How does GINA expand the genetic information nondiscrimination protections in HIPAA?

Before the Affordable Care Act, HIPAA prevented a plan or issuer from imposing a preexisting condition exclusion based solely on genetic information. Under the Affordable Care Act, plans are prohibited from excluding coverage or benefits due to any preexisting condition. HIPAA continues to prohibit discrimination in individual eligibility, benefits, or premiums based on any health […]
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What is the Genetic Information Nondiscrimination Act (GINA)?

The subject of these Frequently Asked Questions is the requirements of Title I of GINA under the Employee Retirement Income Security Act (ERISA), prohibiting discrimination in group health plan coverage based on genetic information. GINA expands the genetic information nondiscrimination protections included in Title I of the Health Insurance Portability and Accountability Act of 1996 […]
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How should health care providers seek reimbursement when delivering COVID-19- related services to the uninsured?

Congress provided and HHS administers two sources of federal funding to reimburse providers for providing services related to COVID-19 to uninsured patients. The FFCRA Relief Fund and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) collectively appropriated $2 billion to reimburse providers for COVID-19 testing for uninsured individuals. Additionally, the CARES Act established […]
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May an employer offer benefits for COVID-19 vaccines (and their administration) under an EAP that constitutes an excepted benefit?

Yes. The Departments’ final regulations provide that for the purpose of determining whether an EAP provides benefits that are significant in the nature of medical care, the amount, scope, and duration of covered services are taken into account. An EAP will not be considered to provide benefits that are significant in the nature of medical […]
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Do plans and issuers have to cover the vaccine administration fee when the plan or issuer is not billed for the vaccine?

Yes. As the Departments previously explained in the preamble to the Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency interim final rule with request for comments, plans and issuers subject to section 2713 of the PHS Act must cover without cost sharing an immunization that is a qualifying coronavirus preventive […]
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When must plans and issuers begin providing coverage for qualifying coronavirus preventive services?

Plans and issuers must cover qualifying coronavirus preventive services without cost sharing starting no later than 15 business days (not including weekends or holidays) after the date the USPSTF or ACIP makes an applicable recommendation regarding a qualifying coronavirus preventive service. A recommendation from ACIP is considered in effect after it has been adopted by […]
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Do plans and issuers have to cover all COVID-19 vaccines with a recommendation in effect from ACIP (and associated administration)?

Yes. Plans and issuers must provide coverage without cost sharing for all COVID-19 vaccines that have received a recommendation that makes them a qualifying coronavirus preventive service with respect to the individual involved, and their administration. Plans and issuers are not permitted to exclude coverage for (or impose cost sharing on) any qualifying coronavirus preventive […]
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Do point-of-care tests for COVID-19 have to be covered without cost sharing under the FFCRA?

Yes. The FFCRA and the CARES Act make no distinction between point-of-care and other tests; all COVID-19 diagnostic tests that meet one of the criteria outlined in section 6001 of the FFCRA, as amended by section 3201 of the CARES Act, must be covered without cost sharing, prior authorization, or medical management (including for asymptomatic […]
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Under the FFCRA, are plans and issuers required to cover COVID-19 diagnostic tests provided through state- or locality-administered testing sites?

Yes. Any health care provider acting within the scope of their license or authorization can make an individualized clinical assessment regarding COVID-19 diagnostic testing. If an individual seeks and receives a COVID-19 diagnostic test from an authorized provider, including from a state-or locality-administered site, a “drive-through” site, and/or a site that does not require appointments, […]
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