COVID-19生命保険および健康保険の規制に関するアップデート

米国各州の州保険局（以下「保険局」または「DOI」）が、COVID-19の流行に関連して保険会社向けの特別規則、規制、またガイドラインを発行しています。本レポートの対象は、傷害・医療保険のみに該当する情報に限定し、COVID-19の規制行動が以下の主要トピックスをはじめとする商品管理に与える影響に着目します。

1. 保険局のリソースと役割：COVID-19が保険局のリソースおよび役割に与える影響
2. 契約解除、更新、猶予期間：解除や更新に関する期限の一時停止と、猶予期間の延長
3. COVID-19給付に対するコストシェアの放棄：COVID-19検査と治療のコストシェアへの制限
4. テレヘルス：給付のガイダンスとテレヘルスの要件変更
5. ネットワークの適正性：ネットワークの適正性の確認やネットワークの制約の取り扱いの変更を保険会社に要請
6. 利用度のレビューと事前承認：利用度レビュー制度の調整と事前承認の停止
7. 処方薬へのアクセス：薬剤給付の変更と補充制限の停止
8. 規制上の届出と期限の延長：規制上の届出要件の変更と期限の延長

上記8分野を超えて州ガイダンスがある場合は、追加情報も提供しています。下記チャートは、州別に示しており、各州の該当トピックスは下線付きの太字で示しています。可能な場合は、出典元のリンクも提供しています。州間保険商品規制委員会（Interstate Insurance Product Regulation Commission）のInsurance CompactもCOVID-19リソースページにリソースおよび申請・届出に関連した多くの情報を提供しています。PDF版のリンク付き全法制地域のレポート全文については、[email protected]までご連絡ください。

IMPORTANT: The information provided herein is not intended to be a comprehensive compilation of all state rules, regulations, and guidance related to COVID-19. Readers should review the linked sources for complete information on the categories covered and refer to the Department website links provided for guidance on other topics. Additionally, state regulatory responses to the COVID-19 pandemic are constantly evolving. As such, this document may need revision to account for changes in Department positions. We intend to provide updates as they become available; please refer to the date above, which represents the most recent revisions. This document is prepared and maintained by Stacy Koron, Taylor McKinnon, and Stephen Tabachnick in Milliman’s Tampa office. You may reach Stacy at [email protected].

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

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Alabama

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Department Public Release 3/16/2020. The DOI is working remotely until at least 4/30/2020. The DOI remains operational: “While the employees of Department of Insurance may be teleworking until April 30, the business of the Department will continue. We will return to normal operations as soon as possible.”
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin No. 2020-05. The DOI recommends that insurers relax due dates for premium payments, extend grace periods, waive late fees and penalties, and allow premium payment plans which will avoid a lapse in coverage.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin No. 2020-02. The DOI asked health carriers to waive cost-sharing for COVID-19 testing.
• Telehealth: Bulletin No. 2020-02 Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.
• Network Adequacy: Bulletin No. 2020-02 The DOI is requesting that health carriers verify their provider networks are adequate to handle a potential increase in the need for health services due to COVID-19.
• Utilization Review and Preauthorization: Bulletin No. 2020-02 The DOI reminds health carriers that they must comply with the timeframes for utilization review decisions under state law and be prepared to expedite the process for COVID-19 treatment. In addition, the DOI instructs carriers to not use preauthorization requirements as a barrier to access treatment for COVID-19.
• Access to Prescription Drugs: Bulletin No. 2020-02. Health carriers are asked to make expedited formulary exceptions for insureds suffering from health conditions that may seriously jeopardize the insured’s health or life.
• Regulatory Filings and Deadline Extensions: Insurers are instructed to provide the DOI with information related to their response to COVID-19 and the specific steps they are taking in response to Bulletin No. 2020-02.
• Other – Group Policy Employee Eligibility Requirements: Bulletin No. 2020-07. Insurers are encouraged to permit employers to continue covering employees under group policies even if the employee would otherwise become ineligible due to a decrease in hours worked per week, or regardless of any “actively at work” or other similar eligibility requirements. The Department will not take enforcement action with respect to filed forms and rates against insurers that adjust policies or practices to provide the flexibility suggested by this bulletin. (4/20/2020)
• Other – COVID-19 Health Insurance Premium Reduction Filing Guidance: Bulletin 2020-13. For health insurers considering implementing premium reductions as a result of the pandemic, an informational rate filing should be submitted in SERFF to include the timeframe, individual premium impact, and whether the action applies to new business and/or renewal. (06/26/2020)

Alaska

DOI website (no dedicated COVID-19 page)

Department Guidance

• Department Resources and Functions: DOI offices are closed and the staff are working remotely for “the next few weeks.” Contact information is available on the DOI’s website.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 20-08 and Order R20-04 (see also Order R20-07 modifying Order R20-04). (4/24/2020). Carriers are prohibited from cancelling coverage due to non-payment of premium through June 01, 2020. Extension of grace period does not eliminate the obligation to pay premium but limits the policy cancellation for late payment.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 20-09 and Order R20-05. Cost sharing requirements must be waived for RSV, influenza, and COVID-19 testing. Insurers are also encouraged to liberalize telehealth benefits during the period of increased infection.
• Telehealth: Bulletin 20-07 and Order R20-05 summarizes the changes to AS 21.42.422 based on passage of SCS HB 29(HSS). Telehealth coverage must be expanded to all covered services of health care insurance plans in the individual and group market. Not applicable to excepted benefits based on AS 21.42.599. See also, COVID-19 Coverage below. Bulletin 20-11 goes a step further and requires that services which can be offered through telehealth to avoid unnecessary exposure to the virus and prevent regression of symptoms MUST be covered.

  Bulletin 20-18. The Department has received numerous reports of insurers notifying consumers and health care providers that they will no longer cover telehealth services. The Department would like to remind insurers that under Bulletin 20-07 and SCS HB 29(HSS), telehealth coverage is mandatory for individual and group plans subject to Title 21. (10/16/2020)

• Utilization Review and Preauthorization: Bulletin 20-12 and Order R20-06. Certain utilization review requirements are suspended during the emergency. Additionally, insurers that exclude coverage for treatment in government facilities may not enforce those exclusions for alternate sites established by the government for treatment during the pandemic. Order R20-08 updates the expiration date of the Order R20-06 utilization review suspension requirements to June 01, 2020. (5/29/2020)
• Access to Prescription Drugs: Bulletin 20-03 and Order R20-05. Insurers are expected to provide for early refills or replacements of lost or damaged medications. It is expected that insurers will allow affected consumers to obtain emergency supplies or refills without applying additional authorization requirements.
• Regulatory Filings and Deadline Extensions: Bulletin 20-06 The DOI has extended the time period for review of form and rate filings, allowing a longer period of time before products are deemed approved and extensions to respond to objection responses.

  Order R20-04. Insurers may request filings originally submitted as File and Use be treated as Prior Approval if their company experiences operational challenges due to COVID-19. The division reserves the right to treat File and Use filings as Prior Approval if deemed necessary by the director.

• Other-Product Administration: Bulletin 20-11 and Order R20-04 Employers must be allowed to continue covering employees that would otherwise lose eligibility due to a drop in hours worked per week. Insurers must suspend deadlines for claim filing and appeals. Once the emergency ends, the insurer must also extend the time to file claims because there may be a backlog of insurance claims in medical offices. The DOI also encourages insurers to implement fully electronic claim processes, though it is not mandatory.
• Other – Claim Filing Deadlines: Order R20-04. Insurers shall suspend deadlines for claim filing and appeals. (4/24/2020)

Arizona

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: The Department of Insurance remains open and fully staffed, though they are currently having some phone issues. Email addresses are available on the website. AZ DOI website.
• Policy Cancellations, Non-renewals, and Grace periods: Bulletin 2020-04. Insurers are urged to provide relief measures to insureds including the following: refraining from cancelling or nonrenewing policies, granting premium payment grace periods, waiving late fees, interest, and penalties, extending timeframes for health providers to submit claims, and extending timeframes to undergo medical examinations. (4/20/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Executive Order 2020-07 and Bulletin 2020-02. Insurers must cover the cost of COVID-19 testing from all qualified laboratories regardless of network, not subject to cost sharing requirements.
• Telehealth: Executive Order 2020-15. Insurers are required to provide coverage for all healthcare services that are provided through telemedicine if the healthcare service would be covered were it provided through an in-person visit.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-03. Establishes a 30-60 day extended filing deadline for certain required filings, and waives the hard copy filing requirement for certain documents. Any hard copy filings may instead be sent to the Department’s electronic filing email address, [email protected]. Bulletin 2020-04 requires insurers implementing COVID-19 related customer relief programs to make an informational filing in SERFF to document their programs. (4/20/2020)

Arkansas

DOI COVID-19 webpage

Department Guidance

• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin No. 6-2020 establishes a moratorium on cancellation for non-payment of premium for all insurance policies issued to an individual diagnosed with COVID-19. Bulletin 20-2020 has rescinded Bulletin No. 6-2020 effective May 11, 2020. (5/15/2020). Bulletin 28-20 and Bulletin 28-20A reinstate the moratorium on cancellation for nonpayment of premium for life and health policyholders who are diagnosed with COVID-19. Policyholders eligible for an extension under the moratorium order must request the extension from their insurance carriers. (09/04/2020)

  Bulletin 21-2020 establishes a 45-day moratorium on cancellation or nonrenewal for premium nonpayment for policyholders who have been diagnosed with COVID-19 or who have been laid off or lost business as a result of the pandemic. (5/15/2020). Bulletin 26-20 extends Bulletin 21-2020 for the duration of the pandemic. (06/26/2020)

   

• Telehealth: Bulletin No. 13-2020. All health insurance carriers, including short-term limited-duration insurance plans, must comply with the reimbursement requirements for telemedicine found in Ark. Code Ann. § 23-79-1602(c) and (d). Requirement applies to “health benefit plans” per the cited statutes. Bulletin 20-2020 has rescinded Bulletin 13-2020 effective May 11, 2020. (5/15/2020)

  Bulletin 23-2020. The Department reminds all health insurance carriers offering health insurance plans, including short-term limited-duration insurance plans that they must comply with the reimbursement requirements for healthcare services provided through telemedicine found in Ark. Code Ann. § 23-79-1602(c) and (d). (5/15/2020)

   

• Utilization Review and Preauthorization: Statement 04-16-2020. For cases involving COVID-19 patients, the Department is temporarily suspending healthcare insurer prior authorization protocols. (5/01/2020)
• Regulatory Filings and Deadline Extensions: Bulletin No. 6-2020. The DOI requires insurers provide them with any alternate contact information for consumer complaints. Bulletin No. 18-2020. If a company believes that it will not be able to meet a mandatory filing deadline, please contact the Finance Division via email at: [email protected] to submit an extension request. Additionally, if a company is not able to make required hard copy filings at this time, the Department will accept electronic filings containing e-signatures as an alternative. (4/20/2020) Bulletin 20-2020 has rescinded Bulletin 18-2020 effective May 11, 2020. (5/15/2020), but Bulletin 22-2020 restores the deadline extension guidelines and electronic filing permissions originally outlined in Bulletin 18-2020. Bulletin 26-20 extends Bulletin 22-2020 for the duration of the pandemic. (06/26/2020)
• Other – Claims Adjudication: Bulletin No. 6-2020. Insurers must continue to pay claims as quickly as possible.
• Other – PBM and Pharmacy Regulation: Bulletin 7-2020, Bulletin 8-2020, and Bulletin 10-2020 address Pharmacy Benefit Manager and other Pharmacy related requirements. Bulletin 20-2020 has rescinded Bulletin 7-2020, Bulletin 8-2020, and Bulletin 10-2020 effective May 11, 2020. (5/15/2020)

  Bulletin No. 24-2020. The Department directs all health insurance carriers offering health insurance plans, including short-term limited-duration insurance plans to suspend random audits of pharmacies and to suspend the requirement that pharmacy plan beneficiaries sign for the rendering of pharmacy services. (05/15/2020)

  Bulletin 29-2020. The Department orders that all health insurance carriers suspend the requirement that pharmacy plan beneficiaries sign for the rendering of pharmacy services for the duration of the pandemic. (09/04/2020)

• Other – Suspension of Provider Payment Audits: Bulletin 15-2020 requires insurers to suspend payment audits of healthcare facilities and providers. Bulletin 20-2020 has rescinded Bulletin 15-2020 effective May 11, 2020. (5/15/2020)

 

