Insights

COVID-19 and Health Insurance Coverage Updates


On March 20, 2020, the Department of Insurance released Bulletins 2020-03 and 2020-05, and the Department of Medicaid (ODM) released Emergency Rules — all of which provide guidance on testing and/or treatment related to COVID-19 and its impact on health and welfare benefits administration.

As explained further in Bulletin 2020-03, Director Froment ordered insurers to comply with certain requirements such as:

  • Insurers must permit employers to continue covering employees under group health plan coverage even if the employee would otherwise become ineligible due to a reduction in hours. In other words, insurers are required to allow employers to continue providing coverage to employees regardless of any “actively at work” provisions in the policies. Further, insurers are not permitted to increase premium rates based on decreased enrollment as a result of COVID-19.
  • Insurers are required to provide an option to defer premium payments due for up to 60 calendar days from the premium due date (i.e., requiring a 60-day grace period for premium payment).
  • Eligible employees may elect to continue coverage under COBRA (or state continuation coverage applicable to employers with less than 20 employees) as long as one person remains actively employed. However, if no active employees remain covered under a plan, COBRA and continuation coverage are not options and employees will be eligible for a special enrollment period in the health insurance exchange.
  • Employees who lose coverage are eligible for a special enrollment period to enroll in new coverage. For plans on the federal exchange, coverage is effective the first day of the month following enrollment. For coverage outside for the federal exchange, insurers must allow individuals to obtain coverage effect the day after their loss of employment.

Director Froment further states in Bulletin 2020-05 that testing and treatment related to COVID-19 is considered emergency medical conditions so that such services must be covered without preauthorization and must be covered at the same cost sharing as if provided in-network (in the instance where an insured is directed to an out-of-network hospital for treatment and testing). Additionally, insurers must ensure coverage without balance billing for out-of-network emergency services.

Employers should be aware of these developments.

Bulletin 2020-03 »
Bulletin 2020-05 »