New Guidance Provides Employers with COVID-19-related SBC and Plan Document Relief

New Guidance Provides Employers with COVID-19-related SBC and Plan Document Relief

The Trump Administration recently issued FAQs about the health coverage provisions in the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security (CARES) Act, which provide employers with some significant compliance relief. This guidance addresses the new mandate for all health insurance plans to cover COVID-19 testing. It also includes the latest specification that issuers may allow qualified high deductible health plans (HDHPs) to cover telehealth services without a deductible or with a lower deductible in plan years that start on or before December 31, 2021.  Among other things, the document gives summary of benefits and coverage (SBC) notice and plan document modification relief when it comes to material modifications of a group health plan due to the new federal COVID-19 health coverage law changes. 

Normally, if there is a material change made to plan benefits outside of open enrollment that would impact the text of the summary of benefits and coverage, then plan participants need to get a revised SBC at least 60 days before the effective date of the change.  The FAQs provide enforcement relief and direct employers and health insurance issuers to provide notice of any changes as soon as reasonably practicable.

HHS also will not take enforcement action against any health insurance issuer that changes the benefits or cost-sharing structure of its plans mid-year to provide increased coverage for services related to the diagnosis or treatment of COVID-19. The FAQs encourage states to take a similar approach.

These non-enforcement policies apply to changes made during the COVID-19 public health emergency declaration (currently slated to run through June 16, 2020, but might be extended) or while national emergency declaration under the National Emergencies Act related to COVID-19 is in effect. If a plan sponsors or issuer decides to maintain any of the plan changes it makes beyond the emergency period (for example continuing to allow the use of telehealth outside of the deductible in HDHPs), then employers and issuers must update plan documents or terms of coverage at that time.

Notably, this SBC/coverage terms/plan document relief only applies to the COVID-19 testing coverage mandate and the telehealth provisions. The guidance does not address enforcement relief related to any other plan modification an employer or issuer may make due to circumstances created by COVID-19.

Finally, the FAQs make it clear that employers and health plans may not reduce, limit, eliminate or change other benefits or cost-sharing to adjust for increased expenses related to COVID-19 testing coverage or telehealth coverage deductible requirements for HDHPs.  If they do, they will be subject to enforcement action.