Bulletin 23-2020. The Department directs all health insurance carriers offering health insurance plans, including short term limited-duration insurance plans, to suspend payment audits of hospitals and healthcare providers for 45 days effective May 05, 2020. (05/15/2020). Bulletin 26-20 extends Bulletin 23-2020 for the duration of the pandemic. (06/26/2020)
• Other – Consumer Complaint Email Address on File with Department: Bulletin 22-2020. The Department directs all insurers to provide it with the appropriate email address the company has designated to field consumer contacts during this health emergency. Carriers should forward their consumer contact email address to [email protected] as soon as possible. (05/15/2020)
• Other – Overpayment Recovery Time Limit Tolling Requirement: Bulletin 24-2020. The Department directs all health insurance carriers offering health insurance plans, including short-term limited-duration insurance plans to toll the time limit on overpayment recovery or any other agreed upon time limit between health insurers, and hospitals and healthcare providers for 45 days effective May 05, 2020. (5/15/2020). Bulletin 26-20 extends Bulletin 24-2020 for the duration of the pandemic. (06/26/2020)

California

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: DOI is working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Notice 3/18/2020, updated by Notice 4/3/2020. Insurers are requested to provide their policyholders with a 60-day grace period to pay policy premiums. All licensees should not attempt to enforce policy or statutory deadlines on policyholders until ninety (90) days after the end of the statewide “state of emergency.” Notice 05-15-2020 extends the grace period requirement for an additional 60 days to July 14, 2020. (05/22/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 3/5/2020 and APL-20-006. Health insurers are required to eliminate cost sharing for all COVID-19 screening test expenses.
• Telehealth: Notice 3/30/2020. DOI expects that health insurers will provide increased access to health care services through telehealth delivery platforms and encourage patients to use telehealth delivery options, so as to limit the amount of in-person health care they seek while continuing to receive the essential care that they need during this challenging time.
• Utilization Review and Preauthorization: Bulletin 3/5/2020 and APL-20-006. The Insurance Department and Department of Managed Health Care (DHMC) reminded health carriers that they must comply with the timeframes for utilization review decisions under state law and be prepared to expedite the process for COVID-19 treatment. The state is strongly encouraging health plans and insurers to waive prior authorization requests for services related to COVID-19.
• Access to Prescription Drugs: Bulletin 3/5/2020 and APL-20-006. In the event of a shortage of any particular prescription drug, plans should waive prior authorization and/or step therapy requirements if provider recommends a different drug to treat the enrollee’s condition.
• Regulatory Filings and Deadline Extensions: Notice 4/6/2020. The deadlines for California licensed entities to file statutory financial statements are extended for 90 days from the original due dates. Notice 04/22/2020. Any insurer filing a premium tax return that requires the payment of less than $1 million in premium tax (based on the 2019 Annual Tax Liability) is hereby granted an automatic three month extension to file its premium tax return and to pay any required premium tax. (4/24/2020)
• Other – Unfair Claims Settlement Practices: Notice 05-14-2020. Insurers are directed to comply with their various legal obligations under the California Unfair Practices Act (Cal. Ins. Code §790.03 et seq.) to promptly and fairly settle insurance claims during the pandemic. (5/29/2020)
• Other – Premium Refund to Reflect Cost Savings Associated with Underutilization of Health Services Due to COVID-19 Pandemic: Notice 10-07-2020. Due to the fact that many insureds have refrained from seeking care for ailments unrelated to COVID-19, all health insurance and specialized health insurance companies are requested to provide their policyholders with a partial premium refund no later than December 31, 2020. These refunds should be reflected in the November or December 2020 premium statements sent to policyholder or certificate holders. (10/16/2020)

Colorado

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: DOI is working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin No. B-4.105 (Health). Carriers must make reasonable accommodations to prevent businesses and employers from losing coverage due to non-payment of premium, including extension of premium grace periods or premium deferrals; waiver of late payment fees or interest; a moratorium on cancellations for non-payment of premium.

  Bulletin B-4.107. Carriers are directed to defer the triggering of a grace period for policyholder nonpayment of premium, and are urged to extend premium deferrals and premium due dates, accept partial payments, establish payment plans, and waive late fees or other penalties in order to ease consumer hardship. (4/24/2020)

• Cost Sharing Waivers for COVID-19 Coverage: Emergency Regulation 20-E-01. Health Benefit Plans ONLY Telehealth services for COVID-19 should be provided in network without any cost share. Bulletin No. B-4.104. COVID-19 testing shall be provided with no cost sharing.

  Emergency Regulation 20-E-07. Treatment of COVID-19 is subject to the provider reimbursement requirements, in-network benefits, direct payment rules and consumer protections against balance billing under Colorado law. (4/24/2020)

  Bulletin No. B-4.108. Health insurance companies must utilize both in-network and in-state out of network laboratories to process COVID-19 tests with no cost share by the covered person. Additonally, the carrier must reimburse any in-state out of network laboratory used to process COVID-19 tests in accordance with Colorado laws relating to emergency medical services. Carriers shall also cover cost sharing where licensed health care providers are administering testing for COVID-19, including in-network urgent care center settings, emergency room settings, and nontraditional care settings. (5/08/2020)

  Emergency Regulation 20-E-09. Establishes coverage and cost-sharing requirements for health insurance carriers related to claims arising from the testing and treatment of COVID-19. (09/04/2020)

  Emergency Regulation 20-E-12. Carriers are required to provide covered persons with treatment related to COVID-19. (09/04/2020)

• Telehealth: Emergency Regulation 20-E-05 and Bulletin No. B-4.104. Emergency regulation addresses telehealth coverage requirements. The Bulletin directs carriers to conduct an outreach and education campaign to remind individuals of their telehealth coverage options. Telehealth FAQ are available here.

  Emergency Regulation 20-E-11. Requires carriers offering health benefit plans to reimburse providers for provision of telehealth services using non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. (09/04/2020)

• Utilization Review and Preauthorization: Emergency Regulation 20-E-07. Carriers shall suspend preauthorization requirements for emergency services rendered to covered persons with emergency medical conditions during the COVID-19 emergency. (4/24/2020)
• Access to Prescription Drugs: Bulletin No. B-4.104. Carriers shall cover at least one additional early refill of all necessary prescriptions to ensure access to necessary medications.
• Other – Special Enrollment Period: Emergency Regulation 20-E-05 and Emergency Regulation 20-E-02. Colorado has issued emergency regulations establishing special enrollment periods (SEP) for uninsured individuals to enroll in individual health benefit plans. The first SEP ran from March 20 to April 3. The second runs from April 4 to April 30.
• Other – Home Health Services Coverage: Bulletin B-4.106. Health insurance carriers are reminded that they must provide coverage for necessary medical equipment and medications for in home treatment of persons with COVID-19 or COVID-19-like symptoms, including pulse oximeters, oxygen, medications for the treatment of COVID-19, home infusion therapy, and electrocardiographs. (4/20/2020)

Connecticut

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: DOI is working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin No. IC-40. The Department is requesting that all carriers give insureds at least a 60-day grace period for the payment of premium. This is not a forgiveness of premium but an extension of the period of time to pay to avoid lapses in coverage.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin No. IC-39. Carriers are encouraged to waive cost sharing for COVID-19 testing, including any cost sharing related to the in-network provider office visit, urgent care visit, or emergency room visit to be tested.
• Telehealth: Bulletin No. IC-39. Health insurers are encouraged to offer and waive cost sharing for medical advice and treatment of COVID-19 via telehealth services. See also Executive Order 7G.

  Bulletin HC-128. Provides updated definitions of “Telehealth” and “Telehealth provider” according to Public Act 20-02. (09/04/2020)

• Network Adequacy: Bulletin No. IC-39. Health insurers are encouraged to verify their networks are adequate for a surge in need for health care services.
• Utilization Review and Preauthorization: Bulletin No. IC-39. Health insurers are encouraged to relax utilization review requirements for COVID-19 testing. They are also encouraged to extend claims filing deadlines requirements.
• Access to Prescription Drugs: Bulletin No. IC-39. Health insurers and health care centers are encouraged to authorize payment to pharmacies for a 90-day supply of maintenance prescription medications.
• Regulatory Filings and Deadline Extensions: Bulletin No. FS-36. The Department has relaxed the requirements for notarization and paper filing for insurance company license applications, and for notarization and hard copy filings for financial statements.

  Bulletin No. FS-36. First quarter financial report deadline has been extended to June 15, 2020 (previously May 15). The due date for annual statement supplements has also been extended to June 15, 2020.

  Bulletin No. HC-90-20A. State extended ACA filings; the due date for such filings until July 6, 2020 for forms and July 20, 2020 for rates.

   

Bulletin No. FS-38. For Domestic companies, the Department is willing to extend financial reporting deadlines for certain required hard copy filings by up to 90 days by request and subject to Department approval. If your domestic company believes that it will not be able to meet any of the filing deadlines listed in this bulletin, please contact the Department at [email protected] to submit a request for waiver of the filing deadline. (5/08/2020). Bulletin No. FS-40 (supersedes Bulletin No. FS-38). For Domestic companies, all hard copy filings delayed because of COVID-19 will be due not later than 2 weeks after essential company personnel have returned to work. (06/26/2020)

Bulletin No. FS-39. For Foreign companies, the Department is willing to extend financial reporting deadlines for certain required hard copy filings by up to 90 days by request and subject to Department approval. If your foreign company believes that it will not be able to meet any of the filing deadlines listed in this bulletin, please contact the Department at [email protected] to submit a request for waiver of the filing deadline. (5/08/2020). Bulletin No. FS-41 (supersedes Bulletin No. FS-41). For Foreign companies, all hard copy filings delayed because of COVID-19 will be due not later than 2 weeks after essential company personnel have returned to work. (06/26/2020)

Bulletin No. HC-81-20A. The Department is removing a recently established requirement for rate filing submissions which obligated health insurers to include a demonstration of compliance with non-quantitative treatment limitations (NQTLs). This demonstration of compliance requirement has been removed due to the pandemic. (05/15/2020)

• Other – Special Enrollment Period: DOI has extended the enrollment period for uninsured individuals to April 17 per Department COVID-19 webpage.
• Other – Out of Network Coverage: Executive Order 7U provides financial protection for individuals receiving out of network treatment for COVID-19 and limits provider liability.
• Other – Life Insurance Applications: Notice 04-20-2020. Any life application form filed for review should not include medical questions related to COVID-19. (4/24/2020)

Delaware

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Most department employees are working remotely but are still operational and answering emails and phone calls. Department contact information is included in Bulletin 117.
• Policy Cancellations, Non-renewals, and Grace Periods: No. 116. No insurer, without a court order, may lapse or terminate an insurance policy.

  Bulletin No. 117 (reissued 07-02-2020). As of July 01, 2020, the policy cancellation moratorium announced in Bulletin No. 116 is lifted. Insurers shall provide policyholders who were excused from paying premiums between March 25, 2020 and July 01, 2020 a 90-day repayment period. Insurers must give notice to policyholders concerning the availability of the repayment plans. (07/17/2020)

• Cost Sharing Waivers for COVID-19 Coverage: Bulletin No. 115. The Department encourages carriers to waive cost sharing for COVID-19 diagnostic testing.
• Telehealth: Bulletin No. 116. See also Bulletin No. 115. Health insurance companies must provide coverage for telemedicine services that would otherwise be covered under the plan (all services, not just those related to COVID-19). The location of the insured or provider should not be relevant.

  Bulletin No. 120. Outlines new rules relating to telehealth (codified in 18 DE Admin. Code 1409). (09/04/2020)

• Network Adequacy: Bulletin No. 115. Carriers must ensure that their provider networks are able to handle a potential increase in demand for health care services.
• Utilization Review and Preauthorization: Bulletin No. 116. See also Bulletin No. 115. There shall be no pre-authorization requirements for lab testing and/or treatment of suspected COVID-19.
• Access to Prescription Drugs: Bulletin No. 115. An expedited formulary exception may be requested if the insured is suffering from a health condition that may seriously jeopardize the insured’s health or life. The Department expects insurers to provide for early refills or replacements of lost or damaged medications.
• Regulatory Filings and Deadline Extensions: Bulletin 117. The Department is allowing electronic communication of information that was otherwise required to be provided via hard copies so long as the carrier maintains a log or record of the communications. Bulletin 117. The deadline to pay premium taxes is not extended and taxes must still be paid by 4/15/2020. The State’s licensing and examination division is still processing applications. The Department reiterates that it is not granting blanket extensions for any regulatory filings but companies that are not able to meet the filing or response deadlines should contact the state to discuss alternatives. Bulletin 118. Insurers may request an extension for certain annual and corporate filings.
• Other – Catastrophic Health Coverage Plan Enforcement: Bulletin No. 116. The state will not enforce the requirement that essential health benefits may not be provided under a catastrophic health plan until the deductible has been met in regard to the diagnosis or treatment for COVID-19.
• Other – Electronic Filings, Electronic Signatures, and Notarization: Bulletin 117. Insurers are encouraged to utilize electronic signatures. For documents that ordinarily require a “wet” signature and notarization, those documents may be provided without notarizations during the COVID-19 emergency but must be provided with notarization within 60 days after the end of the emergency.

