In late October, the Trump Administration released an interim final rule (IFR) regarding employer health plan coverage of COVID-19 vaccines.  In summary, the IFR provides rules from multiple federal agencies, including  the Internal Revenue Service (IRS), Department of Labor (DOL), and Department of Health and Human Services (HHS). Certainly, with the recent release of COVID-19 vaccines from Pfizer and BioNTech, understanding the impact of this IFR is imperative. In addition to group health plan insurers complying with the new rules, employers should also be aware of key provisions.

Key Provisions of the IFR

  • Firstly, the IFR covers only “qualifying coronavirus preventive services.” To clarify, qualifying coronavirus preventive services include an item, service, or immunization intended to prevent or mitigate COVID-19. In short, it’s any service designated as preventive care by the United States Preventive Services Task Force (USPSTF). Likewise, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control can also make the designation.
  • Secondly, the IFR requires non-grandfathered employer health plans to cover qualifying coronavirus preventive services, including the COVID-19 vaccine. Most importantly, this coverage starts no later than 15 business days from its designation as a preventive service.
  • Thirdly, non-grandfathered employer health plans must cover the COVID-19 vaccine without cost-sharing. To clarify, that is regardless of whether the plan member receives the vaccine in-network or out-of-network.

The effective date of the IFR was November 2nd, 2020.

Employer Takeaways

In conclusion, the IFR rules will expire when the federal government declares an end to the COVID-19 public health emergency. However, this does not mean that employer health plans will no longer have to cover the COVID-19 vaccine. But, it means certain exceptions including this IFR will expire. For example, that includes the 15-day coverage time frame, and the coverage of vaccines administered by an out-of-network provider.