Order on COVID-19 Coverage

On March 20, 2020, the Department of Insurance published Commissioner’s Order 01-2020, relating to COVID-19 screening, testing and treatment. The order requires carriers to cover all medically necessary screening, testing and treatment for COVID-19 or suspected COVID-19 or respiratory diseases/illnesses detected in the course of seeking screening, testing or treatment for COVID-19 without cost sharing of any kind (including deductibles, copayments and coinsurance). This includes all associated costs, such as processing fees and clinical evaluations. In addition, carriers may not require any preauthorization for any COVID-19-related screening, testing or treatment, and carriers must cover all out-of-network charges (including cost sharing and balance billing) unless the employee was first offered the service in-network without unreasonable delay. Further, if and when an immunization or vaccine becomes available for COVID-19 per CDC guidelines, carriers must immediately cover the cost for those services without cost sharing.

In addition, the order states that carriers must enhance their coverage of telehealth services, and are directed to review their telehealth programs with participating providers; cost sharing for telehealth must not be more than for in-person services. Also, with respect to prescription drug access, carriers must allow enrollees to obtain refills of their prescription medications before the scheduled refill date, and should waive any additional costs associated with accessing prescriptions from a mail-order pharmacy.

The order is directed towards carriers, but employers should be aware of the DC order’s requirements, and should work with their carrier on any questions relating to COVID-19-related coverage.

Commissioner’s Order 01-2020  »