President to Require Employer Health Plans Pay for At-Home COVID Tests

December 03, 2021

The Biden administration’s announcement that it will require employers to cover the cost of over-the-counter at-home COVID tests beginning in January raises a number of important questions about when the employer may try to limit the number and circumstances of those tests.

Currently, employer plans are required to provide first-dollar coverage for COVID tests when an individual seeks and receives a diagnostic test from a licensed or authorized health care provider, or when a provider refers an individual for a diagnostic test, including asymptomatic individuals with no exposure to COVID.

However, employer plans are not required to cover asymptomatic testing for general workplace health and safety, public health surveillance, or other purposes not primarily intended for diagnosis or treatment of COVID—but may do so at their discretion.

The new rules, expected by mid-January, will enable individuals to seek reimbursement from their employer health plan for the cost of over-the-counter at-home tests.  However, covering the cost of workplace screening would remain consistent with current guidance.

The forthcoming policy change will not be retroactive, meaning no reimbursement for at-home tests purchased before the guidance is issued in January.

Questions remain:  It is unclear if limitations can be placed on the number of at-home tests individuals can submit for reimbursement or if employers will be able to limit reimbursement to proctored at-home tests, which are required by the currently stayed OSHA ETS.  It is also unclear if employers will have to cover at-home tests that are used to determine if it is safe to get together with friends and family, or after attending a large public event.