The DOL, IRS, and HHS have issued FAQ Part 51. While six of the FAQs provide advance guidance on the plan’s coverage of over-the-counter COVID-19 tests (see our Checkpoint article), three FAQs address questions related to the preventive health services requirements of the Affordable Care Act (ACA). Here are highlights of the preventive services guidelines:
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Colonoscopies. Q/A-7 states that a group health plan or insurer must cover, without cost sharing, a colonoscopy performed after a positive non-invasive stool-based screening test or a direct visualization screening test of the colorectal cancer, pursuant to the May 18, 2018 directive. 2021 United States Preventive Services Task Force (USPSTF) Recommendation. Q/A-8 adds that the USPSTF recommendation is considered to have been issued beginning May 31, 2021, therefore coverage without cost sharing must be provided for plan or policy years beginning on or after May 31, 2022 (one year after the contract expiration date). date the recommendation was issued).
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Contraceptives. Highlighting complaints and reports that group health plans and insurers are not complying with the contraceptive coverage mandate as amplified by Health Resources and Services Administration (HRSA) guidance, Q/A-9 warns that Agencies actively investigate compliance with this requirement and may take enforcement or other corrective action. Additionally, agencies are evaluating what types of changes to existing guidelines might be necessary to ensure that individuals receive mandatory coverage. Q/A-9 also notes that the agencies received comments that the current FDA guidance on birth control referenced in the HRSA guidance may not identify the most recent contraceptive products or all approved, authorized contraceptive products or granted by the FDA. The agencies caution that, as a result, plans and insurers may not provide coverage for the full range of contraceptive products approved, authorized, or licensed by the FDA under the current 2019 HRSA guidelines.
EBIA comment: These FAQs illustrate that employers and their advisors must be vigilant to stay current on preventive health service requirements for group health plans. Current Lists USPSTF Recommendations And HRSA Guidelines are available online and are continually updated. For more information, see the EBIA guide Group health plan mandates manual in Section XIV.C (“Required Coverage of Preventive Health Services”) and the EBIA Manual. Health care reform manual in Section XII.C (“Coverage of preventive health services”). See also EBIA Self-Insured Health Plans manual in section XIII.C.1 (“Preventive health services”).
Contributing editors: EBIA staff.