Health plans are only required to cover most COVID-19 testing without deductibles, co-pays and co-insurance when testing is ordered by a medical provider for diagnostic purposes. Following U.S. Centers for Disease Control and Prevention (CDC) guidelines, the provider must make an individual clinical assessment that the test is medically appropriate for symptomatic individuals or for asymptomatic individuals with known or suspected exposure to the virus.
Federal law does not require health plans to cover tests if the reason for testing is not an individualized diagnosis or treatment. For example, return-to-work screenings would not have to be paid by an employee’s health plan. State laws vary in terms of whether an employer must pay for all or some portion of the cost of the test. California and other states also require reimbursement for mileage to and from the testing sites, travel time and test-taking time.
Americans with Disabilities Act (ADA) guidance must also be taken into consideration. The Equal Employment Opportunity Commission’s Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA states that if an employer requires an employee it reasonably believes will pose a “direct threat” to the health and safety of themselves or others to be examined by a health care professional of the employer’s choice, then the employer must pay all costs associated with the visit.
To date, the percentage of employees working remotely as well as the cost and scarcity of COVID-19 testing supplies has limited the number of employers mandating testing. For now, most employers and insurance companies requiring testing are voluntarily covering certain costs.