Legislative/Regulatory Review
Jurisdiction: New York
Subject: Health Insurer Guidance on Coverage Requirements for Novel Coronavirus
Version date: 4/29/21
Law/Regulation: 57th and 58th Amendments to Regulation 62 – Applicability of DFS Regulations to Waive Cost-Sharing for Certain Services during the Novel Coronavirus State of Emergency
Effective Date: March 16, 2020
Main Provisions: |
Summary | The regulation prohibits issuers from imposing copayments, coinsurance, or annual deductibles on any in-network laboratory tests necessary to diagnose COVID-19, related health care visits, and antibody testing. There is no limitation on number of visits. No issuer shall impose copayments, coinsurance, and annual deductibles for the following services when covered under the policy or contract: - in-network laboratory tests to diagnose COVID-19; and
- visits to diagnose COVID-19 at an in-network provider’s office, an in-network urgent care center, any other in-network outpatient provider setting able to diagnose COVID-19 including when in-network telehealth services are used, or an emergency department of a hospital
The insurer pays the patient’s cost-sharing to the provider |
Applicability | - A policy or contract delivered or issued for delivery in this State that provides comprehensive health insurance coverage by an insurer authorized to write accident and health insurance in New York State;
- Non-profit medical and dental indemnity or health and hospital service corporations (Insurance Law Article 43);
- Municipal cooperative health benefit plans (under Insurance Law Article 47);
- Student health plans (under Insurance Law §1124);
- HMO’s; and
- New York State Empire Plan (covering state employees and retirees
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Other Information | - Insurers cannot deny coverage of a COVID-19 diagnostic test from a licensed or authorized health care provider because an insured is asymptomatic or has no known or suspected exposure to COVID-19.
- If the policy or contract is a high deductible health plan as defined in Internal Revenue Code § 223(c)(2), the services listed in the regulation may not be subject to the plan’s annual deductible.
- Copayments, coinsurance, or annual deductibles may be imposed for any follow-up care or treatment for COVID-19, including an inpatient hospital admission, as otherwise permitted by law or regulation.
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Main Provisions: |
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Other Information (continued) | - Insurers are prohibited from excluding coverage for a service that is otherwise covered under the contract or policy because the service is delivered using telehealth.
- Insurers may limit or exclude coverage for non-network telehealth providers
- Issuers are required to send written notification to in-network providers that they shall not collect any annual deductibles, copayments, or coinsurances in accordance with the regulations.
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