Mandated Coverage for Certain COVID-19 Antibody Therapies
April 27, 2021
On March 22, 2021, Commissioner Birrane invoked her emergency powers to require health insurance carriers to provide coverage for monoclonal antibody therapies. This includes Bamlanivimab and the combination of Casirivimab and Imdevimab. Any cost sharing, including copayments, coinsurance and deductibles must be waived.
Although this mandated coverage applies to health insurance carriers, employer plan sponsors should be aware of this change.
Bulletin 21-09 »
Infertility Coverage Changes for 2021
December 08, 2020
The Maryland Legislature enacted SB988 on May 8, 2020. Effective for policies issued or renewed on or after January 1, 2021, SB 988 requires the following changes to infertility coverage:
- Infertility coverage is available to all subscribers, not just those that are married. Thus, unmarried subscribers will be eligible for infertility coverage where they could have previously been excluded from such.
- An insured that is married to the opposite sex must have a demonstrated one-year history of intercourse failing to result in pregnancy (previously two years).
- If the insured and the spouse are of the same sex, they must demonstrate three attempts of artificial insemination over a one-year period that failed to result in pregnancy; OR the insured or spouse has one of four medical conditions (endometriosis, exposure in utero to diethylstilbestrol, blockage of surgical removal of at least one fallopian tube, or abnormal male factors). The requirement was previously six attempts in two years. This same requirement applies to unmarried subscribers.
Employers should work with carriers to revise plan documents and communicate changes to participants.
Paid Sick Leave Revised
August 18, 2020
Effective October 1, 2020, HB 880 revises the definition of a family member for Maryland paid sick leave (under the Maryland Healthy Working Families Act) to include the legal guardian or ward of the employee or the employee’s spouse. As a reminder, employees (of employers with 15 or more employees) earn one hour of paid sick leave for every 30 hours worked up to an annual maximum of 40 hours. Smaller employers must provide unpaid leave.
This leave may be taken so that an employee can care for an ill family member, among other reasons. For this purpose, the term family member already included a biological/adopted/step/foster child, a child under the employee’s legal guardianship, a child for whom the employee has physical or legal custody, a child for whom the employee stands in loco parentis, the employee’s or spouse’s biological/adoptive/step/foster parent, the employee’s spouse, an individual who stood in loco parentis of the employee or spouse, biological/adoptive/step/foster grandparent of the employee, biological/adopted/step/foster grandchild of the employee, and a biological/adopted/step/foster sibling of the employee.
Employers should revise their paid sick leave policy appropriately.
HB 880 »
Coverage for Pediatric Autoimmune Neuropsychiatric Disorders
May 27, 2020
Effective for health insurance policies issued on or after January 1, 2021, SB 475 requires coverage for medically necessary diagnosis, evaluation and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Coverage must be provided for intravenous immunoglobulin therapy. Coverage is not required for Rituximab unless the US FDA approves the use of Rituximab for this purpose.
SB 475 »
Accommodations for Nonpayment of Premiums During COVID-19 State of Emergency
March 31, 2020
On March 20, 2020, the Insurance Administration published Bulletin No. 20-10. The bulletin relates to the difficulties individuals and businesses may be facing as a result of the State of Emergency declared by the governor on March 5, 2020, in connection with COVID-19. The bulletin encourages carriers to make reasonable accommodations so that individuals and businesses don’t lose coverage due to nonpayment of premium during the emergency. Reasonable accommodations may include suspension of premiums due, extension of billing due dates and premium grace periods, and waiver of installment and late payment fees. Carriers should also use electronic payment technology on websites, apps and electronic bank transfers whenever possible.
The bulletin contains no new employer compliance obligations. Maryland employers that may be in a difficult spot with cash flow or other business issues, though, may want to reach out to their carrier with respect to some of the accommodations above that may be available.
Bulletin No. 20-10 »
Maryland Health Connection Announces Special Enrollment Window for all Marylanders
March 31, 2020
On March 20, 2020, the Maryland Health Connection – Maryland’s state health insurance exchange – announced that any uninsured Marylander can enroll in Maryland Health Connection health coverage beginning March 16, 2020, through April 15, 2020. Marylanders do not need a special enrollment event to enroll; the window is open for anyone who is otherwise eligible. The announcement also confirms that all medically necessary screening and testing for COVID-19 are free of charge, and that all health plans available through the Maryland Health Connection.
For employers, the announcement does not bring new compliance obligations. However, employers should be aware of the opportunity for furloughed employees to enroll on the exchange should they be terminated from their group health plan coverage.
