New Federal Guidance Regarding COVID-19 Home Tests May Impact Employers
January 18, 2022
mployers continue to feel the effects of the pandemic as both employees and customers contract COVID-19 and its variants. As the country has adapted, the Food and Drug Administration (“FDA”) has approved COVID-19 home testing kits. Although helpful in stopping the spread of COVID-19 and its variants, a new question has emerged: is the cost of a home test kit covered by health insurance?
The United States Departments of Labor, Health and Human Services, and Treasury (collectively, “The Departments”), have just published FAQs, which expand upon existing requirements, and state that group health plans must cover the cost, with or without the involvement of a healthcare provider, so long as the test is taken for “diagnostic purposes.” This mandate imposes a major financial burden on self-insured employers and other providers of group health insurance.
Here is what self-insured employers, and other providers of group health insurance, should know:
- A group health plan must cover the costs of at home COVID-19 tests for participants either directly (i.e. “direct coverage”) or by requiring participants to pay for the tests upfront and then submit a claim for reimbursement.
- If the group health plan provides direct coverage at home COVID-19 tests, both through its pharmacy network and a direct-to-consumer shipping program, it may limit reimbursement for these tests from non-preferred pharmacies or other retailers to the lesser of $12 per test or the actual cost of the test.
- The group health plan must ensure that participants have access to at home COVID-19 tests through an adequate number of retail locations (in-person and online).
- A group health plan may limit the number of at home COVID-19 tests covered for each participant to no less than eight tests per 30-day period (this limit applies only to tests purchased without a health care provider order or clinical assessment; no limit if the health care provider orders or administers the test following a clinical assessment).
- A group health plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test.
We will keep you updated as the COVID-19 pandemic continues to evolve.
If you have questions about employer healthcare coverage, or any other general employment issues, please do not hesitate to contact the attorneys at The Royal Law Firm at 413-586-2288.
Why this matters now. After Charlie Kirk’s killing, workers across sectors posted remarks that mocked or celebrated his death. Employers responded within hours. Some fired workers for policy violations; others suspended them pending review. ABC preempted Jimmy Kimmel Live! after affiliates refused to carry the show and a federal regulator publicly criticized Kimmel’s on-air comments. Events moved quickly, and confusion spread just as fast. The First Amendment restrains government. It does not create a job right to speak without workplace consequences. Private employers retain broad discretion, and public employers face a different constitutional test. Knowing where actual protection begins and ends will help you act quickly and lawfully. What counts as protected speech? · Concerted activity under the National Labor Relations Act. Employees who speak with, or on behalf of, co-workers about pay, scheduling, staffing, safety, or other working conditions engage in “concerted” activity. That protection covers many social-media discussions directed to co-workers or seeking to start group action. It does not cover personal gripes, threats, disclosure of trade secrets, or harassing content. · Anti-retaliation “opposition” rights. Federal and state EEO laws protect employees who oppose or report discrimination in good faith, even if they are ultimately proven wrong on the facts. Crude insults and slurs fall outside that protection; specific, work-focused complaints usually fall inside it. · State off-duty and political-activity laws. Some states protect lawful off-duty conduct or political activity outside work. New York protects many lawful off-duty political and recreational activities. California limits employer control of political activity. Colorado protects broad lawful off-duty conduct, subject to narrow exceptions. Connecticut’s statute extends free-speech protections to private employees on matters of public concern, balanced against legitimate business interests. Multistate employers should map these rules before disciplining off-duty posts. · Public-sector balancing. Government employers must apply the Pickering/Garcetti framework. Speech by a public employee as a citizen on a matter of public concern can receive protection unless it impairs efficiency or disrupts operations; speech made as part of job duties receives no constitutional protection. What does not count as protected speech? · Policy-violating speech. Private employers may discipline speech that breaches social-media, civility, confidentiality, or brand guidelines, so long as the rule and its enforcement do not infringe concerted-activity rights or a state protection. · Harassment and threats. Speech that targets protected classes or creates a hostile environment falls outside any protection and often requires prompt action. · Disclosure of confidential or proprietary information. Revealing nonpublic business information, client data, or trade secrets invites discipline and potential legal remedies. · Speech that predicts or causes disruption. Even in the public sector, officials may discipline speech that reasonably threatens operations, safety, or public trust after applying the required balancing test. How the rules apply to current events. · Kirk-related terminations. Employers dismissed or suspended workers who posted content perceived as celebrating violence or taunting the victim. In private workplaces, the analysis turned on clear policy language, the connection to the employer’s brand, and whether the post involved coworkers or working conditions. Where a post targeted protected classes, anti-harassment duties reinforced the decision. Where a post was unrelated to working conditions and did not fall under state protection, at-will principles typically allowed discipline. Public employers had to apply the constitutional balancing test and document expected disruption before acting. · The Kimmel preemption. ABC removed the show from its schedule after affiliates announced they would not air it and after public criticism from a federal regulator. Two practical lessons follow. First, business partners can force rapid action; affiliate refusals and advertiser pressure often shorten timelines and narrow options. Second, overt regulatory attention raises stakes for content decisions in media and adjacent industries. Employers should plan in advance for partner pushback and regulatory scrutiny, with ready playbooks and internal sign-offs. · Other instructive precedents. Google’s termination of an engineer over a workplace memo survived a federal labor challenge because the content did not qualify as protected concerted activity and risked discriminatory impact. ESPN suspended an anchor for tweets that violated its social-media rules, a reminder that brand and business relationships can justify discipline even when speech occurs off the clock. Franklin Templeton prevailed against a wrongful-termination suit after firing an employee whose viral conduct damaged trust and reputation. Each example turns on the same themes: a clear policy, a documented business rationale, evenhanded enforcement, and—where required—a constitutional or statutory analysis. A clean decision path for employers. When a post or clip surfaces, move in sequence and record the answers. Concerted or not. Does the speech seek to involve coworkers about working conditions or present a group complaint to management? If yes, treat it as potentially protected and consult counsel before acting. Harassment or threats. Does the content target protected classes, include slurs, or threaten harm? If yes, act under anti-harassment and safety policies. Public or private employer. If public, apply the citizen-speech and disruption balancing; if private, proceed to step four. State protections. Do any off-duty or political-activity statutes apply? If yes, analyze the statute’s scope and exceptions. Contracts and past practice. Do CBA provisions, employment agreements, morals clauses, or progressive-discipline rules constrain options, and have you enforced similar cases consistently? Confidentiality and brand risk. Did the content reveal nonpublic information or predict reputational harm with customers, partners, or regulators? If yes, incorporate that rationale into your file. Proportional response. Choose counseling, suspension, or termination based on the conduct, the role, and the risk, and issue a neutral, policy-based communication. Policy and training steps that work. Rewrite social-media, civility, and confidentiality policies with concrete workplace examples. Cross-reference complaint channels and anti-retaliation language. Add explicit savings clauses for NLRA rights and any state-law protections. Train managers to escalate issues to HR and Legal, and to avoid engaging in online arguments. Maintain a short internal script and an external statement template for high-profile events. Consistency across viewpoints reduces legal risk and public blowback. Takeaway. Citizens hold broad speech rights against the state; employees do not gain broad job rights for speech in private workplaces. Your safest course is clear policy, measured triage, and disciplined, neutral enforcement, with special care for concerted activity, anti-harassment duties, state protections, and—if you are a public employer—the constitutional balancing test. When leaders understand what the law actually protects, they act faster and with less risk.
