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Interim Final Rule on COVID-19 Vaccine Coverage

Since COVID-19 was declared a public health emergency, Operation Warp Speed has been working towards producing and delivering 300 million doses of safe and effective vaccines. According to the Centers for Disease Control and Prevention (CDC), multiple COVID-19 vaccines are currently being developed; which means additional coverage may be necessary for patients under the Coronavirus Aid, Relief and Economic Security (CARES) Act.

On November 6, 2020, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury published an interim final rule requiring Medicare, Medicaid and private insurers to cover a COVID-19 vaccine. This means, under the CARES Act, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage are required to provide treatment, without cost sharing, for qualifying COVID-19 preventative services, including COVID-19 immunizations. It is important to note that cost sharing will not apply regardless of whether an in-network or out-of-network provider delivers these services.

Additionally, the rule reduces the period of time in which coverage of qualifying COVID-19 preventive services is required. Coverage must be provided within 15 business days after the recommendation regarding a qualifying COVID-19 preventive service is made.

Plans and issuers subject to Section 2713 of the Public Health Service Act must also cover, without cost sharing, items and services that are integral to the furnishing of recommended preventive services, that are fundamental to a patient’s health.

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Questions? Contact the Creative Benefits team at 866-306-0200 or solutions@creativebenefitsinc.com.