b' Wordw w w. w m i m u t u a l . c o mDoes Insurance COVER MY COVID-19 Testing?By David Leo, Mis, Does insurance pay One question Ive been asked a lot latelyfor my COVID test, and if so, how much? Ok, that was two questions, but we all know 5 out of 4 people struggle with math. The point is that people want to know if insurance pays for coronavirus testing; what is/isntPresident ofWMI Mutual covered; and if its covered, at what percentage its paid and whether Insurance Company deductibles, co-insurance and/or copayments apply. As usual, Ive found a & WMI TPAcouple of good sources and pirated information from them. In the interest of full disclosure, Id like to give those sources proper attribution and refer anyone who wants to learn more about this topic to visit Mercer.com 1and the U.S. Department of Labors website. 2When COVID-19 first appeared in the U.S., we saw a rare moment of biparti-sanship in Congress when both parties came together very quickly and passed a couple laws aimed at helping individuals and businesses affected by the corona-virus. The two main laws are the Families First and Coronavirus Response Act (FFCRA) (Pub. L. No. 116-127 (enacted on March 18, 2020)) and the Corona-virus Aid, Relief and Economic Security (CARES) Act (Pub. L. No. 116-136 (enacted on March 27, 2020)). These laws address a multitude of critical needs in the U.S., including COVIDs impact on the economy and on Americans health, safety and welfare, but they are also aimed at making sure health care providers and insurance companies do everything possible to help those people who are af-fected by the disease and to minimize its spread and lethality. It should be noted that these health-related provisions apply equally to fully insured and self-funded health plans, and they apply to coverage under Medicare and Medicaid programs as well.To briefly summarize, these laws require group health plans to pay for COV-ID-19 testing and other related services without any cost-sharing, prior authori-zation, or medical management requirements during the public health emergency as declared by the U.S. Department of Health and Human Services (currently until late January 2021). More specifically, they require full payment for in vitro diagnostic tests (i.e., tests done on samples taken from the human body), office visits, facility fees and emergency room visits related to COVID-19, medically-appropriate items and services, and at-home testing. Multiple diagnostic tests for COVID-19 must be covered, and once a COVID-19 vaccine is approved, health plans will be required to pay for it without any cost sharing. An important caveat to this general cover everything rule is that testing or screening for employ-ment purposes or surveillance testing is not required to be covered by insurance.One of the biggest challenges for health insurance companies is figuring out how much to pay for all these services and treatments without overpaying or encouraging abusive billing by unscrupulous providers. When the provider is a preferred provider or is under contract, its relatively easy for insurers to know how much to pay. When a provider is non-contracted, however, the insurance company is required to reimburse the provider their cash price as advertised online (or negotiated rate in the absence of such online disclosure). According to 1 https://www.mercer.com/our-thinking/law-and-policy-group/plan-coverage-of-covid-19-tests-issues-remain-after-june-guidance.html2https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-42.pdf; https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-43.pdf20 www.wpma.com / Winter 2020'