Employers need to revisit coverage as end of COVID emergency approaches

Employers and plan sponsors who spent nearly three years adjusting their health coverage and policies to address the COVID-19 pandemic now must adapt to a new reality. The Biden administration announced late last month that both the National Health Emergency and the Public Health Emergency will end on May 11.

“Employers should prepare to modify their plans and communicate to participants about those changes,” according to a report from Gallagher. “To understand the upcoming changes, employers should understand the scope of each emergency declaration and the steps to unwind their effects on employer plans.”

The end of the emergencies will affect several aspects of health coverage.

Testing. Group plans and insurers no longer will be required to provide coverage of COVID-19 diagnostic tests without cost sharing or medical-management techniques.

“Employers might choose to continue to provide coverage for the tests despite the lack of the public health emergency, but we expect most employers will implement cost-sharing requirements, limit coverage to network providers or put in medical-management techniques to prevent overuse of the tests,” the report says.

Employee Assistance Programs. An EAP can be designed as an excepted benefit by not providing significant benefits, not requiring employee contributions as a condition of participating and not coordinating benefits with another group health plan. Employers that offer COVID benefits through an EAP may need to amend their plans to remove those benefits if the EAP is to continue to be considered an excepted benefit.

Telemedicine-only plans. Plan sponsors that have used standalone telemedicine plans will need to make it a component of the major medical plan to bring it into compliance. Practically, this means they may offer telemedicine benefits only to employees and their dependents enrolled in the employer’s medical plan.

Vaccines. At the end of the emergency, non-grandfathered group health plans will be required to cover all recommended preventive services, including COVID vaccines, but consistent with the ACA preventive care mandate can limit it to in-network coverage. There is some question whether there will be a gap in the mandate, because the Centers for Disease Control and Prevention has not yet approved the Advisory Committee on Immunization Practices’ recommendations for COVID vaccines.

Related: 4 ways to measure value of employee benefits in the COVID-19 era

“If employers choose to or are required to modify coverage as a result of the end of the public health emergency, those changes should be communicated in a timely fashion to prevent confusion,” the report says. “Employers subject to ERISA will need to communicate the reduction of benefits in the form of a Summary of Material Reduction within 60 days from the date the plan made the decision to change the coverage.”