Consistent with Federal guidance, tests will not be covered if conducted solely for return-to-work or return-to-school purposes, for travel purposes unrelated to seeking medical care, for public health surveillance, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition. Providers have been directed to use standard procedures to designate that the test was performed at a third-party’s request.
FDA-authorized antibody testing for COVID-19 is covered only when it has been determined by a provider who has performed an individualized clinical assessment to be medically necessary to help make decisions about a patient’s care.
We support these guiding principles around testing:
- Facilitate necessary patient testing
- Ensure resources are targeted
- Distinguish public health surveillance, occupational health and health insurance
- Base our recommendations on medical evidence
- Accommodate evolution of testing
- Protect against fraud and abuse
- Avoid 2021 premium spikes
There is emerging evidence that demonstrates testing for both the virus and the antibody may not be valuable for determining if a person is not contagious, therefore safe to return to work. Tests for the virus reflect point in time data. Antibody testing reliability is unclear and new studies and data show that the antibodies may be short-lived - a few months and maintained at different strengths - and may not be evidence that an employee may safely return to work without risk of getting the illness again.
Keeping sick employees home, social distancing and wearing masks may be safer for return-to-work practices and policies than testing.