April 28, 2020
On April 9, 2020, Commissioner Anderson released Bulletin 2020-13, which supplements prior bulletins concerning the appropriate coverage of treatment for COVID-19. Specifically, the bulletin modifies Bulletins 2020-02 and 2020-04, by communicating how insurers are expected to cover COVID-19 testing and treatment on an in- and out- of network basis. It also communicates that the Division of Insurance expects that insurers will allow for treatment at acute care hospitals.
Additionally, out-of-network emergency and inpatient treatment should be paid at the provider’s contracted rate, or if there is no contract between the hospital and the insurer, services should be paid at a rate equal to 135% of the rate paid by Medicare for those services. The bulletin also indicates that they expect insurers acting as TPAs for self-funded plans to encourage plan sponsors to meet these same guidelines.
While this bulletin doesn’t impose any additional obligations on employers, they should familiarize themselves with this guidance.
Bulletin 2020-13 »