the recent government guidance on employee benefit plans. You can check out this guidance here.

Sincerely,

Your Further/HealthEquity team

This general summary is intended to educate employers and plan sponsors on the potential effects of recent government guidance on employee benefit plans. This summary is not and should not be construed as legal or tax advice. The government’s guidance is complex and very fact specific. As always, we strongly encourage employers and plan sponsors to consult competent legal or benefits counsel for all guidance on how the actions apply in their circumstances.

Arizona’s Surprise Out of Network Billing Dispute Resolution (SOONBDR) Program

Balance billing – or a surprise medical bill – happens when you get a bill from a doctor, laboratory, durable medical equipment provider, or other health care provider who isn’t part of your health plan’s network. Often, consumers didn’t know they were getting care from out-of-network providers. For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network doctor. The doctor and the hospital each bill $1,000 for their services, and the health plan pays them each $400. The in-network hospital can only bill the patient for copays, deductibles, and coinsurance amounts. The out of network doctor, however, may bill for copays, deductibles, and coinsurance as well as any other amounts that the health plan did not pay.

The SOONBDR program is defined in Arizona Revised Statutes 20-3111 through 20-3119, and Arizona Administrative Code R20-6-2401through R20-6-2406

To find out what the requirements of the SOONBRD are, click here.