Map showing just about every state has some confirmed coronavirus cases (Credit: CDC)

(Related: Keep Calm and Carry On (With Your Practice))

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

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

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

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

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

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

Wisconsin

Wyoming

The Wyoming Covid-19 bulletin for health insurers.

— Read Pandemic Ready: What Your Clients Need From You, on ThinkAdvisor.

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