Insights

Guidance Issued on Mental Health Services for Essential Workers


On May 29, 2020, the Department of Financial Services (DFS) released COVID-19 information for insurers and providers regarding mental health coverage for essential workers. The guidance, which is in the form of questions and answers, addresses issues such as the scope, administrative aspects and notice obligations of the new coverage requirements. 

As background, on May 2, 2020, DFS amended the state’s Insurance Regulation 62 to provide essential workers with temporary relief from cost sharing for mental health services. The amendment recognized the emotional and psychological impact of the COVID-19 public emergency on these workers by alleviating costs they would otherwise incur for seeking in-network mental health services.

The questions clarify that the cost sharing waiver applies to all outpatient mental health services provided by in-network providers on or after May 2, 2020, but does not extend to prescription drugs. This relief measure extends to all individuals who are, or were, essential workers during the state of emergency declared by Gov. Cuomo on March 7, 2020.

Insurers are required to notify in-network mental health providers not to collect any deductible, copayment, or coinsurance from essential workers, and to provide a definition and list of these workers. However, the issuer remains responsible for reimbursing the provider for the cost-sharing amount.

Although this emergency relief measure is primarily directed at issuers, employers may want to be aware of the amendment and this subsequent guidance. For a summary of the underlying insurance amendment, please see our May 27, 2020, issue of Compliance Corner.

Coronavirus (COVID-19) Information for Insurers and Providers on Coverage for Mental Health Services for Essential Workers »