(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.
- Alaska Covid-19 announcements. (In the Headlines section, on the home page.)
- The bulletin for insurers .
The Arkansas Insurance Department has not posted formal guidance, but Arkansas BlueCross BlueShield provides coverage for the majority of Arkansas residents.
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.
- The Florid Covid-19 information page.
- The cost-sharing bulletin for health insurers.
- The prescription refill bulletin for health insurers.
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.”
- Links to Covid-19 documents are available under the Insurance News and Directives tabs here.
- A Covid-19 preparedness and cost-sharing directive for health insurers.
- A directive that discourages Covid-19 testing labs from price gouging and waives in-person agent continuing education requirements through April 30.
- The Idaho Covid-19 resources page.
- An announcement about Idaho health insurers’ voluntary decision to waive Covid-19 test cost-sharing.
- The Illinois Covid-19 benefits guide for consumers.
- The bulletin for health insurers and travel insurance providers.
The bulletin states the following about travel insurance: