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State Regulators, Health Insurers Muster for Coronavirus Fight

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Health insurers and state insurance regulators are continuing to race to see who can get health insurers into the battle to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus first.

(Related: Health Insurers Mobilize for the Covid-19 Fight)

Here’s a look at what some states and insurers are saying about the war against the virus that causes Covid-19 pneumonia.

State Regulators

The California Department of Insurance has issued a bulletin calling for all commercial health insurance providers in the state to waive any co-payments, deductibles, coinsurance amounts, or cost-sharing arrangements that might discourage people from getting tested for SARS-CoV-2.

The department is told insurers to make sure their call center staffers, nurse lines and customer service representatives know about the cost-sharing waivers; to cover all medically necessary emergency care without prior authorization; to protect enrollees against any surprise bills related to SARS-CoV-2 testing; and to cover out-of-network care on an in-patient coverage basis if a surge in SARS-CoV-2 cases overwhelms the in-network providers.

A copy of the bulletin is available here.

The Maryland Insurance Administration has a state-of-emergency proclamation from Gov. Larry Hogan to impose SARS-CoV-2-related requirements on health insurers. The state is requiring health insurers to allow one-time prescription refills, in preparation for a possible quarantine; to educate enrollees about SARS-CoV-2; and to get their provider networks ready to handle a surge in the number of patients with severe cases of Covid-19 pneumonia.

Al Redmer Jr., the state’s insurance commissioner, has issued emergency regulations that require health carriers to waive cost-sharing for any SARS-CoV-2 testing and diagnostic work done in any setting, and to waive cost-sharing for SARS-CoV-2 vaccinations.

A carrier may evaluate a request to use an out-of-network provider for SARS-CoV-2 testing only on the basis of whether the use of the out-of-network provider is medically necessary or appropriate.

Any adverse decisions related to requests for SARS-CoV-2 testing must be handled on an emergency basis.

The Nevada Division of Insurance has adopted an emergency regulation that calls for health insurers to cover SARS-CoV-2 exams and diagnostic tests without imposing any requirements for co-payments or deductibles. Health insurers in the state must cover any available treatments for SARS-CoV-2 infections and Covid-19 pneumonia, and they must cover SARS-CoV-2 testing and care from out-of-network providers if care from in-network providers is not immediately available.

Links to information about the Nevada emergency regulation are available here.

The Oregon Department of Consumer and Business Services has negotiated a voluntary agreement with the state’s main health insurance issuers to waive cost-sharing for SARS-CoV-2 infection testing; in-network provider office visits for SARS-CoV-2 testing; in-network urgent care center visits for SARS-CoV-2 testing; emergency rooms for SARS-CoV-2 testing; and SARS-CoV-2 immunizations.

The Oregon SARS-CoV-2 coverage agreement web page is available here.

Washington State Insurance Commissioner Mike Kreidler has issued an emergency order calling for insurers in the state to waive co-payments and deductibles for SARS-CoV-2 testing; allow a one-time early refill for prescription drugs; and suspend any prior authorization requirements for treatment or testing for SARS-CoV-2 infections.

If an enrollee can’t get in-network SARS-CoV-2 testing, then a plan must let the enrollee get treated by an out-of-network provider “within a reasonable distance” at no additional cost.

Kreidler’s order applies to short-term health insurance policies as well as to major medical insurance coverage, and it is set to stay in effect until May 4.

A copy of Kreidler’s emergency order is available here.

The Wisconsin Office of the Commissioner of Insurance has issued a bulletin asking health carriers to waive SARS-CoV-2 testing cost-sharing, and to review their networks’ ability to handle SARS-CoV-2 cases.

A copy of the Wisconsin bulletin is available here.

Insurers

Here’s a look at what some health insurers are doing, based on the companies’ own announcements, and compilations created by America’s Health Insurance Plans:

Aetna will waive co-pays for all SARS-CoV-2 testing for all insured enrollees, whether the enrollees are in commercial, Medicare or Medicaid plans. Self-insured employers can opt-in. Aetna is also offering zero co-pay telemedicine visits for any reason, and it’s offering its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members.