Florida

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Insurers are encouraged to use email to arrange teleconferences with OIR staff as many staff members are working remotely.
• Policy Cancellations, Non-renewals, and Grace Periods: Informational Memo OIR-20-04M. Insurers are encouraged to be flexible with premium payments in order to avoid lapses in coverage. Insurers should only consider termination because of non-payment of premium if all possible efforts to continue coverage have been exhausted.
• Cost Sharing Waivers for COVID-19 Coverage: Informational Memo OIR-20-01M. Insurers must consider all practicable options to reduce the barriers of cost-sharing for testing and treatment of COVID-19.
• Telehealth: Informational Memo OIR-20-06M. Department recommends insurers make telehealth options more accessible to insureds.
• Access to Prescription Drugs: Informational Memo OIR-20-02M. In accordance with Florida law, health insurers are allowed to provide early prescription refills in the event the Governor issues a state of emergency.
• Regulatory Filings and Deadline Extensions: Informational Memo OIR-20-04M. Certain regulated entities are granted a 30-day extension for annual statements due to be filed with OIR by May 1, 2020.

  According to the Department's COVID-19 Website, the Quarterly Comprehensive Health Reporting (QCH) filing deadline for the first quarter of 2020 has been extended from May 15 to June 15, 2020. (5/15/2020)

   

• Other – Increased Communication and Customer Service: Carriers are encouraged to devote all available resources to inform consumers of available coverage, respond to inquiries, and avoid misinformation, among other things. Informational Memo OIR-20-01M.
• Other – Relaxation of Handwritten and Hardcopy Requirements: Informational Memo OIR-20-04M. Insurers are encouraged to accept electronic communications in lieu of handwritten statements. The OIR will also accept electronic signatures and electronic notarizations that comply with state law.
• Other - PBM Audits: Informational Memo OIR-20-06M. Insurers and PBM are encouraged to move to electronic audit process or extend audit deadlines during the emergency.

Georgia

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Directive 20-EX-5. The department recognizes that companies may find themselves repricing and re-filing products. The Commissioner will be offering immediate and expedited review for products that are critical due to the COVID-19 outbreak of its effects.
• Policy Cancellations, Non-renewals, and Grace Periods: Directive 20-EX-5. Health insurers are instructed to refrain from cancelling health policies for non-payment of premium for the next 60 days (directive was issued on March 20, 2020). Bulletin 20-EX-7 updates the expiration date for the Directive 20-EX-5 nonpayment cancellation prohibitions to May 31, 2020 as part of a winding down of COVID-19 related emergency measures. (5/01/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Directive 20-EX-3. All carriers are asked to waive cost sharing related to COVID-19 testing.

  Directive 20-EX-4. Insurers are also requested to reimburse labs which are testing for COVID-19 at an in-network rate.

 

• Telehealth: Directive 20-EX-3. Carriers should ensure that their telemedicine services are able to meet increased demand and are reminded to comply with state law regarding payment for telemedicine.
• Network Adequacy: Directive 20-EX-3. Insurers should verify their provider networks are adequate to handle any potential increase in the need for healthcare services.
• Utilization Review and Preauthorization: Insurers should be prepared to expedite utilization review for services related to COVID-19. Directive 20-EX-3. Directive 20-EX-7. Insurers are advised to suspend preauthorization requirements for scheduled surgeries or admissions at hospitals for 60 days from the issuance of Directive 20-EX-7 (issued on March 26, 2020). Bulletin 20-EX-7 updates the expiration date for the Directive 20-EX-7 preauthorization requirement suspensions to May 25, 2020 as part of a winding down of COVID-19 related emergency measures. (5/01/2020)
• Access to Prescription Drugs: Directive 20-EX-3. Insurers are requested to make expedited formulary exceptions if an insured is suffering from a health condition that may seriously jeopardize the insured’s health or life. Also see Directive 20-EX-7 (set to expire on May 25, 2020 per Bulletin 20-EX-7 as part of a winding down of COVID-19 related emergency measures).

  News Release 08/05/2020. Describes a newly enacted bill which allows for early prescription refills during a state of emergency. (09/04/2020)

• Regulatory Filings and Deadline Extensions: Directive 20-EX-5. All non-federal filing deadlines are temporarily suspended, and all applicable late filing fees are waived. This does not apply to product filings. Bulletin 20-EX-7 updates the expiration date for the Directive 20-EX-5 non-federal filing deadline suspensions to May 31, 2020 as part of a winding down of COVID-19 related emergency measures. (5/01/2020)

Hawaii

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: The Department offices are closed, and reviewers are working remotely.
• Policy Cancellations, Non-renewals, and Grace Periods: Memorandum 2020-31 and Memorandum 2020-4A. The state is encouraging insurers to work with their insureds to ensure coverage continues by refraining from cancelling policies due to non-payment of premium and extending grace periods for premium payments. They also ask insurers to waive late fees and penalties and develop structured payment plans. All of these activities should extend for at least 60 days after the health emergency passes.

  Memorandum 2020-9A extends Memorandum 2020-4A throughout the duration of the pandemic. (09/04/2020)

• Telehealth: Insurers are required to cover telehealth, as noted in Department FAQ.
• Other – Rate or Contractual Language Deviations: Memorandum 2020-4A. The Division may allow insurers to deviate from filed rates or contractual language as long as newly proposed rates are lower than the approved rates on file, any deviations are applied uniformly, and as long as the insurer has notified the Division in writing of its specific rate or contractual language deviation proposal. (5/01/2020)

  Memorandum 2020-9A extends Memorandum 2020-4A throughout the duration of the pandemic. (09/04/2020)

Idaho

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: The department is working remotely and can be contacted by phone or email.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin No. 20-01. Health insurers are required to allow flexibility regarding premium deferral, premium holidays, continuation of coverage, grace periods, and waiver of eligibility requirements.
• Cost Sharing Waivers for COVID-19 Coverage: The insurance carriers in Idaho voluntarily waived cost sharing for COVID-19 testing. The Department acknowledged this waiver in a News Release. Additionally, some short-term health insurance companies have also voluntarily waived cost sharing for COVID-19 testing and treatment, according to a subsequent Department News Release.

  Bulletin No. 20-13. The Department recommends that carriers forgo any cost-sharing (copayments, deductibles, or coinsurance) for covered COVID-19 virus diagnostic testing and related services, including influenza testing or other respiratory testing when done in conjunction with COVID-19 virus testing, at in-network doctors’ offices, urgent care centers, or emergency rooms; and at out-of-network doctors’ offices, urgent care centers, or emergency rooms when access to urgent testing or treatment is unavailable from in-network providers. Additionally, The Department expects carriers to cover molecular, antigen, and antibody COVID-19 tests that are FDA-approved and deemed medically appropriate by the insured’s health care provider. (07/17/2020)

• Telehealth: Bulletin No. 20-03. Insurers are authorized to provide coverage for telehealth access to all in-network providers and allow in network providers to use non-HIPAA compliant telehealth platforms if necessary.
• Network Adequacy: Bulletin No. 20-13. The Department recommends that carriers ease out-of-network requirements and procedures when access to urgent testing or treatment is unavailable from in-network providers. (07/17/2020)
• Utilization Review and Preauthorization: Bulletin No. 20-13. The Department recommends that carriers relax prior approval requirements and procedures for medically necessary testing or treatment. (07/17/2020)
• Access to Prescription Drugs: Bulletin No. 20-02. Insurers are authorized to waive policy limitations on early refills and number of refills, restrictions that would disallow 90-day supplies, and requirements for in-person signature logs.
• Regulatory Filings and Deadline Extensions: Bulletin 20-06. Upon request, the Department may allow insurers 30-60 day filing extensions for various annual and quarterly financial reports, subject to Department approval. If your company believes Extension requests should be submitted to Nathan Faragher and Weston Trexler at [email protected] and [email protected]. Additionally, hardcopy and notarization filing requirements are temporarily waived, with electronic submissions being an acceptable substitute. However, insurers must eventually file all temporarily waived hardcopy and notarized filings within 60 days after the state has approved employees to return to work. (4/24/2020)
• Other – Deviation from Contractual Language: Bulletin No. 20-01. Carriers are allowed to deviate from contractual language so long as: 1) the carrier justifies such proposals as increasing access to health insurance coverage during the emergency; 2) such actions are applied uniformly; and 3) the carrier has notified the Director in writing of their specific changes and justifications. The Department requests that carriers submit their intentions, changes, and justifications to Weston Trexler at [email protected].

Illinois

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Bulletin 2020-06. The DOI is temporarily closed but staff continues to work on a limited scale. The Department requests that all documents, filings, and information be submitted electronically to the greatest extent possible.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 2020-2. Insurers may not cancel or non-renew coverage based on an enrollee’s receipt of, or attempt to obtain, treatment or testing for COVID-19.

   

  Bulletin 2020-11. New Department rules establish a 30-60 day premium payment deadline extension in certain circumstances during COVID-19. (4/24/2020)

   

• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 2020-2. Insurers are encouraged to consider all feasible options to reduce the barriers of cost sharing for testing and treatment of COVID-19.
• Telehealth: Bulletin 2020-04. To the extent that a covered service or treatment may be delivered in a clinically appropriate manner via telehealth, health insurers must cover it when medically necessary. This requirement also applies to insurers providing indemnity benefits and excepted benefits, but only to the extent consistent with the coverage they provide.
• Access to Prescription Drugs: Bulletin 2020-2. Insurers are encouraged to cover enrollees for early refills so long as the prescription would remain valid beyond the refill date. Insurers are also urged to allow the temporary use of out of network pharmacies.

   

  Bulletin 2020-11. New Department rules require coverage of off-formulary prescriptions if there is a shortage of a covered formulary drug, and require coverage of a 90-day supply of covered maintenance medications. (4/24/2020)

   

• Regulatory Filings and Deadline Extensions: Bulletin 2020-13 details upcoming filing deadlines for individual and small group health plans offered on and off the marketplace (on exchange/off exchange). For qualified health plans (QHPs), the Department will allow carriers to modify their individual and small group rate filings through July 29, 2020 to reflect updated assumptions for both COVID-19 and risk adjustment. (5/22/2020)
• Other – Electronic Communication and Internal Procedures: Bulletin 2020-06. The Department requests that carriers adjust their internal procedures to allow customers to transact business electronically.
• Other – SERFF Filings: Bulletin 2020-07. All Preferred Provider Administrators, Independent Review Organizations, Utilization Review Organizations, and Discount Health Care Service Plans must file their applications, renewals and updates through the State Electronic Rate and Form Filing (SERFF) system.
• Other – Proof of Death: Bulletin 2020-08 asks preneed life insurers to accept temporary death certificates as proof of death and call the county coroner or medical examiner to confirm death was not homicide or suicide.
• Other – Employer Retainment of Group Health Coverage Despite Reduced Employee Hours or Layoffs: Bulletin 2020-11. New Department rules prohibit group HMO insurers from interfering with an employer who wants to keep their employees on existing health coverage despite reduced hours or layoffs. (4/24/2020)
• Other – Employee COBRA Election When Employment-Based Coverage is Terminated: Bulletin 2020-11. New Department rules restrict the ability of group HMO insurers to prevent an employee whose employment-based coverage is terminated from electing COBRA or state continuation coverage. (4/24/2020)
• Other – Premium Credits for Health insurance Coverage: Bulletin 2020-17. The Department notifies health insurers that no state enforcement actions will be taken against insurers for availing themselves of CMS’ relaxed enforcement to provide financial relief to their small group and individual enrollees in the 2020 plan year, provided that it is done in the manner set forth in the CMS guidance (see CMS guidance document entitled “Temporary Policy on 2020 Premium Credits Associated with the COVID-19 Public Health Emergency”). The Department, however, requires any health insurer wishing to offer such financial relief to its enrollees in these markets to file a request with the Department for informational purposes within SERFF. (10/16/2020)

