The FFCRA and the CARES Act

Information for Health Insurers (COVID-19)

The FFCRA and the CARES Act

The FFCRA was enacted on March 18, 2020. Section 6001 of the FFCRA generally requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide benefits for certain items and services related to diagnostic testing for the detection of SARS-CoV-2 or the diagnosis of COVID-19 (referred to collectively in this document as COVID-19) when those items or services are furnished on or after March 18, 2020, and during the applicable emergency period.  Under the FFCRA, plans and issuers must provide this coverage without imposing any cost-sharing requirements (including deductibles, copayments, and coinsurance) or prior authorization or other medical management requirements.

The CARES Act was enacted on March 27, 2020. Section 3201 of the CARES Act amended section 6001 of the FFCRA to include a broader range of diagnostic items and services that plans and issuers must cover without any cost-sharing requirements or prior authorization or other medical management requirements.  Additionally, section 3202 of the CARES Act generally requires plans and issuers providing coverage for these items and services to reimburse any provider of COVID-19 diagnostic testing an amount that equals the negotiated rate or, if the plan or issuer does not have a negotiated rate with the provider, the cash price for such service that is listed by the provider on a public website.

Below are CHC cash prices for office visits related to COVID-19:

99211 Office/outpatient visit est – $44.00

99212 Office/outpatient visit est – $89.00

99213 Office/outpatient visit est – $147.00

99214 Office/outpatient visit est – $214.00

99215 Office/outpatient visit est – $288.00

99201 Office/outpatient visit new – $89.00

99202 Office/outpatient visit new – $149.00

99203 Office/outpatient visit new – $212.00

99204 Office/outpatient visit new – $325.00

99205 Office/outpatient visit new – $412.00

Transparency in Coverage Information

The Federal Transparency in Coverage Rule requires that all group health plans provide Machine-Readable Files (MRF) of detailed pricing data to comply with the regulation’s public disclosure requirements.  Below is the MRF for the Blue Cross Blue Shield of Illinois policy holders.