Insights

Coronavirus Preparedness Guidance and Cost Sharing for Coronavirus Diagnosis Waived


On March 3, 2020, the Department of Financial Services issued Insurance Circular Letter No. 3 regarding coronavirus (COVID-19) preparedness and cost sharing. The guidance is directed at insurers authorized to write accident and health insurance in the state.

As a result of the COVID-19 outbreak, which includes cases in the state, the letter instructs insurers to take action to prepare for the impact. These issuers should be ready to address potential COVID-19 cases and to provide insureds with timely information and access to all medically necessary covered health services.

Accordingly, insurers are directed to identify and remove barriers to COVID-19 testing and treatment, including by waiving cost sharing for laboratory tests and in-network office, urgent care and emergency visits. Additionally, carriers are asked to review their telehealth delivery services, network adequacy and out-of-network services to ensure these are capable of handling increased demands. The letter further reminds carriers of the state’s coverage requirements with respect to non-formulary prescription drug access, hospital, emergency and ambulance services, and surprise billing, among other items.

The circular also discusses the Fifty-Seventh Amendment to Insurance Regulation 62 as an emergency measure. This amendment is applicable to policies or contracts delivered or issued for delivery in the state that provide hospital, surgical or medical coverage.

As background, this measure was enacted in response to the increasing number of coronavirus (COVID-19) cases in the United States, including in New York. Given the health implications of a rapid spread of the virus, it is important that cost sharing not serve as a barrier to COVID-19 testing.

As a result, the amendment prohibits health care plans from imposing copayments, coinsurance or annual deductibles for covered in-network laboratory tests to diagnosis COVID-19 and for COVID-19 diagnostic visits (including through telehealth) at an in-network provider’s office, urgent care center or other in-network outpatient provider, or a hospital emergency department. However, copayments, coinsurance and annual deductibles may be imposed for any follow-up care or treatment for COVID-19, including an inpatient hospital admission, in accordance with the policy and applicable law.

Insurers are required to provide written notification of the amendment requirements to in-network providers to ensure that prohibited copayments, coinsurance or annual deductibles are not imposed or collected from insureds. Employers of insured plans should also be aware of this emergency measure.

Circular Letter No. 03 »