Indiana

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Department staff members are working remotely per Department website. Email communication is preferred.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 252. The DOI requests that all insurance companies institute a moratorium on policy cancelations and non-renewals to allow a 60-day grace period for premiums due between March 19, 2020 and May 18, 2020. Bulletin 254 extends the policy cancellation/nonrenewal moratorium announced in Bulletin 252 to May 31, 2020. (05/15/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 252 and Bulletin 253. Insurers must cover and waive cost sharing for COVID-19 testing and treatment.
• Telehealth: Bulletin 252 and Bulletin 253. DOI encourages the use of telemedicine in all reasonable instances in connection with testing, screening, and treatment of COVID-19. Insurers are also encouraged to extend the waiver of cost sharing to COVID-19 telemedicine care.
• Access to Prescription Drugs: Bulletin 253. The Department encourages insurers to cover enrollees for prescription drug refills even when the enrollee has not yet reached their scheduled refill date, and encourages insurers to consider allowing enrollees the temporary use of out-of-network pharmacies at the in-network benefit level of coverage in the event of a shortage. (4/24/2020)
• Utilization Review and Preauthorization: Bulletin 252. Insurers must waive pre-authorization requirements for COVID-19 testing and treatment.
• Regulatory Filings and Deadline Extensions: Bulletin 252. The DOI modified its own internal rules and will provide a 60-day grace period for renewals and cancellations of licensees, certificate holders, and registrants. The 60-day grace period also applies to premium tax filings. No late fees will be assessed.
• Other – Temporary Healthcare Facility Provider Agreements: Bulletin 253. The Department requests that any temporary healthcare facility established for services or treatment related to COVID-19 will be subject to the same provider agreement as the primary hospital has with regards to policy benefits. (4/24/2020)

Iowa

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Many of the DOI staff are working remotely but the consumer protection, financial regulations, product review, and licensing operations remain functional. Bulletin 20-03.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 20-04. Applicable to individual and small employer group health coverage ONLY. DOI requests that health insurers put procedures in place to allow individual and small employer policyholders the ability to request extensions for payment of premium due to COVID-19 hardships. Insurers must provide the same policyholders with 60-day grace periods for premiums falling due between March 17, 2020 and June 30, 2020.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 20-10. Serologic or antigen testing not deemed “medically necessary,” such as serologic or antigen testing of employees required by an employer to maintain a safe workplace, is typically not a covered service by Iowa health care plans. (06/26/2020)
• Telehealth: Bulletin 20-06. Carriers should promote the use of telehealth services for COVID-19 and other medical care. Reimbursement rates for all telehealth services should be the same as in-person. Carriers should work with health care providers to increase access to telehealth services. Telehealth services should be expanded to eliminate restrictions on audio-only treatment and should be extended to explicitly allow the use of telephones, audio/video, secure test messaging, email, or use of patient portals.

Kansas

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Bulletin 2020-1.The Department has implemented alternative working arrangements for its employees that may result in a delay in processing times for matters requiring Department approval. The Department is waiving all “deemed approved” clauses during the period of the emergency proclamation. Bulletin 2020-2. The department building will continue to remain closed until April 26, 2020.
• Policy Cancellations, Non-renewals, and Grace Periods: COVID-19 FAQ. The Insurance Department is taking the position that it lacks authority to require a moratorium on cancellations and non-renewals of policies for non-payment of premium. Insureds are encouraged to work with insurers.
• Cost Sharing Waivers for COVID-19 Coverage: See News Release 3/13/2020 and COVID-19 FAQ. All major medical carriers in Kansas have committed to waiving the cost sharing for COVID-19 testing. This was not based on a directive from the state but a voluntary waiver.
• Telehealth: COVID-19 FAQ. The Insurance Department is taking the position that it lacks authority to require telemedicine service expansion/coverage, Insureds are encouraged to work with insurers.
• Access to Prescription Drugs: COVID-19 FAQ. The Insurance Department is taking the position that it lacks the authority to mandate prescription refill requirements for insurers, Insureds are encouraged to work with insurers.

Kentucky

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: State Guidance April 3, 2020. The DOI is accepting electronic version of health benefit plan rate filing documents in lieu of paper versions as is typically required by law. Written versions must be provided within 30 days of the end of the state of emergency.
• Policy Cancellations, Non-renewals, and Grace Periods: Department Guidance 04-24-2020. The Department will not consider relief measures such as grace period extensions, late penalty waivers, and premium refunds to be unfair trade practices. (5/15/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Executive Order 2020-220. All insurers must waive cost sharing for screening and testing for COVID-19. Insurers shall notify contracted providers of this waiver and should ensure that their websites contain complete and accurate information related to coverage for COVID-19 screening, testing, and treatment.
• Telehealth: Guidance Document 03-18-2020. Insurers must not require that insureds have a prior relationship with the provider before covering telehealth services. The DOI will not enforce a provision of Kentucky law that requires telehealth to be provided over secure communications and will allow the use of public telecommunication services.
• Network Adequacy: Executive Order 2020-220. Insurers should ensure that provider networks are adequate to handle the increase in need for health care services and offer out-of-network service where appropriate.
• Utilization Review and Preauthorization: Executive Order 2020-220. All insurers must waive any preauthorization requirements for screening and diagnostic testing for COVID-19. Insurers must notify insureds of this waiver including information on the insurer’s website.

  Department Guidance 04-30-2020. In order to assist hospitals and healthcare facilities with focusing resources on the pandemic, insurers are required to waive preauthorization for various inpatient services and patient facility transfers. (5/15/2020)

   

• Access to Prescription Drugs: Executive Order 2020-220. Insurers shall allow insureds to obtain refills even if prescriptions were recently filled, extending the supply of the prescription.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-02. For regulatory reporting requirements (such as quarterly financial statements or audited financial statements), the state is extending reporting deadlines by 30-60 days upon written request by companies. Department Guidance. Insurers submitting health benefit plan rate filings are normally required to submit a written copy of filing documents to the Kentucky Attorney General’s Office in addition to the Department’s office. For the duration of the state of emergency, insurers submitting health benefit plan rate filings may submit electronic materials to Attorney General’s Office instead of written copies. However, insurers must still file written copies with the Attorney General’s office within 30 days of the end of the state of emergency. (5/01/2020)
• Other – Suspension of Pharmacy Audits: Guidance from the department temporarily suspends all pharmacy audits. Updated Guidance from the Department extends the expiration date of pharmacy audit suspension requirements to June 15, 2020, and specifies that statutorily compliant audits of pharmacy records may resume on June 15, 2020. (06/05/2020)
• Other – Inpatient Services Audits: Department Guidance 04-30-2020. In order to assist hospitals and healthcare facilities with focusing resources on the pandemic, insurers are required to suspend all inpatient services audits. (05/15/2020)
• Other – Counting Employees to Determine Group Size During Pandemic: Department Guidance 06-10-2020.. Employer group size should be determined based on the average number of employees over the past year. Further, furloughed employees should be counted as employees, while employees who have been laid off should not be counted for the purpose of determining group size. Renewals of group health benefit plans should be considered in accordance with this guidance. (06/26/2020)

Louisiana

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Department staff members are working remotely pursuant to department website. No in person visitors are allowed.
• Policy Cancellations, Non-renewals, and Grace Periods: Emergency Rule 40. Insurers may issue a notice of cancellation for nonpayment of premium during the pendency of Emergency Rule 40, but in no event may the insurer cancel the insurance policy for non-payment of premium until after the expiration of Emergency Rule 40. Any such notice shall be reissued.
• Cost Sharing Waivers for COVID-19 Coverage: Emergency Rule 36. All health insurance carriers shall waive all cost-sharing for screening and testing for COVID-19, including hospital, emergency department, urgent care, provider office visits, lab testing, telehealth, telemedicine, and any immunizations that are made available. 

  Emergency Rule 37. All health insurance issuers shall evaluate differences in cost-sharing responsibilities for their insureds seeking in-network and non-network care and ensure that patients in areas in which in-network surge capacity is exceeded are not subject to unreasonable cost sharing requirements due to access limitations.

• Telehealth: Emergency Rule 37. Health insurance issuers shall waive any limitation on the use of audio-only telephonic consultations in the provision of telemedicine services. Health insurance issuers shall waive any coverage limitations restricting telemedicine access to providers included within a plan’s telemedicine network.
• Network Adequacy: Emergency Rule 36. All health insurers shall verify that their provider networks are adequate to handle cases of COVID-19 and offer access to out-of-network services where appropriate.
• Utilization Review and Preauthorization: Emergency Rule 36. All health insurers shall waive prior authorization requirements or restrictions for screening and diagnostic testing for COVID-19 and respond to requests for treatment on a timely basis.
• Access to Prescription Drugs: Emergency Rule 36. All health insurers shall allow insureds to obtain refills even if even if the prescription was recently filled, consistent with healthcare providers and/or pharmacists. Health insurers shall waive any and all restrictions relative to out-of-network access to pharmacy services or prescriptions.
• Other –  Medical Surge-Related Patient Transfers: Emergency Rule 41. Insurers must provide coverage for post-transfer care to health care facilities not traditionally used in the delivery of general acute care.

Maine

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: The department requests that all parties use online, email, or telephone communications to contact the department.
• Policy Cancellations, Non-Renewals, and Grace Periods: ME BOI Bulletin 442. Carriers must make all reasonable accommodations for late payments and other problems that are beyond the consumer’s control.
  

  ME BOI Emergency Response Order 03-27-2020. Carriers are required, when requested by an employer, to suspend the application of any group health plan contract provision that terminates coverage when an eligible employee is no longer actively employed by the group policyholder, provided that the employer’s offer of continued coverage is made to all affected employees on a nondiscriminatory basis.

• Cost Sharing Waivers for COVID-19 Coverage: ME BOI Bulletin 442. Carriers must make COVID-19 testing available with no cost sharing, included all associated costs such as processing fees and clinical evaluations.

   

  Bulletin 450 and Bulletin 451. SARS-CoV-2 molecular testing services performed under the authorization of the State Epidemiologist’s Standing Order on June 8, 2020 for persons described within Categories A (known exposure) and B (elevated risk factors), are considered “medically necessary” within the meaning of the Health Plan Improvement Act, and as such, are eligible for coverage with no deductibles or cost sharing under ME BOI Bulletin 442. (06/26/2020)

   

  Bulletin 453. A new Standing Order has been issued by the State Epidemiologist which eliminates defined risk criteria and expands COVID-19 testing eligibility to all individuals 12 months of age or older. As a result, Bulletin 453 has now superseded Bulletins 450 and 451. Carriers are reminded that their obligations to provide COVID-19 testing with no cost sharing have not changed. (10/16/2020)

• Telehealth: ME BOI Bulletin 442. Health carriers are reminded that 24-A M.R.S. § 4316 requires parity between coverage of telehealth and in-person services. Health carriers are directed to ensure that their telehealth programs are robust and will be able to meet any increased demand.
  

  Emergency Response Order 03-20-2020. Coverage of telehealth is expanded to include “audio-only telephone,” which had previously been excluded in Maine statutory definition of telehealth.

• Network Adequacy: ME BOI Bulletin 442. Health carriers need to be prepared for the likelihood that their networks could be overloaded from time to time. If this happens, they are required by Bureau of Insurance Rule 850, § 7(B)(5), to ensure that the covered person’s cost to obtain the covered benefit is no higher than if the benefit were obtained from participating providers, or to make other arrangements acceptable to the Superintendent.
• Utilization Review and Preauthorization: ME BOI Bulletin 442. No prior authorization requirements. Insurers are also required to expedite utilization review for both COVID-19 treatment as well as treatments or services for other conditions.
• Access to Prescription Drugs: ME BOI Bulletin 442. In the event of formulary drug shortages, insurers must allow non-formulary substitutes at no greater cost to insureds. Carriers shall also allow enrollees to obtain one-time refills of their prescription medications before the scheduled refill date. 
• Regulatory Filings and Deadline Extensions: ME BOI Bulletin 446. The Department has extended the deadline for 2021 Qualified Health Plan (QHP) uniform rate and form filings from June 01, 2020 to June 16, 2020. ME BOI Bulletin 447. The Department will grant 30-60 day deadline extensions for certain quarterly and annual financial filings by request and subject to Department approval. Additionally, hard copy and notarization filing requirements are temporarily waived, with electronic submissions serving as an acceptable substitute. However, insurers will be required to file all temporarily waived hard copy and notarized filings within 60 days after the state of emergency has been lifted. (5/01/2020)
• Other – Communication. ME BOI Bulletin 442. Carriers must provide clear and prominent notice that they are waiving cost-sharing for medically necessary screening and testing for COVID-19, guidance on how enrollees can access such care, and notice that they are permitting early prescription refills.
• Other – Premium payment deadline deferrals. ME BOI Emergency Response Order 04-06-2020. Carriers issuing individual coverage on the Health Insurance Marketplace must postpone the commencement of the premium grace period until at least June 1, 2020, for all policyholders receiving APTC (advanced premium tax credits) who fail to pay premium when due.

  For all other individual and group policyholders - Until at least June 1, 2020, carriers must provide relief from premium cancellation to any individual policyholder not receiving APTC and to any small or large group policyholder, if the policyholder applies to the carrier for such relief and certifies that the policyholder’s inability to make timely premium payment was the result of hardship arising out of the COVID-19 pandemic.

