The Coronavirus and the Workplace: NYS Health Insurers Are Required to Waive Cost-Sharing for Coronavirus (COVID-19) Testing

On March 3, 2020, Governor Andrew Cuomo announced a new directive by the New York State Department of Financial Services (DFS) that requires New York health insurers to waive cost-sharing for coronavirus (COVID-19) testing. This includes emergency room, office and urgent care visits. In addition, New Yorkers receiving Medicaid coverage will not be expected to pay a co-pay for any testing related to COVID-19.

Costsharing is the split of costs covered by health insurance that the consumer pays out of their own pocket. Examples include deductibles, coinsurance, and copayments, but do not include premiums (except under Medicaid and CHIP), balance billing amounts for non-network providers, or the cost of non-covered services.

Along with their directive, DFS has issued guidance to health insurers for actions that should take place regarding the impact of COVID-19 on New York state:

  • Keep consumers updated by “devoting resources to inform consumers of available benefits, quickly respond to consumer inquiries, and consider revisions needed to streamline responses and benefits for consumers.”
  • Provide telehealth medical advice and treatment by “developing robust telehealth programs with their participating providers where appropriate, particularly for individuals who may have difficulty making an office visit and where a phone call with a medical professional can alleviate the need for a hospital visit.” 
  • Prepare health systems for increased volume by “verifying that provider networks are adequately prepared to handle a potential increase in the need for health care services, including offering access to out-of-network services where appropriate and required, in the event more COVID-19 cases are diagnosed in New York.”  
  • Cover costs if immunization becomes available. At this time there is no vaccine for COVID-19, however “in the event an immunization becomes available for COVID-19, DFS is reminding insurers that they must cover the cost of vaccination for children under 19. For adults, DFS’s guidance states that all insurers should be prepared to cover the immunization immediately at no cost-sharing.”
  • Expand access to prescription drugs. “With reports of prescription drug shortages due to supply chain issues, DFS is directing insurers to provide insurance coverage for off-formulary prescription drugs if there is not a formulary drug available to treat the insured, through a formulary exceptions process as required by law.”
  • Ensure emergency care. “Coverage for emergency services in hospital facilities is required at the in-network cost-sharing even if the hospital is out-of-network or overseas, and that no insurer may require a patient to seek preauthorization prior to seeking emergency care, including for ambulance service.
  • Regarding surprise medical bills DFS is directing insurers that they are required to hold harmless insureds who receive surprise medical bills for health care services, including those related to testing and treatment of COVID-19. 

Read the full directive from DFS (Insurance Circular Letter No. 3 (2020) here and also the governor’s news release.

Also, check out our previous blog post on what employers need to know about the coronavirus in the workplace. 

Rose & Kiernan, Inc. will continue to monitor the coronavirus and its impact on the workplace. As always, we encourage all employers in New York state to stay informed. Should you have any questions on health insurance and cost-sharing for coronavirus (COVID-19) testing reach out to us today.

Please note that news and events surrounding the COVID-19 pandemic are changing quickly. The information provided in this blog post represents where things stand on the date of publication.

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