Each state is taking its own approach to Covid-19 health
insurance regulation. Here's a directory.
(Credit: CDC)
The Centers for Medicare and Medicaid Services
(CMS) has announced that the diagnosis and treatment of Covid-19 pneumonia
are part of the “essential health benefits” package.
That means that, under federal rules, every
individual or small-group major medical insurance policy that meets the
Affordable Care Act (ACA) benefits standards should provide at least as much
coverage for Covid-19 care as for care for ordinary strep throat, or a broken
leg.
The Centers for Disease Control and Prevention
has issued guidelines that recommend
But the essential health benefits package
coverage rules don’t apply to self-funded employer health plans. Self-funded
fall under the jurisdiction of the U.S. Department of Labor’s Employee Benefits
Security Administration, and they do not have to meet the ACA essential health
benefits coverage standards.
Even if a plan does have to meet the ACA
essential health benefits coverage standards, the CMS guidelines don’t
directly affect what that plan does about co-payments, deductibles or other
cost-sharing requirements.
The CMS guidelines also have no effect on
“grandfathered” plans, or coverage that has been in place, with minimal
changes, since before all ACA benefits standards took effect.
State insurance regulators are in charge of
the benefits standards for fully insured health insurance policies, including
grandfathered major medical policies, Medicare supplement insurance policies,
and “non-ACA” health insurance policies, such as short-term health insurance
policies.
Most states have been arranging for
state-regulated health insurers to:
·
Cover testing for
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that
causes Covid-19 pneumonia, without imposing cost-sharing requirements on the
patients, either through formal regulatory actions or through informal
agreements with the health insurers.
·
Ease preauthorization
requirements related to Covid-19 testing.
·
Cover or expand
coverage of telehealth services.
·
Provide an in-network
level of coverage for patients who seek out-of-network care due
Covid-19-related health care system disruption.
·
Cover early refills of
enrollees’ prescription medications, to help enrollees prepare for quarantines
or other events that might make it difficult for the enrollees to get to drug
stores.
·
Cover any Covid-19
vaccine that becomes available with no cost-sharing.
Each state is presenting SARS-CoV-2 benefits
guidelines and other SARS-CoV-2 coverage guidelines in its own way.
Here’s a guide to all of the state SARS-CoV-2
health insurance rules and guidelines sites we could find, along with notes
about efforts that go beyond the standard emergency response guidelines.
Alabama
Alaska
·
Alaska Covid-19
announcements. (In the Headlines section, on the home page.)
Arizona
Arkansas
The Arkansas Insurance Department has not
posted formal guidance, but Arkansas BlueCross BlueShield provides coverage for
the majority of Arkansas residents.
California
Colorado
Connecticut
Delaware
District of Columbia
DC Health Link has developed a spreadsheet
that shows how all district-regulated health insurers are covering Covid-19
care.
As of March 12, all issuers were covering
testing without cost-sharing, and all classified Covid-19 treatment as a
covered benefit.
Florida
Insurance regulators in Florida, as in a
few other states, have published formal business continuity guidelines for
insurers. The Florida bulletin gives insurers advice about what to do if, due
to Covid-19, their “business operations are compromised to the extent that it
jeopardizes the company’s ability to provide essential insurance services.”
Georgia
Hawaii
Idaho
·
An announcement
about Idaho health insurers’ voluntary decision to waive Covid-19 test
cost-sharing.
Illinois
The bulletin states the following about
travel insurance:
Unless a travel
insurance policy contains an exception applicable to Covid-19, a policy of
travel insurance that covers the risks of sickness, accident, or death incident
to travel presumptively must cover such risks relating to Covid-19. The extent
of coverage for health care services, including emergency transportation within
a foreign country, as well as the costs of returning to the United States for
further treatment, may depend on the terms and conditions of the policy.
Indiana
The Indiana Department of Insurance has posted
a guide to how 14 insurers in the state are handling Covid-19 testing on its
home page.
All insurers contacted said they are covering
Covid-19 diagnostic testing cost-sharing waived. Some are covering testing
without cost-sharing only at approved locations.
Iowa
The Iowa Insurance Division says on the
resources page that the four big major medical insurance issuers in Iowa and
the Iowa Farm Bureau Health Plan have all agreed to waive cost-sharing for
Covid-19 testing.
Kansas
Kentucky
·
Kentucky
Covid-19 insurance announcements. (In the Announcements
section, on the home page)
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
·
The Minnesota letter requesting that health insurers remove financial
barriers to Covid-19 testing.
Mississippi
Missouri
Montana
Nebraska
·
A discussion of Nebraska health insurers’ voluntary decision to waive
Covid-19 testing cost-sharing.
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
The travel insurance provision states:
Unless a travel
insurance policy contains an exception applicable to Covid-19, a policy of
travel insurance that covers the risks of sickness, accident, or death incident
to travel presumptively must cover such risks relating to Covid-19. The extent
of coverage for health care services, emergency transportation within a foreign
country, as well as the costs of returning to the United States for further
treatment [may depend on the terms and conditions of the policy].
Ohio
The travel insurance provision states:
Issuers of travel
insurance are reminded that unless a specific exclusion applicable to Covid-19
applies, a travel insurance policy that covers sickness, accident, disability,
or death occurring during travel must cover such risks related to Covid-19
according to the terms of the policy. Many travel insurance policies also must
cover cancellation or interruption of a trip or event, emergency transportation
and/or costs of returning to the United States for further treatment pursuant
to the terms of the policy.
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
·
A description of
South Carolina health insurers’ voluntary decision to waive Covid-19
cost-sharing.
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington state’s order applies to issuers of
short-term health insurance as well as to major medical insurance issuers.
West Virginia
·
The West Virginia bulletins and
orders. (In the Headlines and Events section.)
Wisconsin
Wyoming
Allison Bell, ThinkAdvisor's insurance editor, previously
was LifeHealthPro's health insurance editor. She has a bachelor's degree in
economics from Washington University in St. Louis and a master's degree in
journalism from the Medill School of Journalism at Northwestern University. She
can be reached at abell@alm.com or on Twitter at @Think_Allison.
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