• Other– Credentialing.ME BOI Emergency Response Order 03-19-2020. For the duration of this emergency, health carriers shall not refuse, because of lack of credentials, to pay claims submitted by providers credentialed within a health care organization but not at that health care organization’s location where the service was provided or at a location not in that health care organization.

Maryland

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Maryland Insurance Administration remains fully operational during COVID-19 emergency per Department notice. Contact information for key individuals is available on the COVID-19 webpage.
• Policy Cancellations, Non-renewals, and Grace Periods. Bulletin 20-10. All insurers are encouraged to make reasonable accommodations so that individuals and businesses do not lose coverage due to non-payment of premium during this emergency.

  Bulletin 20-30. Health carriers are required to suspend health benefit cancellations and nonrenewals of individual health policies for nonpayment of premium. (09/04/2020)

  Bulletin 20-39 outlines several conditions under which carriers can continue to cancel and nonrenew policies during the nonpayment cancellation moratorium. (10/16/2020)

• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 20-05 (Also see Bulletin 20-06, Emergency Action on Regulations Updating COMAR Sections 31.01.02 and 31.01.06, Emergency Action on Regulations Updating COMAR Sections 31.01.03 and 31.01.06, and Bulletin 20-36). Health carriers must waive cost-sharing for COVID-19 testing, lab fees and vaccination.
• Telehealth: Bulletin 20-05. Encourage the use of telehealth services by all members to reduce the likelihood of exposure to and transmission of COVID-19.
• Network Adequacy: Bulletin 20-05. Carriers should review their provider panels to ensure reasonable access to providers with the expertise to treat severe cases of COVID-19. Out of network coverage payable solely based on medical necessity or appropriateness.
• Utilization Review and Preauthorization: Bulletin 20-06, Emergency Action on Regulations Updating COMAR Sections 31.01.02 and 31.01.06, and Emergency Action on Regulations Updating COMAR Sections 31.01.03 and 31.01.06. Health carriers may only require prior authorization for COVID-19 testing based on medical necessity. Any adverse decision regarding COVID-19 diagnosis is required to be treated as an emergency and is subject to expedited review.
• Access to Prescription Drugs: Bulletin 20-05 (Also see Bulletin 20-06, Emergency Action on Regulations Updating COMAR Sections 31.01.02 and 31.01.06, and Emergency Action on Regulations Updating COMAR Sections 31.01.03 and 31.01.06). Carriers are required to waive any time restrictions on prescription drug refills for at least a 30-day supply of medication.
• Regulatory Filings and Deadline Extensions: Bulletin 20-27. The Department will consider the impact of COVID-19 on factors such as appointment waiting times, office closures, and reduced hours of operation when reviewing 2020 network access plan filings (filings due July 01, 2020). (06/26/2020)
• Other – Payment of Experimental Treatment: Bulletin 20-06, Emergency Action on Regulations Updating COMAR Sections 31.01.02 and 31.01.06, and Emergency Action on Regulations Updating COMAR Sections 31.01.03 and 31.01.06. The Maryland Insurance Commissioner may require health insurers to pay claims for experimental treatment of COVID-19.
• Other – Waiver of Statutory Accounting Principle for Past Due Premium Receivables: Bulletin 20-14. Maryland-domiciled insurers that provide premium grace periods to policyholders may request a permitted accounting practice to waive the Statutory Accounting Principle that requires an insurer to non-admit premium receivable assets over 90 days past due. The permitted accounting practice will be effective for the year 2020. The number of days past due that will be allowed as an admitted asset will be based on an insurer’s grace period. Please email requests for a permitted accounting practice to: [email protected]. (5/01/2020)
• Other – Suspension of Pharmacy Audits: Bulletin 20-22. Health insurers are required suspend random audits of pharmacies, including in-person audits, unless there is a reasonable suspicion of fraud. (5/01/2020)

Massachusetts

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues as usual.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 2020-05. All carriers should explore ways to relax premium due dates, extend grace periods, waive fees, provide payment plan options, and assist affected policyholders to find ways to avoid policy lapses.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 2020-02 and Bulletin 2020-13 (Also see Bulletin 2020-04 and Bulletin 2020-16). Forgo any cost-sharing for services related to COVID-19 when delivered by telehealth services. Health carriers must also forgo cost-sharing for medically necessary in-network outpatient care, medically necessary in-network or out-of-network emergency and inpatient treatment. Bulletins address reimbursement amounts for out-of-network providers.

  Bulletin 20202-23. Carriers are expected to cover PCR and antigen testing for COVID-19 under certain circumstances as outlined in the bulletin. (07/17/2020)

• Telehealth: Bulletin 2020-02 (Also see Bulletin 2020-04 and March 15 Emergency Order). Expand the use of telehealth services to treat all covered health services as they would be covered on an in-person basis. Specific requirements on technology used to provide telehealth services waived.
• Utilization Review and Preauthorization: Bulletin 2020-10 The Division expects all carriers to suspend any prior authorization requirements related to COVID-19 testing and treatment and suspend any unnecessary procedures or information requests which may delay providers from being able to provide necessary care, including patients being moved to a lower level of care facilities.

  Bulletin 2020-13. The Division expects carriers will provide coverage for medically necessary emergency department and inpatient services rendered by out-of-network acute care hospitals without prior authorization requirements. (5/08/2020)

  Bulletin 2020-15. The Division expects carriers to forego prior authorization for any scheduled surgeries and behavioral health or non-behavioral health admissions at acute care and mental health hospitals for a period of 60 days. This bulletin applies to all inpatient treatment, both COVID-19 and non-COVID-19. (5/08/2020)

  Bulletin 2020-16. Carriers may develop utilization review systems that apply to COVID-19 tests, provided that they are consistent with the provisions of MGL c. 176O. (5/22/2020)

   

• Access to Prescription Drugs: Bulletin 2020-06. Carriers are expected to waive in-person signature requirements at pharmacies or for mail order deliveries. Carriers are also expected to permit early refills of maintenance prescriptions.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-07 Carriers are expected to provide information to consumers via phone lines and on their websites regarding benefits, how to use telehealth services, advising consumers of potential scams, and provide to the Department updated carrier contact information. Bulletin 2020-11 provides an extension for certain annual and corporate filings. Bulletin 2020-24 provides additional extensions for various corporate filings. (09/04/2020)
• Other – Special Enrollment Period: Bulletin 2020-09 provides a special enrollment period for individual health plans. The period runs from March 30 to May 25. Bulletin 2020-18 extends the special enrollment period through June 23, 2020. (5/29/2020)
• Other – Relaxing Certain Health Plan Administrative Procedures: Bulletin 2020-15, Bulletin 20-21, and Bulletin 20-28. Bulletins outline several measures that the Division expects health insurers to take with respect to helping hospitals and providers during the pandemic, including continuing to assist hospitals with discharge planning, delaying hospital payment audits, and providing hospitals with additional time to respond to insurer requests for claims review information. (5/08/2020) and (10/16/2020)
• Other – Flexibility with Provision of Early Intervention Services: Bulletin 2020-19. As a result of school closures resulting from the pandemic, the Department expects health carriers to extend coverage for Early Intervention services provided between June 01, 2020 and October 15, 2020 to those children who turn three between March 15, 2020 and August 31, 2020 and who meet various criteria outlined in the bulletin. (06/26/2020)

Michigan

DOI COVID-19 webpage

Department Guidance

• Policy Cancellations, Non-renewals, and Grace periods: Bulletin 2020-16-INS. Insurers are encouraged to provide their insureds with at least a 60-day grace period to pay insurance premiums so that insurance policies are not cancelled for nonpayment of premium. Insurers may effectuate this directive by offering payment accommodations, such as allowing consumers to defer payments (without incurring interest), extending payment due dates, and/or waiving late or reinstatement fees. Insurers are also encouraged to allow payment plans for back-due premium after the 60-day grace period instead of a balloon-type premium bill. (4/20/2020)
• Department Resources and Functions: Employees working remotely. Business continues.
• Telehealth: Press Release The Governor expanded access to telemedicine by immediately allowing Medicaid beneficiaries to receive services in their home. Some insurance companies are waiving cost-sharing for COVID-19 testing.
• Access to Prescription Drugs: Executive Order 2020-25 Pharmacists may dispense emergency refills of up to a 60-day supply of any non-controlled maintenance medication if, in the pharmacist’s professional judgment, failure to refill the prescription might interrupt the patient’s ongoing care and have a significant adverse effect on the patient’s well-being. Specific requirements apply.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-17-INS provides an extension for certain annual and corporate filings. Bulletin 2020-16-INS requires insurers to submit any plan implementing flexibility measures (such as extended grace periods, premium payment deferrals, or prolonged claim filing deadlines) no later than 7 days after plan implementation to [email protected].
• Other – Claim Processing: Bulletin 2020-12-INS All claims must continue to be processed and paid in a timely manner. Bulletin 2020-16-INS. The Department asks insurers to make adjustments to claim filing deadlines as insureds may encounter difficulties making timely claims. (4/20/2020)
• Other – Individual and Small Group Market Plan Year 2021 Rate Filings: Bulletin 2020-24-INS. Michigan, as an Effective Rate Review state, will allow issuers to decide whether to include emerging experience related to COVID-19 in their rate development. Issuers that decide to include COVID-19 experience must provide an exhibit which specifically details whether rates include COVID-19 experience, and which describes the rating methodology. The exhibit must describe the rating and trending impact by Essential Health Benefit category and must include actuarial support. (5/08/2020)
• Other – Health and Dental Insurer COVID-19 Premium Refunds/Credits Filing Requirements: Bulletin 2020-26-INS. Health or dental insurers that plan to issue premium refunds or credits to their customers as a result of the COVID-19 pandemic must submit a filing to DIFS. Such filings must include a filing memorandum, actuarial support, and any policyholder notices. (05/29/2020)
• Other – In re Certified Questions (Midwest Inst of Health v Governor) Impact on DIHS COVID-19 Bulletins: Bulletin 2020-38. At this time, all pandemic related bulletins issued by the Department remain in effect pending the Michigan Supreme Court’s ruling on In re Certified Questions. (10/16/2020)

Minnesota

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Cost Sharing Waivers for COVID-19 Coverage: Memorandum. The Department requests that health carriers eliminate all cost-sharing for COVID-19 testing.
• Telehealth: Memorandum. Health carriers should take any necessary steps to expand the availability of telemedicine services for their enrollees and eliminate any barriers to its use.
• Network Adequacy: Memorandum. Health plans are asked to continue to consistently verify that their provider networks are up to date and are adequate to handle an increase in utilization.
• Utilization Review and Preauthorization: Memorandum. Health plans should also take steps to ease any other requirements, such as prior authorization or pre-certification requirements, for treatment of COVID-19.
• Access to Prescription Drugs: Memorandum. The Departments request that health carriers provide a one-time refill of covered prescription medications prior to the expiration of the waiting period between refills.
• Regulatory Filings and Deadline Extensions: Department issued a letter stating that filings can be submitted electronically via the NAIC or email to the Department and followed by hard copies at a later date. In addition, Regulatory Guidance 20-16 extends deadlines for certain MCHA filings.

   

  Regulatory Guidance 20-28. The deadline for Pharmacy Benefit Managers to file the Annual Transparency Report that is due on or before June 1, 2020 has been extended to October 1, 2020 as a result of the pandemic. (05/29/2020)

   

Mississippi

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 2020-3. Department issued a 60-day moratorium on the cancellation/non-renewal of policies for the non-payment of premiums, effective March 24^th. Also see Bulletin 2020-3 Questions and Answers and Clarification of Bulletin 2020-3. According to the Department website, the Department has made the decision to not extend the 60-day policy cancellation/nonrenewal moratorium announced in Bulletin 2020-3 and Clarification of Bulletin 2020-3. (5/15/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Department landing page. Cost sharing will be waived for consumers with fully-insured individual and group health plans.
• Telehealth: Bulletin 2020-1. Insurance companies have been directed to adopt procedures that will encourage policyholders to use telemedicine. Directive suspends certain limitations applicable to telemedicine services, including audio-only communications. Bulletin 2020-9 extends the provisions of Bulletin 2020-1 through June 30, 2020. (5/01/2020). Bulletin 20-10 extends the provisions of Bulletin 2020-1 through September 30, 2020. (06/26/2020)

  Bulletin 2020-13 extends the provisions of Bulletin 2020-1 through December 31, 2020. (10/16/2020)

• Access to Prescription Drugs: Department landing page. Consumers requesting an additional supply either due to their own concerns about being out in the public, or at the advice of their Physician, are being given priority approval review by the Health Insurer’s Clinical Team.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-7. Allows insurers a 30-day extension for various required financial reports but the extension must be requested and is subject to Department approval. Additionally, the 30-day extension is not an option for reports with an original due date beyond July 01, 2020. Hardcopy and notarization filings requirements are currently waived, but temporarily waived hardcopy and notarized filings must eventually filed within 60 days after the state permits employees to return to work. (4/24/2020)
• Other – Waiver of On-Site Review Requirements During Covid-19 Emergency: Bulletin 2020-12. The Department will not require insurers to conduct any onsite reviews of managing general agents or third-party administrators in 2020. For 2020 only, these reviews may be conducted through electronic information. (10/16/2020)

Missouri

DOI website (no dedicated COVID-19 page)

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 20-05. Health carriers are strongly encouraged to extend a grace period of at least 60 days for coverage in effect as of March 13, 2020, where premium or subscription charges are unpaid, in an effort to allow consumers to take actions necessary to keep their policies in force. Bulletin 20-10 extends the expiration date of Bulletin 20-05 to June 15, 2020. (5/08/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 20-03. The Department asks health carriers to waive any cost-sharing for COVID-19 testing.
• Telehealth: Bulletin 20-03. Health carriers are reminded to review state law regarding the delivery of health care services via telehealth. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.