Anthem will waive prior authorizations  and cost-sharing for SARS-CoV-2 testing, and it’s encouraging patients to consider to change to a 90-day supply of their regular medications, from a 30-day supply.

Blue Shield of California says it will cover SARS-CoV-2 testing without cost-sharing for all insured enrollees, whether the enrollees are in commercial plans or Medicaid plans, no matter where the testing is done, and that it’s working on testing coverage levels for workers in employer self-funded plans. The company is waiving preauthorization requirements for medically necessary emergency care and encouraging use of telehealth services.

Blue Cross and Blue Shield of Massachusetts says it will cover SARS-CoV-2 testing without cost-sharing for all insured enrollees, and that employers with self-funded plans can opt in to providing testing coverage without cost-sharing. The company says it’s also removing administrative barriers, such as prior authorization and referral requirements.

Blue Shield and Blue Shield of Minnesota says it will cover SARS-CoV-2 testing without cost-sharing for all insured enrollees, and that employers with self-funded plans can opt in to providing testing coverage without cost-sharing. The company says it’s also removing administrative barriers, such as prior authorization and referral requirements for Covid-19 pneumonia care.

BlueCross Blue Shield of Tennessee says it will waive all cost-sharing on FDA-approved testing for SARS-CoV-2.

Bright Health says it will require SARS-CoV-2 diagnostic testing with no cost-sharing.

Cigna will waive co-pays for all SARS-CoV-2 testing for all insured enrollees. Self-insured employers can opt in. Cigna is also adding a special enrollee support hot line.

Florida Blue will waive co-pays for all SARS-CoV-2 testing for all insured enrollees, including people who have Affordable Care Act (ACA) individual exchange plan coverage and Medicare Advantage plan coverage. The company is waiving early medication refill limits on 30-day prescriptions.

Health Alliance Plan will waive cost-sharing for SARS-CoV-2 testing for all insured enrollees. Self-insured employer health plans can opt in.

Health Net will waive co-pays for all SARS-CoV-2 testing for all insured enrollees. 

Highmark will cover coronavirus testing, when recommended by a medical professional, for insured enrollees. Self-insured employer health plans can opt out.

Horizon Blue Cross Blue Shield of New Jersey will waive prior authorizations for SARS-CoV-2 testing, cover the full cost of diagnostic testing, waive early medication refill limits for 30-day prescription medications, and provide access to telehealth services at no cost.

Independence Blue Cross will cover and waive cost-sharing for SARS-CoV-2 testing for all insured enrollees when the testing is performed at a hospital or an approved laboratory. Self-insured employer plans can opt-on.

Molina Healthcare will waive prior authorizations  and cost-sharing for SARS-CoV-2 testing,

Oscar will waive cost-sharing for diagnostic testing for SARS-CoV-2, and it continues to offer telemedicine services at no cost to the patient.

Regence Blue Shield of Idaho will waive co-pays for all SARS-CoV-2 testing for all insured enrollees. The company is working with federal officials to ensure coordination of benefits for Medicare members and those with health savings accounts (HSA).

Regence BlueCross BlueShield of Oregon  will waive cost-sharing for SARS CoV-2 testing for insured members, and it will reach out to high-risk enrollees.

Regence BlueCross BlueShield of Utah will waive cost-sharing for SARS CoV-2 testing for insured members.

Regence BlueShield of Washington will waive cost-sharing for SARS CoV-2 testing for insured members, and it will reach out to high-risk enrollees.

UnitedHealth Group Inc. says its UnitedHealthcare and Optum units have waived all SARS-CoV-2 diagnostic test cost-sharing for all insured enrollees, whether the enrollees are in commercial, Medicare or Medicaid plans, and that it’s encouraging self-insured employers to offer diagnostic testing benefits without cost-sharing.

The company is opening up its Optum Emotional-Support Help Line to anyone feeling worried about the SARS-CoV-2 outbreak. The service is available at (866) 342-6892, 24 hours a day, seven days a week.

UPMC and UPMC Health Plan will waive cost-sharing for SARS CoV-2 testing for insured members. Self-funded employer health plans can opt in.

— Read AHIP Cancels Two Events Due to Covid-19 Worrieson ThinkAdvisor.

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