Health Insurer COVID-19 Coverage Requirements

On March 13, 2020, the Department of Commerce and the Department of Health (the “Departments”) issued a Memorandum to Health Insurance Carriers Related to Coronavirus (COVID-19) to address the pandemic. Noting the importance of health plans related to the public health emergency, the Departments' requested that health carriers (in the fully-insured market):

  • Eliminate all cost sharing for COVID-19 testing, including costs related to an office or urgent care visit to be tested.
  • Limit or eliminate cost sharing for treatment for COVID-19 for in-network providers. To this end, insurers should ease other requirements (such as prior authorization or precertification requirements for COVID-19 treatment).
  • Allow out-of-network care when in-network is unavailable to provide services.
  • Expand the availability of telemedicine services.
  • Provide one-time refill of covered prescription medications prior to the expiration of the waiting period between refills.

Employers should be aware of these developments. While the above relates to fully insured plans, the Departments strongly encourage self-insured plans to follow the same guidance as outlined in the memorandum.

Memorandum to Health Insurance Carriers Related to COVID-19 »