Insureds Protected from PPE Fee Assessments

On August 5, 2020, the Department of Financial Services (DFS) issued Circular Letter No. 14 regarding personal protective equipment (PPE) fee assessments by healthcare providers. This communication was issued to all insurers authorized to write health insurance in the state, health maintenance organizations (HMOs), student health plans, municipal cooperative health benefit plans and prepaid health service plans.

As background, DFS recently received consumer complaints that healthcare providers, particularly dental providers, were improperly assessing PPE fees and other COVID-19 related charges for in-person visits by insureds. These costs were being passed to insurers and extended beyond the insured patient's applicable cost sharing.

The letter reinforces that participating providers should not bill a patient for any charges that are in addition to the patient's cost sharing obligations for covered services. Insurers should also not cover these charges. Additionally, DFS will not approve policy or contract provisions that hold the insureds responsible for the cost of a healthcare provider's PPE.  

Accordingly, insurers are obligated to ensure covered individuals are not assessed PPE fees. To this end, the letter advises insurers to notify participating providers not to charge PPE fees, to hold insureds harmless for these charges, and to refund PPE fees already collected. Furthermore, insurers must notify insureds that they should not be charged for PPE fees and provide contact information to submit related complaints. The insurers are required to work with providers to resolve related issues and ensure refunds are provided. Finally, within 90 days, insurers are required to report to DFS the amount of PPE fees charged to insureds, the number of insureds impacted and a description of how refunds will be provided. 

Although the letter is primarily directed at insurers, employers may also want to be aware of this guidance.

Circular Letter »