Insights

Essential Workers Receive Temporary Cost-Sharing Relief for Mental Health Services


On May 2, 2020, the Department of Financial Services (DFS) amended the state’s Insurance Regulation 62 to provide essential workers with temporary relief from cost sharing for mental health services. The amendment pertains to all policies or contracts delivered or issued for delivery in the state.

Following the declaration of a public emergency in the state on March 7, 2020, the coronavirus (COVID-19) pandemic has significantly impacted all New Yorkers, but especially essential workers who have directly interacted with the public and exposed themselves and their families to health risks. The amendment recognizes the emotional and psychological toll on these essential workers by alleviating cost they would otherwise incur for seeking in-network mental health services.

Specifically, insurers and health maintenance organizations that provide comprehensive coverage for hospital, surgical or medical care are prohibited from imposing copayments, coinsurance or annual deductibles for mental health services rendered by in-network providers on an outpatient basis for essential workers. The amendment excepts high deductible health plans as defined in Code Section 223(c) (2) that may be required under federal law to subject a service to the plan’s annual deductible.

Additionally, the amendment requires an insurer to provide written notification, which may be by email, to in-network outpatient mental health providers that they shall not collect any deductible, copayment or coinsurance from an essential worker. The notice must include the definition of an essential worker.

For purposes of the amendment, essential workers are defined to include individuals who are or were employed as health care workers, first responders, or in any position within a nursing home, long-term care facility or other congregate care setting during the state of emergency declared in the state on March 7, 2020. Furthermore, the definition includes individuals employed as essential workers who interact with the public, such as transit workers, retail workers at essential businesses, delivery workers, food service workers, funeral service workers and security guards.

Although the amendment is primarily directed at issuers, employers may want to be aware of this emergency relief measure.

Insurance Regulation 62 Amendment »