Under a new rule, HHS will now require employers to fully cover the cost of approved COVID-19 vaccines, even if the medical provider who administers the vaccine is out-of-network.
Specifically, the interim final rule requires employers with non-grandfathered health plans to fully cover a COVID-19 vaccine without any cost sharing within 15 business days after the United States Preventive Services Task Force or the Centers for Disease Control and Prevention makes a recommendation regarding a vaccine.
The rule also requires providers to make the cash price of a COVID-19 diagnostic test publicly available on the internet or in writing within two business days of a request.
Employers will have to continue to cover COVID vaccines even after the pandemic ends. However, the coverage mandate for coronavirus testing will end when the end of the public health emergency is declared.
Takeaway: Employers may not be able to amend their benefit schedules for specific vaccines in 15 business days and may want to confirm with their medical insurance carrier or third-party claims administrator if they are able to administer coverage for any vaccine that is approved.