Health Insurance Coverage for Coronavirus

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 »