Sec. 3. Coverage of prevention and treatment related to public health emergencies
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Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 et seq.) is amended by adding at the end the following: A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide coverage for such services related to a disease or condition relating to a public health emergency declared under section 319, which, as applicable, shall include any services for the prevention or treatment, of the disease or condition. The prevention and treatment measures for which coverage is required under subsection
(a)shall— be at the same level as benefits for the prevention or treatment of other similar or related diseases or conditions, if applicable, under the plan or coverage; and include, with respect to the disease or condition reasonably related to the public health emergency, even if no diagnosis has been made and even if the enrollee ultimately is determined not to have the disease or condition, as applicable— vaccines to prevent the disease or condition, if applicable; testing for diagnosis of the disease or condition, if applicable; care related to symptoms an enrollee may experience; and treatments for the disease or condition. Cost-sharing for services for which coverage is required under subsection
(a)shall be comparable to similar such services that would be covered by the plan or coverage outside of a public health emergency. A group health plan or health insurance issuer offering group or individual health insurance coverage shall waive any restriction (including any prior authorization requirement, limitation on filling or refilling prescription drugs, or other restrictions) on access to covered benefits required under this section, if the service is determined by a qualified health professional to be medically necessary by the provider and the Secretary determines such restriction to be unduly burdensome in the context of the applicable public health emergency. Any waiver of restrictions pursuant to paragraph
(1)shall apply only for the duration of the public health emergency, as declared under section 319. . Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1181 et. seq.) is amended by adding at the end the following: A group health plan or a health insurance issuer offering group health insurance coverage, shall provide coverage for such services related to a disease or condition relating to a public health emergency declared under section 319 of the Public Health Service Act, which, as applicable, shall include any services for the prevention or treatment, of the disease or condition. The prevention and treatment measures for which coverage is required under subsection
(a)shall— be at the same level as benefits for the prevention or treatment of other similar or related diseases or conditions, if applicable, under the plan or coverage; and include, with respect to the disease or condition reasonably related to the public health emergency, even if no diagnosis has been made and even if the enrollee ultimately is determined not to have the disease or condition, as applicable— vaccines to prevent the disease or condition, if applicable; testing for diagnosis of the disease or condition, if applicable; care related to symptoms an enrollee may experience; and treatments for the disease or condition. Cost-sharing for services for which coverage is required under subsection
(a)shall be comparable to similar such services that would be covered by the plan or coverage outside of a public health emergency. A group health plan or health insurance issuer offering group health insurance coverage shall waive any restriction (including any prior authorization requirement, limitation on filling or refilling prescription drugs, or other restrictions) on access to covered benefits required under this section, if the service is determined by a qualified health professional to be medically necessary by the provider and the Secretary determines such restriction to be unduly burdensome in the context of the applicable public health emergency. Any waiver of restrictions pursuant to paragraph
(1)shall apply only for the duration of the public health emergency, as declared under section 319 of the Public Health Service Act. . The table of sections for subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following: Sec. 715. Additional market reforms. Sec. 716. Coverage of prevention and treatment related to public health emergencies. . Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section: A group health plan shall provide coverage for such services related to a disease or condition relating to a public health emergency declared under section 319 of the Public Health Service Act, which, as applicable, shall include any services for the prevention or treatment, of the disease or condition. The prevention and treatment measures for which coverage is required under subsection
(a)shall— be at the same level as benefits for the prevention or treatment of other similar or related diseases or conditions, if applicable, under the plan; and include, with respect to the disease or condition reasonably related to the public health emergency, even if no diagnosis has been made and even if the enrollee ultimately is determined not to have the disease or condition, as applicable— vaccines to prevent the disease or condition, if applicable; testing for diagnosis of the disease or condition, if applicable; care related to symptoms an enrollee may experience; and treatments for the disease or condition. Cost-sharing for services for which coverage is required under subsection
(a)shall be comparable to similar such services that would be covered by the plan outside of a public health emergency. A group health plan shall waive any restriction (including any prior authorization requirement, limitation on filling or refilling prescription drugs, or other restrictions) on access to covered benefits required under this section, if the service is determined by a qualified health professional to be medically necessary by the provider and the Secretary determines such restriction to be unduly burdensome in the context of the applicable public health emergency. Any waiver of restrictions pursuant to paragraph
(1)shall apply only for the duration of the public health emergency, as declared under section 319 of the Public Health Service Act. . The table of sections for subchapter B of chapter 100 of such Code is amended by adding at the end the following new item: Sec. 9816. Coverage of prevention and treatment related to public health emergencies. .
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- 42 USC 300gg–11
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Sec. 3
Coverage of prevention and treatment related to public health emergencies
Cite42 USC 300gg–11
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