April 28, 2020
The Department of Financial Services (DFS) recently released questions and answers regarding coronavirus (COVID-19) coverage requirements. This guidance pertains to health insurance policies issued or delivered in the state.
In March, DFS enacted emergency regulations to waive cost sharing for certain testing and diagnostic services related to COVID-19. These amendments also addressed the use of telehealth during the state of emergency. Similar legislation has been passed on the federal level.
Accordingly, the questions and answers address the specific coverage requirements resulting from the new laws. The guidance reinforces the prohibitions against copayments, coinsurance and annual deductibles for in-network laboratory tests and health care provider visits, including telehealth, urgent care and emergency department services, to diagnose COVID-19. However, cost sharing can be imposed for COVID-19 follow-up care or treatment, such as inpatient hospital admissions. Additionally, no cost sharing can be imposed for any medically appropriate in-network services (not limited to COVID-19 diagnosis) delivered via telehealth, if otherwise covered under the policy if delivered in person. The guidance further addresses related issuer notice and filing requirements, as well as utilization review suspensions and overpayment concerns.
Although the underlying DFS regulations are primarily directed at issuers, employers may find the questions and answers helpful in better understanding the COVID-19 coverage requirements during the state of emergency.
Health Insurer Guidance on Coverage Requirements for Novel Coronavirus (COVID-19) »