  Bulletin 20-07. The DOI waives telehealth provider licensing requirements and encourages carriers to expand coverage for telehealth services. Bulletin 20-15 extends the provisions of Bulletin 20-07 through June 15, 2020. (5/15/2020)

• Network Adequacy: Bulletin 20-03. Health carriers are asked to verify their provider networks are adequate to handle a potential increase in the need for health care services in the event COVID-19 cases are diagnosed in Missouri.
• Utilization Review and Preauthorization: Bulletin 20-03. Health carriers should not use preauthorization requirements as a barrier to access necessary treatment for COVID-19, and health carriers should be prepared to expedite utilization review and appeal processes for services related to COVID-19.
• Access to Prescription Drugs: Bulletin 20-03. Health carriers are asked, where appropriate, to make expedited formulary exceptions if the insured is suffering from a health condition that may seriously jeopardize the insured’s health.
• Regulatory Filings and Deadline Extensions: Bulletin 20-06. The DOI is allowing electronic submission of certain annual filings. Bulletin 20-14 extends the provisions of Bulletin 20-06 through June 15, 2020. (5/15/2020)
• Other ‐ Premium Relief Programs: Bulletin 20-17. Health carriers that have already instituted a premium relief program as a result of the pandemic or those seeking to offer premium relief programs in the future are required to provide several categories of information about their plans to the Department at [email protected]. (06/26/2020)

Montana

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees are working remotely. Business continues. Department’s physical location is closed to the public until further notice.
• Policy Cancellations, Non-renewals, and Grace Periods: Letter to Industry. The Commissioner recommends insurance companies delay premium payments through grace periods, suspend premium billing for small businesses, and waive insurance premium late fees.
• Cost Sharing Waivers for COVID-19 Coverage: Press Release. Some major health insurance companies are voluntarily waiving cost sharing for COVID-19 testing.
• Telehealth: Press Release. Some major health insurance companies have voluntarily expanded telehealth services.

Nebraska

DOI COVID-19 webpage

Department Guidance

• Policy Cancellations, Non-renewals, and Grace Periods: Notice allowing flexibility in policy administration so long as it is done on a non-discriminatory basis.
• Telehealth: Notice – March 23^rd. Health care providers are not required to obtain a patient’s signature on a written agreement prior to providing telehealth services and insurance claims for telehealth will not be denied solely on the basis of lack of a signed written statement.
• Regulatory Filings and Deadline Extensions: Notice April 8^th.The NDOI is willing to consider companies’ written request for late filing and reserves the right to reject any such individual company requests based upon the financial condition of that company and unique circumstances deemed applicable to that company.

Nevada

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: The Division's offices in Carson City and Las Vegas are closed to walk-in traffic, however the Division is still serving consumers. Consumers, licensees, and the general public are encouraged to contact the Division for essential services via online, telephone and by email.
• Policy Cancellations, Non-renewals, and Grace Periods: Statement Regarding Health Due to COVID-19, March 30, 2020. Insurers are encouraged to provide an additional 60-day grace period before cancellation, provide flexibility with due dates for premiums , waive late fees and penalties, establish payment plans for premiums to avoid lapse, continue coverage regardless of any “actively at work” requirements, only cancel or non-renew if all other efforts are exhausted, and encourage the use of electronic payments.
• Cost Sharing Waivers for COVID-19 Coverage: Emergency Regulation 03-05-2020. Insurers shall not impose cost sharing for COVID-19 testing or immunizations, when a vaccine is available.
• Telehealth: Statement Regarding Health Due to COVID-19, March 30, 2020. Insurers are encouraged to proactively communicate with consumers regarding available services and support expanded telehealth opportunities.
• Utilization Review and Preauthorization: Statement Regarding Health Due to COVID-19, March 30, 2020 Insurers are encouraged to eliminate or simplify preauthorization standards.
• Access to Prescription Drugs: Statement Regarding Health Due to COVID-19, March 30, 2020. Insurers are encouraged to consider early or extra refills for chronic health conditions, take necessary steps to prevent disruption in drug access, and provide allowances for out-of-network pharmacy refills at network prices if in-network prescription supply chain is disrupted. Emergency Regulation 03-05-2020 provides that insurers should also provide coverage for off-formulary prescription drugs if there is not a formulary drug available to treat the insured.
• Regulatory Deadlines and Filing Extensions: Bulletin 20-002. The Department will potentially grant insurers 30-60 day extensions for certain regulatory filing deadlines upon request and subject to Department approval during the pandemic. To request an extension, the insurance company: (1) must submit a request for late filing at least 10 business days prior to when the filing is due, and (2) must submit the request electronically to [email protected] (for traditional insurers and RRGs) or [email protected] (for captives). Additionally, electronic notarization is encouraged in lieu of hard copy notarization. If an insurance company is unable to obtain notarization at this time, the insurance company must timely file the documents with DOI, then provide notarized, signed copies to DOI within 60 days of the date on which the documents were filed. (06/05/2020)
• Other – Consumer Information: Emergency Regulation 03-05-2020. Health insurers must provide insureds with guidance regarding COVID-19 related coverage.
• Other – COVID-19 Resources: Nevada has created this website, to better share information and resources as it pertains to the current status of COVID-19.
• Other – Special enrollment period: In response to the Governor’s March 12, 2020 Emergency Declaration, Nevada announced a limited-time Exceptional Circumstances Special Enrollment Period for eligible individuals to enroll in a qualified health plan, which will run through May 15, 2020.

New Hampshire

DOI COVID-19 webpage

Department Guidance

• Cost Sharing Waivers for COVID-19 Coverage: Health carriers must waive cost sharing for COVID-19 testing and telehealth services. Docket: INS No. 20-016-AP, Order
• Telehealth: All carriers shall cover medically necessary treatment via telehealth related to COVID-19 by in-network providers. Emergency Order # 8. Pursuant to RSA 415-J, health carriers may not deny coverage because it was provided through telemedicine. Health carriers are directed to ensure that their telehealth programs are robust and will be able to meet any increased demand. Docket: INS No. 20-016-AP, Order and Bulletin 20-024-AB.
• Network Adequacy: Health carriers are directed to verify that their provider networks are adequate to handle potential increases in COVID-19 cases. Additionally, per 04(d), if the network is inadequate and has not been granted an exception by the Department, the carrier must provide access to an out-of-network provider at the in-network cost-sharing. Docket: INS No. 20-016-AP, Order
• Utilization Review and Preauthorization: Health carriers shall take steps to minimize the extent to which prior authorization requirements might act as a barrier to accessing necessary treatment for COVID-19 and shall be prepared to expedite utilization review and appeal processes for services related to COVID-19 when medically appropriate. Docket: INS No. 20-016-AP
• Access to Prescription Drugs: Health carriers shall take steps to ensure early one-time refills and permit a 90-day supply for maintenance medications. Insurers may limit early refills for certain drug classes in consideration of patient safety. Docket: INS No. 20-016-AP
• Regulatory Filings and Deadline Extensions: Any member facing communications that health carriers develop regarding COVID-19 resources and information should be provided to the Department via email at [email protected]. Regulatory filings may be submitted electronically and followed by hardcopy at a later date according to Bulletin 20-022-AB and Bulletin 20-26-AB. Bulletin 20-26-AB also extends the filing deadlines for various domestic insurer and holding company financial reports. The Department may also allow an additional 30 days to submit filings beyond the deadline extensions announced in the bulletin, but the extension must be requested and is subject to Department approval. Insurers should email [email protected] with extension requests. (4/24/2020)

  Docket INS No. 20-059-AB. Due to COVID-19, the Department will allow domestic companies to submit the required second quarter financial filings (due August 15, 2020) via email to [email protected]. Foreign companies should continue to send the August 15th Second Quarter Statement filing through the NAIC portal. (07/17/2020)

  Docket 20-072-AB. Due to COVID-19, the Department will allow domestic companies to submit the required third quarter financial filings (due November 15, 2020) via email to [email protected]. Foreign companies should continue to send the November 15th Third Quarter Statement filing through the NAIC portal. (10/16/2020)

• Other – Third Party Administrator Onsite Audits: Docket 20-073-AB. Due to COVID-19, the Department will not enforce the requirement that an insurer perform an onsite audit of a third party administrator as required under New Hampshire law. During the state of emergency virtual audits shall be sufficient to comply with the onsite audit requirement. (10/16/2020)

New Jersey

DOI website (no dedicated COVID-19 page)

Department Guidance

• Department Resources and Functions: Employees are remotely working. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 20-04. Health carriers are encouraged to relax due dates, extend grace periods, waive late fees and penalties, and allow forbearance with regard to the cancellation/non-renewal of policies. Bulletin 20-16 adds a 90-day grace period for life insurers. Bulletin 2020-14 extends grace period for Medicare Supplement plans. Large employer group health, small employer group health, and individual health guidance, including grace periods, are addressed in Bulletins 2020-13,2020-12, and 2020-11, respectively.

   

  Bulletin No. 20-27. The Bulletin applies to carriers’ insurance products that are not otherwise addressed in Bulletin Nos. 20-11, 20-12, 20-13 or 20-14. The Department is directing carriers to provide policyholders and contract holders for all individual and group accident and health insurance policies who may be experiencing a financial hardship due to COVID-19 with a 60-day emergency grace period to pay premiums. Carriers are directed to, in addition to posting information on their website, provide each policyholder with an easily readable written description of the terms of the extended grace period offered pursuant to this guidance. (06/05/2020)

   

• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 20-03 and Bulletin No. 20-07. No cost-sharing for any healthcare services or supplies delivered or obtained via telemedicine or telehealth. Bulletin 20-24 supplements Bulletin 20-03 and requires insurers to cover any molecular test for SARS-COV-2 (the virus that causes COVID-19) without cost sharing. (5/15/2020)
• Telehealth: Bulletin 20-03. Carriers are required to develop robust telehealth programs with participating providers.

  Bulletin No. 20-07. Network providers should be encouraged to utilize telehealth services. Carriers are required to update telehealth policies to include telephone-only services.

• Network Adequacy: Bulletin 20-03. Carriers should ensure that their provider networks are adequately prepared to handle a potential increase in the need for health care services.
• Utilization Review and Preauthorization: Bulletin No. 20-07. Carriers may not impose prior authorization requirements on medically necessary treatment that is delivered via telemedicine and telehealth.
• Access to Prescription Drugs: Bulletin 20-03. All carriers are encouraged to provide coverage for prescription drugs to treat COVID-19 at a preferred level of cost-sharing.
• Other – External Appeals: Bulletin 20-08 provides alternative external appeal procedures due to COVID-19.

