{ "id": "R46359", "type": "CRS Report", "typeId": "R", "number": "R46359", "active": true, "source": "CRSReports.Congress.gov, EveryCRSReport.com", "versions": [ { "source_dir": "crsreports.congress.gov", "title": "COVID-19 and Private Health Insurance Coverage: Frequently Asked Questions", "retrieved": "2021-05-14T04:03:29.532600", "id": "R46359_4_2021-04-09", "formats": [ { "filename": "files/2021-04-09_R46359_d1ecae8d44e8940cd9f82772ebdd874bafb52b5b.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R46359/4", "sha1": "d1ecae8d44e8940cd9f82772ebdd874bafb52b5b" }, { "format": "HTML", "filename": "files/2021-04-09_R46359_d1ecae8d44e8940cd9f82772ebdd874bafb52b5b.html" } ], "date": "2021-04-09", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R46359", "type": "CRS Report" }, { "source_dir": "crsreports.congress.gov", "title": "COVID-19 and Private Health Insurance Coverage: Frequently Asked Questions", "retrieved": "2021-05-14T04:03:29.531958", "id": "R46359_3_2020-08-24", "formats": [ { "filename": "files/2020-08-24_R46359_8ff8f14c354c09d2e2d308cc392fd532449f300b.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R46359/3", "sha1": "8ff8f14c354c09d2e2d308cc392fd532449f300b" }, { "format": "HTML", "filename": "files/2020-08-24_R46359_8ff8f14c354c09d2e2d308cc392fd532449f300b.html" } ], "date": "2020-08-24", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R46359", "type": "CRS Report" }, { "source": "EveryCRSReport.com", "id": 625059, "date": "2020-05-15", "retrieved": "2020-05-19T13:35:57.711519", "title": "COVID-19 and Private Health Insurance Coverage: Frequently Asked Questions", "summary": "The Coronavirus Disease 2019 (COVID-19) pandemic is affecting communities around the world and throughout the United States, with case counts growing daily. As private health insurance is the predominant source of health coverage in the United States, there is considerable congressional interest in understanding private health insurance coverage of health benefits related to COVID-19. This report addresses frequently asked questions about private health insurance covered benefits and consumer cost sharing related to COVID-19 testing, treatment, and a potential vaccine. It discusses recent legislation, references existing federal requirements and recent administrative interpretations of them in relation to COVID-19, and notes state and private-sector actions. \nFederal and state health insurance requirements may relate to covered benefits and consumer cost sharing, among many other topics. These requirements can vary by coverage type (i.e., individual coverage, fully insured small- and large-group coverage, and self-insured plans). Covered benefits, consumer costs, and other plan features may vary by plan within each type of coverage, subject to applicable federal and state requirements. \nThe following bullets summarize federal requirements related to coverage and cost sharing (which includes deductibles, coinsurance, and copayments) of COVID-19 testing, treatment, and vaccination. Additional details are addressed in the report, including the applicability of the requirements to different types of plans; whether the coverage requirements apply even when furnished by out-of-network providers; whether plans are allowed to impose prior authorization or other medical management techniques; and the applicable dates of any coverage requirements. \nCOVID-19 Testing. The Families First Coronavirus Response Act (FFCRA; P.L. 116-127), as amended by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136), requires most private health insurance plans to cover COVID-19 testing, administration of the test, and related items and services, as defined by the acts. This coverage must be provided without consumer cost sharing.\nCOVID-19 Treatment. There are no federal requirements that specifically require coverage of COVID-19 treatment. However, the existing federal requirement that certain plans cover a set of 10 categories of essential health benefits (EHB) is potentially relevant to coverage of COVID-19 treatment items and services, depending on state and plan variation with regard to implementation of this requirement. Even where treatment items and services are required to be covered as EHB, cost sharing could apply. \nCOVID-19 Vaccine. As of the date of this report, there is no vaccine against COVID-19 approved by the Food and Drug Administration (FDA) for use in the United States, although several candidates are in development. The CARES Act requires most plans to cover a COVID-19 vaccine, when available, without cost sharing, if it is recommended by the Advisory Committee on Immunization Practices (ACIP). Similarly, most plans must cover, without cost sharing, any other COVID-19 preventive services that are recommended for use by the United States Preventive Services Task Force (USPSTF).\nSome states have also announced relevant requirements on the plans they regulate, and some insurers have reported that they will cover certain relevant benefits. Several organizations are tracking these announcements, as noted in this report.\nCongressional Research Service (CRS) experts on other topics related to private health insurance and COVID-19, including types of plans and coverage of benefits not addressed in this report, are listed in the Appendix for the benefit of congressional clients. For information on other COVID-19 issues, congressional clients can access the CRS Coronavirus Disease resources page at https://www.crs.gov/resources/coronavirus-disease-2019.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R46359", "sha1": "713ddcc623940aa66752b41805377dd43f7937b2", "filename": "files/20200515_R46359_713ddcc623940aa66752b41805377dd43f7937b2.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R46359", "sha1": "87525802dd2589bf543464b76df7bf71c71c720e", "filename": "files/20200515_R46359_87525802dd2589bf543464b76df7bf71c71c720e.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] } ], "topics": [ "Domestic Social Policy", "Health Policy" ] }