Health Insurance Coverage for Coronavirus
March 17, 2020
The Maryland Insurance Administration (MIA) recently published several bulletins relating to health insurance coverage of the coronavirus (COVID-19), and other measures relating to public emergencies. These include Bulletin No. 20-05 (published on March 6, 2020), Bulletin No. 20-06 (published on March 10, 2020), and Bulletin No. 20-06 (published on March 13, 2020), as described below.
Bulletin No. 20-05 requires carriers to waive any time restrictions on prescription medication refills and authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date upon which the medication had most recently been filled by a pharmacist (thus allowing individuals to obtain medications in advance of any quarantine). Importantly, copayments and deductibles may apply to the prescription medication refills (in accordance with the terms of the carrier’s contract/policy). The bulletin also states that emergency regulations would soon be published relating to coverage requirements of COVID-19, which were finalized in Bulletin 20-06.
Bulletin No. 20-06 outlines specific requirements enacted as part of emergency regulations published. According to those emergency regulations, carriers must waive any cost-sharing (including co-payments, coinsurance and deductibles) for:
- Any visit to diagnose or test for COVID-19, regardless of the setting of the testing
- Laboratory fees to diagnose or test for COVID-19
- Vaccination for COVID-19, when a vaccine becomes available
In addition, carriers must evaluate a request to use an out-of-network provider to perform diagnostic testing of COVID-19 solely on the basis of whether the use of the out-of-network provider is medically necessary or appropriate. Also, carriers must consider an adverse decision on a request for coverage of diagnostic services for COVID-19 an emergency case for which an expedited grievance procedure is required. The only prior authorization requirements that a carrier may utilize relating to COVID-19 test is one relating to the medical necessity of the testing. The cost-sharing waivers do not apply to Medicare supplement policies.
Bulletins No. 20-05 and 20-06 apply directly to carriers, but are important reminders on coverage of COVID-19-related services and items.
Lastly, according to Bulletin No. 20-07, the MIA reminds carriers that CMS has developed a HCPCS code that will be used by laboratories to bill for certain COVID-19 tests (and it includes a link to the CMS website for more information). This bulletin relates more to carriers and administrators, but may be helpful for employers should questions arise on proper billing of laboratory tests relating to COVID-19.
Bulletin No. 20-05 »
Bulletin No. 20-06 »
Bulletin No. 20-07 »
Mandated Coverage for Lymphedema
December 11, 2018
Effective for group health insurance policies issued or renewed on or after Jan. 1, 2019, HB 847 requires coverage for the medically necessary diagnosis, evaluation and treatment of lymphedema. Coverage must include equipment, supplies, complex decongestive therapy, gradient compression garments and self-management training and education. Gradient compression garments refers to custom-fit garments prescribed by a health care provider and does not refer to disposable over-the-counter supplies. The plan’s normal annual deductibles, copayments and coinsurance requirements may apply to the coverage.
Mandated Coverage for 12-Month Contraceptive Supply
December 11, 2018
Effective for group health insurance policies issued or renewed on or after Jan. 1, 2020, HB 1283 requires coverage for a single dispensing of prescription contraceptives up to a 12-month supply, which are prescribed by a health care provider. The previous limitation was a 6-month supply.
HB 1283 »
Male Sterilization Coverage Under HDHPs
October 16, 2018
On April 10, 2018, Gov. Hogan signed SB 137 into law and it became effective upon signing. The new bill permits high deductible health plans (HDHPs) issued in Maryland to apply male sterilization expenses to the deductible. As background, effective Jan. 1, 2018, all policies issued in MD had to provide coverage for male sterilization without applying the cost to the deductible. However, this caused a problem for the HDHPs as the IRS clarified in March, 2018, through IRS Notice 2018-12: male sterilization didn’t fall under the preventative care category and such coverage would have to be subject to a deductible or the HDHP would fail to be HSA qualified.
There is transition relief in place until Dec. 31, 2019 that permits HSA eligible individuals to have coverage under an HDHP that applies no cost sharing to male sterilization. The relief simply stated it applied to periods prior to 2020. This seems to indicate that the relief applies on a tax year basis and not on a plan year basis. Thus, some carriers are starting to apply male sterilization to the deductible for policy years beginning on or after Jan. 1, 2019. This is so that the HDHP may maintain its qualified status for the months of the policy year that run into 2020 (for example, a policy year that begins Feb. 1, 2019 and ends Jan. 31, 2020).
Importantly, SB 137 includes a provision that if the IRS includes male sterilization as a preventive care expense in the future, then the SB 137 amendment permitting HDHPs to apply male sterilization to the deductible would automatically be void.
SB 137 »