New Mexico

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues through Department will not schedule meetings through April 30, 2020, per Department website.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 2020-006. Department requests that all insurance companies refrain from canceling or non-renewing policies due to non-payment of premiums, or at a minimum, provide extended grace periods for payment of premiums.
• Cost Sharing Waivers for COVID-19 Coverage: Cost-Sharing. Prohibits insurers from imposing cost-sharing for testing and health care services related to COVID-19, pneumonia, influenza, or any disease or condition that is the subject of a public health emergency. See also Bulletin 2020-008 and Bulletin 2020-16.
• Telehealth: Bulletin 2020-004 and Bulletin 2020-005. Providing guidance regarding telehealth coverage requirements.
• Utilization Review and Preauthorization: Bulletin 2020-004. Insurers are asked to take all necessary steps to ensure that your utilization review, prior authorization, care and case management and emergency care policies and procedures are in accord with the CDC guidelines and do not present barriers to testing or treatment. See also Bulletin 2020-008.
• Access to Prescription Drugs: Bulletin 2020-004. Insurers are asked to ensure that insureds who may be in a COVID-19 waiting period of self-isolation can obtain a one-time refill of their covered prescription medications prior to expiration of the normal refill waiting period.
• Regulatory Filings and Deadline Extensions: Docket No. 20-00015-COMP-LH. Health insurers shall furnish certain information and data relating to COVID-19 on a continuous weekly basis to the Department. (05/15/2020)
• Other– Notice Requirements for Excepted Benefits: Docket No. 20-00017-COMP_LH. An insurer who has underwritten an excepted benefits policy or plan described in the Notice must provide every NM resident named as an insured, participant, member, or certificate holder under each such policy the state specific notice included within this Notice.
• Other – Claim Payment and Support of Hospitals: Bulletin 2020-008. Health insurers are required to expedite hospital claims, reduce administrative burdens to hospitals.
• Other – Surprise Medical Billing: Bulletin 2020-009. Sets out various scenarios for insurers to hold insureds harmless for utilizing out-of-network services to diagnose and treat COVID-19, and for insurers to reimburse out-of-network providers using the New Mexico surprise billing rate or the 2017 Medicare reimbursement rate. (4/24/2020)
• Other – Mandatory Insurer OSI Newsletter Subscription: Bulletin 2020-010. Insurers are required to subscribe to the OSI Regulatory Compliance/Government Relations newsletter in order to receive important alerts and notifications from the Department. Insurers can complete subscription signup at the weblink https://newsletter.osi.state.nm.us/. (5/01/2020)

New York

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: NY DFS Press Release 04-02-2020. The DFS will soon issue an emergency regulation to suspend commercial health insurance premiums collection through June 1st for individuals and small groups demonstrating financial hardship due to COVID-19. 59th Amendment to Insurance Regulation 62. An insurer, HMO, and student health plan, subject to consideration by the superintendent of the liquidity and solvency of the applicable insurer, HMO, or student health plan, shall extend the period for the payment of premiums to the later of the expiration of the applicable contractual grace period and 11:59 p.m. on June 1, 2020 for any individual, small group, or student blanket comprehensive health insurance policy, for any policyholder or contract holder who can demonstrate financial hardship as a result of the COVID-19 pandemic. Such an insurer, HMO, and student health plan shall be responsible for the payment of claims during such period and may not retroactively terminate the insurance policy for non-payment of premium during such period. (05/22/2020)

  Insurance Circular Letter No. 7 (2020). All insurance entities are urged to allow consumers to defer payments at no cost, extend payment due dates, or waive late or reinstatement fees which will avoid a lapse in coverage.

  The NY DFS also issued a model notice for life insurers and fraternal benefit societies regarding extended grace periods. Guidance regarding this notice can be found here and here.

  Regulation 216. The Department has issued emergency rules relating to grace periods and premium repayments, which are extended by 30 days by Executive Order 202.28. (5/15/2020)

• Cost Sharing Waivers for COVID-19 Coverage: NY DFS Insurance Circular Letter No. 3 (2020) (issued 03-02-2020) and 57th Amendment to Insurance Regulation 62. Insurers prohibited from imposing any cost-sharing for COVID-19 testing or telehealth services.

  Insurance Circular Letter No. 10 (2020). The NY DFS has adopted the 60th Amendment to Regulation 62 which prohibits health insurers from imposing cost-sharing for mental health services rendered by in-network providers on an outpatient basis for essential workers, regardless of whether the services are provided by telehealth. (5/08/2020)

  Insurance Circular Letter No. 11 (2020). Issuers are directed to comply with the requirements of the 57th Amendment of Insurance Regulation 62 for COVID-19 testing covered under comprehensive health insurance policies and contracts and provided to nursing home and adult care facility personnel covered under the policy or contract consistent with EO 202.30, including the prohibition on cost sharing for such testing. 05/22/2020)

  Insurance Circular Letter No. 12 (2020). Issuers are directed to provide in-network and out-of-network coverage for COVID-19 testing without cost-sharing at pharmacies consistent with EO 202.24, the CARES Act, the 57th Amendment to 11 NYCRR 52, DOH guidance, and this circular letter. (05/29/2020)

   

• Telehealth: Telehealth services for all conditions expanded to include telephonic or video modalities when medically appropriate to deliver health care services if all other requirements for a covered health care service are met. NY DFS Insurance Circular Letter No. 6 and Guidance issued March 21, 2020.

  Issuers are directed to ensure that, as applicable, their telehealth programs with participating providers are robust and will be able to meet any increased demand. NY DFS Insurance Circular Letter No. 3 (2020) (issued 03-02-2020).

  58th Amendment to Insurance Regulation 62. During the state of emergency related to COVID-19, no policy or contract delivered or issued for delivery in this State that provides comprehensive coverage for hospital, surgical, or medical care shall impose, and no insured shall be required to pay, 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. (05/22/2020)

• Network Adequacy: NY DFS Insurance Circular Letter No. 3 (2020) (issued 03-03-2020). Issuers are directed to verify that their provider networks are adequate to handle a potential increase in the need for health care services in the event more COVID-19 cases are diagnosed in New York.
• Utilization Review and Preauthorization: NY DFS Insurance Circular Letter No. 3 (2020) (issued 03-03-2020). Issuers shall be prepared to expedite utilization review and appeal processes for services related to COVID-19 and suspend preauthorization review for scheduled surgeries or admissions at hospitals for 90 days from 03/30/2020. NY DFS Insurance Circular Letter No. 8, NY DFS Insurance Circular Letter No. 8 Supplement No. 1 and NY DFS Insurance Circular Letter No. 8 Supplement No. 2 provide additional detail.
• Access to Prescription Drugs: NY DFS Insurance Circular Letter No. 3 (2020) (issued 03-03-2020). DFS is directing insurers to provide expedited formulary exceptions for insureds.
• Regulatory Filings and Deadline Extensions: Department website has guidance regarding regulatory filing deadlines, including an extended filing deadline (to June 30, 2020) for Holding Company Registration statements and enterprise risk reports. (4/20/2020)  
• Other – Life insurance Company Data Call Pursuant to Insurance Law 308: The Department is seeking information from life insurers regarding business, sales, and underwriting practices related to recent changes in the equity and other financial markets and the impact of the COVID-19 pandemic, and is also seeking information pertaining to the use of accelerated or algorithmic underwriting. (5/15/2020)
• Other – Access to Out of Network Services for Nursing Home and Adult Care Facility Personnel: Insurance Circular Letter No. 11 (2020). Based on the CARES Act, the FFCRA, and the Insurance Law and regulations promulgated thereunder, issuers are directed to provide in-network and out-of-network coverage for COVID-19 testing for twice weekly testing of nursing home and adult care facility personnel. (05/22/2020)
• Other – Charges for Personal Protective Equipment by Participating Providers: Circular Letter No. 14 (2020). Health carriers are reminded that they should ensure that insureds are not charged fees by participating providers for covered services that go beyond the insureds’ financial responsibility as described in the insureds’ policies or contracts, such as for provision of masks, gloves, and gowns. (09/04/2020).

North Carolina

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: NC DOI Advisory 03-24-2020. Insurers are encouraged relax due dates for premiums payments, extend grace periods, waive late fees and penalties, and allow payment plans for premiums payments to otherwise avoid a lapse in coverage. See also Bulletin Number 20-B-06 and associated FAQ.

  Deferral Order. Insurers are ordered to provide a 30-day deferral of premiums due if requested by an insured. Extended Order 04-21-2020 extends the deferral order to 05/27/2020. See also Bulletin 20-B-07. (4/24/2020)

 

• Cost Sharing Waivers for COVID-19 Coverage: Bulletin Number 20-B-05. Insurers are requested to waive cost-sharing for COVID-19 testing.
• Telehealth: Bulletin Number 20-B-05. Insurers are reminded to review provisions in current policies regarding the delivery of health care services via telehealth and ensure they are robust.
• Network Adequacy: Bulletin Number 20-B-05.Insurers are requested to verify their provider networks are adequate to handle a potential increase in the need for health care services in the event more COVID-19 cases are diagnosed in North Carolina.
• Utilization Review and Preauthorization: Bulletin Number 20-B-05. Insurers are requested to waive preauthorization requirements COVID-19 treatment.
• Access to Prescription Drugs: Bulletin Number 20-B-05. Insurers are requested to make expedited formulary exceptions for insureds suffering from health conditions that may seriously jeopardize the insured’s health or life.

  NC statutes section 58-3-228 requires health benefit plans to cover one early refill of a prescription drug, or to fill one replacement prescription of a drug that was recently filled, during disasters in the state (see Bulletin Number 20-B-04).

• Regulatory Filings and Deadline Extensions: Bulletin Number 20-B-05. The Department may request that insurers provide information on the steps they are taking in response to this advisory. Department has issued an Order extending the deadline for CCRC filings.

North Dakota

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Bulletin 2020-5. All company filings related to product form and rate filings should continue to use SERFF.
• Policy Cancellations, Non-renewals, and Grace Periods: ND ID Bulletin 2020-8. The department encourages all insurers to extend grace periods and premium payment deadlines, develop payment plans, and waive fees and penalties.
• Cost Sharing Waivers for COVID-19 Coverage: ND ID Bulletin 2020-1, ND ID Bulletin 2020-1.1, and ND ID Bulletin 2020-08. The Department asks health carriers to waive cost-sharing for COVID-19 testing.

  Bulletin 2020-10. Regarding the three types of available COVID-19 tests (PCR tests, antigen tests, and antibody tests), the Department expects carriers offering health benefit plans to cover PCR tests and antigen tests designed to detect the presence of COVID-19 when a patient’s symptoms indicate the medical need to conduct a test. The Department expects carriers to cover antibody tests only when they are FDA-authorized and are deemed medically necessary by a health professional. (5/22/2020)

   

• Telehealth: ND ID Bulletin 2020-1 and ND ID Bulletin 2020-1.1. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand for services including, but not limited to those listed in ND ID Bulletin 2020-03.
• Network Adequacy: Health carriers are asked to verify and ensure their networks are robust and will be able to meet any increased demand. ND ID Bulletin 2020-1 and ND ID Bulletin 2020-1.1
• Utilization Review and Preauthorization: ND ID Bulletin 2020-1 and ND ID Bulletin 2020-1.1. Health carriers are asked to waive any prior authorization requirements associated with COVID-19 testing or treatment.
• Access to Prescription Drugs: Health carriers are asked to make expedited formulary exceptions if the insured is suffering from a health condition that may seriously jeopardize the insured's health or life. ND ID Bulletin 2020-1 and ND ID Bulletin 2020-1.1
• Regulatory Filings and Deadline Extensions: Bulletin 2020-5. Companies that believe they will not be able to meet a regulatory filing deadline should contact Matt Fischer at [email protected].

Ohio

DOI Website (no dedicated COVID-19 page)

Department Guidance

• Department Resources and Functions: Employees are working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: ODI Bulletin 2020-03 and associated FAQ state that health insurers must permit employers to continue coverage for employees regardless of any “actively at work” requirements. Insurers are to offer an interest-free deferment of premium payments for up to 60 days from insureds’ premium due date. ODI Bulletin 2020-07 provides guidance for life and LTC insurers, including extended grace period and waiver of premium requirements.
• Cost Sharing Waivers for COVID-19 Coverage: ODI Bulletin 2020-05. Out-of-Network COVID-19 testing and treatment must be covered at the same cost sharing level as if provided in network.
• Telehealth: ODI Bulletin 2020-05. Issuers that provide coverage for services delivered via telemedicine are expected to provide such coverage for COVID-19 testing and treatment. Issuers that do not currently provide this coverage are encouraged to implement early adoption of the Ohio law requirements effective January 1, 2021.
• Network Adequacy: ODI Bulletin 2020-02. Issuers should ensure that provider networks are adequate to handle testing and care for COVID-19.
• Utilization Review and Preauthorization: ODI Bulletin 2020-02. Issuers are encouraged to proactively evaluate the appropriateness of applying utilization management techniques to services for testing or treatment of COVID-19.

  ODI Bulletin 2020-05. Testing and treatment for COVID-19 shall not be subject to preauthorization requirements.

