COVID-19 and Health Insurance Coverage

On March 2, 2020, the Department of Insurance (DOI) released Company Bulletin 2020-2 providing information regarding insurance coverage for COVID-19. With the ongoing COVID-19 pandemic, the DOI issued this bulletin for guidance on the role that health insurance coverage plays regarding access to health care services. Highlights include:

  • CDC and Illinois Department of Public Health agreed to bear the cost of COVID-19 testing. However, health care providers may still charge their own fees for collecting specimen for testing, which may be billed to the insurer (or the patient if uninsured).
  • Insurers are prohibited by Illinois Insurance Code Section 356z.3a from charging higher cost sharing for out-of-network providers at an in-network facility (if there are no in-network providers available). However, this does not apply if an individual purposefully chooses an out-of-network provider when an in-network provider was available.
  • Emergency services for an emergency medical condition must be covered at the in-network levels, regardless of which provider performs the services.
  • Health insurers are prohibited from nonrenewing (or cancelling) group health coverage due to any pre-existing conditions (this includes conditions connected with COVID-19).
  • Travel insurance must cover risks related to COVID-19 if it covers sickness, accident, or death incident to travel — unless a policy contains an exception applicable to COVID-19.

In addition, Executive Order 2020-09 expands telehealth services (effective beginning March 19, 2020, and will continue for the duration of the governor’s proclamation of disaster) to also include electronic and telephonic methods, and requires health insurers to cover the costs of in-network telehealth services for any clinically appropriate, medically necessary covered services and treatments. Further, health insurers are prohibited from imposing utilization review requirements on telehealth (or any treatment limits that are more restrictive than in-person care). Bulletin 2020-04 provides guidance to carriers on the governor’s executive order, reiterating that while the executive order is in effect, prior authorizations are not permitted for telehealth services related to COVID-19 (when delivered by in-network providers).

Lastly, on March 23, 2020, CMS notified the Illinois Department of Healthcare and Family Services that the state’s request for Medicaid waivers was approved. This temporarily suspends Medicaid fee-for-service prior authorization requirements, among other items, for the duration of the public health emergency.

Employers should be aware of these developments. As a reminder, the DOI released Frequently Asked Questions about Insurance Coverage and the Coronavirus COVID 19, which answers frequently asked questions regarding health insurance access to health care services.

Bulletin 2020-02 »
Executive Order 2020-09 »
Bulletin 2020-04 »
CMS Notification »
Frequently Asked Questions about Insurance Coverage and the Coronavirus COVID 19 »