I 
117TH CONGRESS 
1ST SESSION 
H. R. 796 
To require group health plans and health insurance issuers offering group 
or individual health insurance coverage to provide coverage without im-
posing any cost sharing requirements for certain items and services 
furnished during any portion of the COVID–19 emergency period, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 4, 2021 
Ms. BLUNT ROCHESTER (for herself, Mr. PASCRELL, and Mrs. TRAHAN) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Ways and 
Means, and Education and Labor, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To require group health plans and health insurance issuers 
offering group or individual health insurance coverage 
to provide coverage without imposing any cost sharing 
requirements for certain items and services furnished 
during any portion of the COVID–19 emergency period, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Coverage for COVID– 
19 Treatment Act of 2021’’. 
SEC. 2. COVERAGE OF COVID-19 RELATED TREATMENT AT 
NO COST SHARING. 
(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance coverage (including a grandfathered health plan (as 
defined in section 1251(e) of the Patient Protection and 
Affordable Care Act)) shall provide coverage, and shall not 
impose any cost sharing (including deductibles, copay-
ments, and coinsurance) requirements, for the following 
items and services furnished during any portion of the 
emergency period defined in paragraph (1)(B) of section 
1135(g) of the Social Security Act (42 U.S.C. 1320b– 
5(g)) beginning on or after the date of the enactment of 
this Act: 
(1) Medically necessary items and services (in-
cluding in-person or telehealth visits in which such 
items and services are furnished) that are furnished 
to an individual who has been diagnosed with (or 
after provision of the items and services is diagnosed 
with) COVID-19 to treat or mitigate the effects of 
COVID-19. 
(2) Medically necessary items and services (in-
cluding in-person or telehealth visits in which such 
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items and services are furnished) that are furnished 
to an individual who is presumed to have COVID- 
19 but is never diagnosed as such, if the following 
conditions are met: 
(A) Such items and services are furnished 
to the individual to treat or mitigate the effects 
of COVID-19 or to mitigate the impact of 
COVID-19 on society. 
(B) Health care providers have taken ap-
propriate steps under the circumstances to 
make a diagnosis, or confirm whether a diag-
nosis was made, with respect to such individual, 
for COVID-19, if possible. 
(b) ITEMS AND SERVICES RELATED TO COVID-19.— 
For purposes of this section— 
(1) not later than one week after the date of 
the enactment of this section, the Secretary of 
Health and Human Services, Secretary of Labor, 
and Secretary of the Treasury shall jointly issue 
guidance specifying applicable diagnoses and medi-
cally necessary items and services related to COVID- 
19; and 
(2) such items and services shall include all 
items or services that are relevant to the treatment 
or mitigation of COVID-19, regardless of whether 
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such items or services are ordinarily covered under 
the terms of a group health plan or group or indi-
vidual health insurance coverage offered by a health 
insurance issuer. 
(c) REIMBURSEMENT TO PLANS AND COVERAGE FOR 
WAIVING COST-SHARING.— 
(1) IN GENERAL.—A group health plan or a 
health insurance issuer offering group or individual 
health insurance coverage (including a grandfathered 
health plan (as defined in section 1251(e) of the Pa-
tient Protection and Affordable Care Act)) that does 
not impose cost sharing requirements as described in 
subsection (a) shall notify the Secretary of Health 
and Human Services, Secretary of Labor, and Sec-
retary of the Treasury (through a joint process es-
tablished jointly by the Secretaries) of the total dol-
lar amount of cost-sharing that, but for the applica-
tion of subsection (a), would have been required 
under such plans and coverage for items and serv-
ices related to COVID-19 furnished during the pe-
riod to which subsection (a) applies to enrollees, par-
ticipants, and beneficiaries in the plan or coverage to 
whom such subsection applies, but which was not 
imposed for such items and services so furnished 
pursuant to such subsection and the Secretary of 
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Health and Human Services, in coordination with 
the Secretary of Labor and the Secretary of the 
Treasury, shall make payments in accordance with 
this subsection to the plan or issuer equal to such 
total dollar amount. 
(2) METHODOLOGY FOR PAYMENTS.—The Sec-
retary of Health and Human Service, in coordina-
tion with the Secretary of Labor and the Secretary 
of the Treasury shall establish a payment system for 
making payments under this subsection. Any such 
system shall make payment for the value of cost 
sharing not imposed by the plan or issuer involved. 
(3) TIMING
OF
PAYMENTS.—Payments made 
under paragraph (1) shall be made no later than 
May 1, 2022, for amounts of cost sharing waivers 
with respect to 2020. Payments under this sub-
section with respect to such waivers with respect to 
a year subsequent to 2020 that begins during the 
period to which subsection (a) applies shall be made 
no later than May of the year following such subse-
quent year. 
(4) APPROPRIATIONS.—There is authorized to 
be appropriated, and there is appropriated, out of 
any monies in the Treasury not otherwise appro-
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priated, such funds as are necessary to carry out 
this subsection. 
(d) ENFORCEMENT.— 
(1) APPLICATION
WITH
RESPECT
TO
PHSA, 
ERISA, AND
IRC.—The provisions of this section 
shall be applied by the Secretary of Health and 
Human Services, Secretary of Labor, and Secretary 
of the Treasury to group health plans and health in-
surance issuers offering group or individual health 
insurance coverage as if included in the provisions of 
part A of title XXVII of the Public Health Service 
Act, part 7 of the Employee Retirement Income Se-
curity Act of 1974, and subchapter B of chapter 100 
of the Internal Revenue Code of 1986, as applicable. 
(2) PRIVATE RIGHT OF ACTION.—An individual 
with respect to whom an action is taken by a group 
health plan or health insurance issuer offering group 
or individual health insurance coverage in violation 
of subsection (a) may commence a civil action 
against the plan or issuer for appropriate relief. The 
previous sentence shall not be construed as limiting 
any enforcement mechanism otherwise applicable 
pursuant to paragraph (1). 
(e) IMPLEMENTATION.—The Secretary of Health and 
Human Services, Secretary of Labor, and Secretary of the 
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Treasury may implement the provisions of this section 
through sub-regulatory guidance, program instruction or 
otherwise. 
(f) TERMS.—The terms ‘‘group health plan’’; ‘‘health 
insurance issuer’’; ‘‘group health insurance coverage’’, and 
‘‘individual health insurance coverage’’ have the meanings 
given such terms in section 2791 of the Public Health 
Service Act (42 U.S.C. 300gg–91), section 733 of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1191b), and section 9832 of the Internal Revenue 
Code of 1986, as applicable. 
Æ 
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