Guidelines explain when COVID-19 diagnostic costs are fully covered

Health plans must pay for costs to diagnose COVID-19, and they have to do that without any cost-sharing for customers who don’t show symptoms or have a suspected exposure to the virus, say officials at the U.S. Department of Labor and the U.S. Treasury.

The federal agencies spell that out in a list of Frequently Asked Questions. That document explains health plans and issuers cannot use medical screening criteria to deny a COVID-19 test claim or pass on any test cost for customers without symptoms or suspected virus exposure.

The guidance further explains health plans can, however, distinguish between diagnostic tests for people without symptoms and general workplace health safety testing or other testing that’s not intended to diagnose and treat an individual for COVID-19.

The FAQs say health plans must assume a test is for an individualized clinical assessment and cover the cost if it’s conducted by a licensed or authorized provider, such as a state-run location, a drive-through site or a location that doesn’t require appointments.

The guidance also weighs in on COVID-19 vaccine coverage, preventative care services, and other issues.