COVID-19 Emergency Regulation Extension: Waiving in-network cost-sharing for diagnosis and testing
Emergency Regulation extended until April 4, 2021
The New York State Department of Financial Services has again extended its emergency regulation requiring insurers to waive in-network cost-sharing for COVID-19 diagnosis and testing. As a result, the terms of the emergency regulation will remain in effect until April 4, 2021. As a reminder, the terms of the emergency regulation(s) are summarized below.
The emergency regulation prohibits any insurance policy that provides hospital, surgical, or medical expense insurance coverage from imposing (or requiring any insured to pay) any copayments, coinsurance, or annual deductibles for the services listed below when covered under the policy:
- In-network laboratory tests to diagnose COVID-19
- Visits to diagnose COVID-19 at the following locations, including through telehealth:
- An in-network provider’s office
- An in-network urgent care center
- Any other in-network outpatient provider setting able to diagnose COVID-19
- An emergency department of a hospital
The prohibition on in-network cost-sharing appears to include in-network cost-sharing for high deductible health plans (HDHPs) as defined by Internal Revenue Services (IRS) rules. (Note that IRS Notice 2020-15 permits exclusion of COVID-19 testing and treatment from HDHP cost-sharing requirements.)
Normal plan copayments, coinsurance, or annual deductibles may apply to any follow-up care or treatment for COVID-19, including an inpatient hospital admission as otherwise permitted by law.
Notably, cost-sharing is not prohibited for out-of-network testing for COVID-19 and out-of-network visits to diagnose COVID-19.
Please read the attached bulletin in its entirety for all relevant details.
COVID-19 Emergency Regulation Extension: Waiving in-network cost-sharing for telehealth services
Emergency Regulation extended until April 4, 2021
The New York State Department of Financial Services has again extended its emergency regulation requiring insurers to waive in-network cost-sharing for telehealth services under comprehensive health insurance policies. As a result, the terms of the emergency regulation will remain in effect until April 4, 2021. As a reminder, the terms of the emergency regulation(s) are summarized below.
For the duration of the state of emergency declared by the NYS governor related to the novel coronavirus (COVID-19), this emergency regulation prohibits any policy delivered or issued for delivery in New York that provides comprehensive coverage for hospital, surgical, or medical care from imposing copayments, coinsurance, or annual deductibles for an in-network service delivered via telehealth when such service would have been covered under the policy if it had been delivered in person. Insureds may not be required to pay for such services.
Providers cannot collect any deductible, copayment, or coinsurance for such services.
For purposes of the emergency regulation, “telehealth” means the use of electronic information and communication technologies, including the telephone, by a health care provider to deliver health care services to an insured while such insured is located at a site that is different from the site where the health care provider is located.
Please read the attached bulletin in its entirety for all relevant details.