The novel coronavirus (“COVID-19”) has spread to millions of people worldwide, with several hundred thousand confirmed cases in New York State. While the number of hospitalizations due to COVID-19 has diminished sharply in New York, there are still numerous cases of New Yorkers testing positive for the disease. The Centers for Disease Control has confirmed that COVID-19 seems to spread easily and sustainably in communities in affected areas. Given the public health implications related to this pandemic, it is essential that cost-sharing does not serve as a barrier to testing for COVID-19 and that the insured continue to have access to health care services in a way that limits the spread of the virus.
New York State Department of Financial Services 57th Amendment to 11 NYCRR 52 (Insurance Regulation 62)
“This amendment prohibits health care plans that provide hospital, surgical, or medical expense insurance policies or contracts from imposing, and provides that no insured shall be required to pay copayments, coinsurance, or annual deductibles for covered in-network laboratory tests to diagnose COVID-19 and for visits to diagnose COVID-19 at the following locations, including through telehealth: an in-network provider’s office, an in-network urgent care center, other in-network outpatient provider setting able to diagnose COVID-19, an emergency department of a hospital. Copayments, coinsurance, or annual deductibles may be imposed in accordance with the applicable policy or contract for any follow-up care or treatment for COVID19, including an inpatient hospital admission, as otherwise permitted by law. The amendment requires every health care plan to provide written notification of the requirements of the amendment to its in-network providers in order to ensure that the providers do not require any insured to pay a copayment, coinsurance, or annual deductible that is prohibited from being imposed under the amendment. This notification should ensure that providers do not collect a copayment, coinsurance, or annual deductible at any time, including when the services are provided, which is typically when such payment is collected.”
Click here for the full DFS Amendment released 11/9/2020
New York State Department of Financial Services 58th Amendment to 11 NYCRR 52 (Insurance Regulation 62)
“This amendment prohibits authorized insurers and health maintenance organizations (collectively, “health care plans”) that provide comprehensive coverage for hospital, surgical, or medical care from imposing, and states that no insured shall be required to pay copayments, coinsurance, or annual deductibles for an in-network service otherwise covered under the policy. The amendment requires every health care plan to provide written notification of the requirements of the amendment to its in-network health care providers (“providers”) to ensure that the providers do not require any insured to pay a copayment, coinsurance, or annual deductible that is prohibited from being imposed pursuant to the amendment. This notification should ensure that providers do not collect a copayment, coinsurance, or annual deductible for telehealth services provided.”