No Cost-Sharing Even if Out-of-Network [Interim Rule]

Updated: Nov 11

T.D. 9931, Code Sec. 9815

As of November 2, 2020 and until the end of the public health emergency ("PHE") for COVID-19 as determined by the Departments of the Treasury, Labor, and Health and Human Services ("HHS") Secretary, plans and issuers must cover qualifying coronavirus preventive services (including immunizations) without cost-sharing.


The Breakdown


This interim regulation enables plan enrollee access to qualifying coronavirus preventive services on an expedited basis. More importantly, plans and issuers must cover coronavirus preventive services, regardless of whether such services are delivered by an in-network or out-of-network provider and without cost-sharing.


What are Coronavirus Preventive Services?


Qualifying coronavirus preventive services include:

  • items, services, or immunizations that prevent or mitigate coronavirus disease 2019 (COVID-19), and that is:

  • (a) an evidence-based item or service that has in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force; or

  • (b) an immunization that has in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (regardless of whether the immunization is recommended for routine use).

A recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention is considered in effect after it has been adopted by the Director of the Centers for Disease Control and Prevention.

These materials have been prepared by Le Tax Law, PLLC for informational purposes only. They are not intended to be and should not be considered legal advice.


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