• Access to Prescription Drugs: ODI Bulletin 2020-02. Issuers must provide expedited formulary exceptions processes for non-formulary prescription drugs and are encouraged to allow access to prescription drug supplies beyond the typical supply limit prior to the scheduled refill date.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-09. The Department will grant 30-60 day filing extensions for certain types of annual and quarterly filings by request and subject to Department approval. Hard copy and notarization filing requirements are temporarily suspended, but all temporarily waived hard copy and notarization filings must ultimately be made within 60 days after the expiration of this bulletin. (4/24/2020)
• Other – Pharmacy Audits: ODI Bulletin 2020-04 suspends pharmacy audits. ODI Bulletin 2020-10 rescinds ODI Bulletin 2020-04 effective June 25, 2020. (07/17/2020)

Oklahoma

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: COVID-19 Information Update. The Oklahoma Insurance Department (OID) is closed to the public until further notice, employees working remotely.
• Policy Cancellations, Non-renewals, and Grace Periods: OID Bulletin LH 2020-02.Health carriers shall not cancel the coverage of any person who has been diagnosed with COVID-19 and is unable to return to work or maintain coverage under their current health carrier because of COVID -19 for the next 90 days. Health carriers shall extend the 30-day grace period to a 60-day grace period for nonpayment of premiums. Carriers shall suspend underwriting rules related to group participation minimum requirements that would normally cause a group policy to be canceled. All health carriers shall continue to pay claims without regard to premium payment during the 60-day grace period. Claims may not be pended for payment during the (60) day period nor shall carriers recoup claims payment amounts from future provider reimbursements. OID Bulletin LH 2020-02 (updated 06/18/2020) stipulates that the grace period provisions contained within LH Bulletin 2020-02 shall expire on June 30, 2020, and that the term of extended grace periods, afforded to insureds pursuant to the original bulletin, shall be allowed to expire upon reaching the end of the extension. (06/26/2020)
• Cost Sharing Waivers for COVID-19 Coverage: OID Bulletin LH 2020-02. Health carriers shall waive cost sharing for lab tests, in-network provider office visits, and in-network urgent care center visits for COVID-19 testing. Health carriers shall follow federal guidelines with respect to payment of anti-body tests related to COVID-19.

   

  OID Bulletin LH 2020-03. Regarding the three types of available COVID-19 diagnostic tests (PCR tests, antigen tests, and antibody tests), the Department expects health carriers to cover PCR tests and antigen tests designed to detect the presence of COVID-19 when a patient’s symptoms indicate the medical need to conduct a test. The Department expects carriers to cover antibody tests only when they are FDA-authorized and are deemed medically necessary by a health professional. (05/29/2020)

   

• Telehealth: OID Bulletin LH 2020-02. Health carriers shall review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand and shall waive telehealth copayments for insureds and reimburse the provider for the copayment. OID Bulletin LH 2020-02 (updated 06/18/2020) tipulates that LH Bulletin 2020-02 shall expire on June 30, 2020, and that after that date, health insurers are encouraged to permit the generalized use of in-network telehealth/telemedicine services and are also encouraged to expand their networks of providers and facilities to perform telemedicine services. (06/26/2020)
• Network Adequacy: OID Bulletin LH 2020-02. Health carriers verify their provider networks are adequate to handle a potential increase in the need for health services due to COVID-19. OID Bulletin LH 2020-02 (updated 06/18/2020) stipulates that LH Bulletin 2020-02 shall expire on June 30, 2020. (06/26/2020)
• Utilization Review and Preauthorization: OID Bulletin LH 2020-02. Health carriers shall not use preauthorization requirements as a barrier to access necessary treatment for COVID-19, and health carriers shall be prepared to expedite utilization review and appeal processes for services related to COVID-19. OID Bulletin LH 2020-02 (updated 06/18/2020) stipulates that LH Bulletin 2020-02 shall expire on June 30, 2020. However, after that date, health carriers must continue to provide access to medically necessary testing and treatment of COVID-19 without requiring preauthorization, and must continue to expedite utilization review. (06/26/2020)
• Access to Prescription Drugs: OID Bulletin LH 2020-02 and Consumer Protection. Health carriers shall make expedited formulary exceptions and allow a 60-day supply to be filled for a 30-day prescription. OID Bulletin LH 2020-02 (updated 06/18/2020) stipulates that LH Bulletin 2020-02 shall expire on June 30, 2020. (06/26/2020)
• Regulatory Filings and Deadline Extension: Financial Bulletin 2020-02 provides extended deadlines for certain regulatory filings.
• Other – Group Policy Underwriting Rules: OID Bulletin LH 2020-02 (amended 04-06-2020). Carriers shall suspend underwriting rules related to group participation minimum requirements that would normally cause a group policy to be canceled. (4/20/2020). OID Bulletin LH 2020-02 (updated 06/18/2020) stipulates that LH Bulletin 2020-02 shall expire on June 30, 2020. However, suspension of underwriting rules related to minimum group participation requirements must continue through December 31, 2020. (06/26/2020)

Oregon

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: COVID-19 Information. Oregon DCBS building is closed to the public but DCBS remains available by phone or email.
• Policy Cancellations, Non-renewals, and Grace Periods: Oregon DCBS Emergency Order 2020-03-25 and COVID-19 Emergency Order FAQ. Insurers must immediately: institute a grace period for premium payments on all insurance policies ending no earlier than the date the Emergency Order is no longer in effect; suspend all cancellations and non-renewals for all active insurance policies; and extend all deadlines for insureds to report claims and communicate about claims. An insurer may not cancel or non-renew a policy because of a claim directly resulting from the circumstances of the COVID-19 outbreak. OR DCBS Extension of Emergency Order 2020-03-25. The Emergency Order implemented on 2020-03-25 is extended through 2020-05-23. (4/24/2020)

   

  OR DCBS Extension of Emergency Order 2020-05-22. The Emergency Order originally implemented on 2020-03-25 and extended to 2020-05-23 is now receiving an additional extension through 2020-06-22. (05/29/2020)

   

   

  Emergency Order 2020-05-05. For health insurers offering coverage other than accidental death and dismemberment, disability, and long term care policies, Emergency Order 2020-03-25 is terminated and replaced with this order. This order requires health insurers offering coverage other than accidental death and dismemberment, disability, and long term care policies to provide a minimum 60-day grace period for premium payments, suspend all involuntary cancellations and nonrenewals, and pay claims incurred during the first month of the grace period. (5/08/2020) Extension of Emergency Order 2020-05-05 extends the provisions of Emergency Order 2020-05-05 through July 03, 2020. (06/05/2020)

   

   

  Second Extension of Emergency Order 2020-05-05 extends the provisions of Emergency Order 2020-05-02 through August 02, 2020. (07/17/2020)

   

  Third Extension of Emergency Order 2020-05-05 extends the provisions of Emergency Order 2020-05-05 through September 30, 2020. (09/04/2020)

   

  Emergency Order 2020-05-22. For disability and life insurers offering coverage other than annuities, Emergency Order 2020-03-25 is terminated and replaced with this order. This order requires disability and life insurers offering coverage other than annuities to extend all deadlines for insureds to report claims, provide a minimum 90 day grace period for premium payments (subject to certain conditions specified in the order), suspend all involuntary cancellations and nonrenewals (with the exception of policies that have completed the applicable 90-day grace period), and pay claims for losses incurred during a grace period according to the terms of the policy (although insurers may not pend claims solely due to nonpayment of premium). (05/29/2020). Extension of Disability and Life Insurance Order 2020-22-06 extends the provisions of Emergency Order 2020-05-22 through July 22, 2020. (06/26/2020)

   

  Extension of Disability and Life Insurance Order 2020-08-21 extends the provisions of Emergency order 2020-05-22 through September 20, 2020. (09/04/2020)

• Cost Sharing Waivers for COVID-19 Coverage: Oregon’s COVID-19 Billing and Claims Guidance and OR DCBS Telehealth Guidance document and OR DCBS Claims Guidance document 03-10-2020. Cost sharing for COVID-19 testing will be waived for fully insured individual and group health plans. Health plans shall ensure cost sharing requirements for services delivered via telehealth are no greater than if the service was delivered through in-person settings.
• Telehealth: OR DCBS Telehealth Guidance document. Health plans shall cover telehealth services for all conditions delivered by in-network providers to replace in-person visits whenever possible.
• Network Adequacy: OR DCBS Telehealth Guidance document. Health plans shall examine their provider networks to ensure continued adequacy and ensure robust telehealth services are available.
• Utilization Review and Preauthorization: Oregon’s COVID-19 Billing and Claims Guidance. Prior authorization should not apply for COVID-19 testing. Utilization review for treatment should be completed timely and insurers should be prepared to expedite the review and appeal process for COVID-19.
• Access to Prescription Drugs: Oregon DCBS Prescription Drug Coverage FAQ. Insurers offering comprehensive health plans are epxected to remove barriers related to early refills of prescriptions for maintenance medication to ensure consumers have an adequate supply of medication and make expedited formulary exceptions for treatments that are not currently covered by the formulary. 

Pennsylvania

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Notice 2020-05. In an effort to prevent further disruption of the business being conducted by our insurance companies and other licensees, the Office of Corporate and Financial Regulation will, for a limited time, accept filings electronically. Via SERFF, department initially asked companies to review filings and determine if they were really necessary for business operations. On April 13, 2020, Department sent a follow up SERFF message advising that they have successfully transitioned to work from home and filings may proceed as normal.
• Policy Cancellations, Non-renewals, and Grace Periods: Notice 2020-04. Insurers should consider the following actions: relaxing due dates for premiums payments, extending grace periods, waiving late fees and penalties, and allowing payment plans for premiums payments to otherwise avoid a lapse in coverage. Insurers should consider cancellation or non-renewal of policies only after exhausting other efforts to work with policyholders to continue coverage.
• Cost Sharing Waivers for COVID-19 Coverage: PA ID Notice 2020-03. Health insurers are urged to waive cost sharing for COVID-19 testing, including in-network provider office visits, in-network urgent care center visits, and emergency care services.
• Telehealth: PA ID Notice 2020-03. Health insurers are encouraged to review their respective participating telehealth service provider arrangements, provide coverage of costs related to telehealth services, and to be prepared to meet any increased demand for that means of delivery.
• Network Adequacy: PA ID Notice 2020-03. Health insurers are asked to verify their provider networks are adequate to handle a potential increase in the need.
• Utilization Review and Preauthorization: PA ID Notice 2020-03. Health insurers are strongly encouraged to ease preauthorization treatment requirements for COVID-19 and be prepared to expedite utilization review decisions for services related to COVID-19.
• Access to Prescription Drugs: PA ID Notice 2020-03. Health insurers are asked to make expedited formulary decisions as well as permit the use of out of network pharmacies (at in-network cost sharing) in the event of a medication shortage at in-network pharmacies. The Department encourages insurers should cover refills even when the scheduled refill date has not been reached so that the insured may maintain a 30-day supply of the drug. 
• Regulatory Filings and Deadline Extensions: PA ID Notice 2020-10. The Department will consider granting 30-60 day extensions for various types of annual and quarterly filings subject to Department approval. Companies interested in seeking an extension should email their assigned analyst with an extension request. Additionally, hard copy and notarization requirements are currently waived, and companies are requested to electronically submit such filings to their assigned analyst. However, temporarily waived hard copy and notarization filings will be due within 60 days after the state permits employees to return to work. (4/24/2020)
• Other – Payback or Credit Programs Filing Requirements: PA ID Guidance Document 05-08-2020. If an insurer offering health insurance products (including major medical, dental only, and vision only products) is contemplating payback or credit programs to reflect reduced exposure to loss during the COVID-19 pandemic, the Department believes such a payback or credit program requires a product filing if a filing would otherwise be applicable (i.e. form filing for an endorsement or a rate filing if the product is subject to rate filings). (5/15/2020)
• Other – Surprise Bills Related to COVID-19: Notice 2020-19. The Department requests that insurers take contractually appropriate action against in-network providers or laboratories who are suspected of engaging in price gouging (such as by improperly charging consumers for personal protective equipment or diagnostic services). If a contractual resolution that avoids imposing costs on insureds is not possible, or if the provider or laboratory suspected of price gouging is out of network, the Department gives insurers the option of referring the issue to the Office of the Attorney General at the email address [email protected]. (06/26/2020)

Rhode Island

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: RI Bulletin 2020-4. The Department requests that insurers extend grace periods for premium payments, allow payment plans for premium payments and waive late fees, insufficient funds and installment fees and penalties.
• Cost Sharing Waivers for COVID-19 Coverage: RI Bulletin 2020-01 with supporting documents. Services provided in relation to COVID-19 (including telehealth services) shall not be subject to cost sharing.

  RI OHIC Bulletin 2020-5. It is the expectation of OHIC that carriers shall cover for the duration of the Rhode Island COVID-19 State of Emergency, PCR and Antigen testing and the administration of such tests where an ordering provider has determined the test is medically appropriate for an individual beneficiary in accordance with accepted standards of medical practice, inclusive of guidance issued by the Rhode Island Department of Health. (09/04/2020)

• Telehealth: RI Bulletin 2020-01 with supporting documents and RI Bulletin 2020-5. Health insurers shall expand access to the use of telehealth services for all covered health conditions and suspend patient and/or provider location requirements. Insurance carriers shall establish reasonable requirements of the coverage of such telemedicine services and shall not impose any specific requirements on technologies used to deliver telemedicine services (e.g., limitations on audio-only or live video). See also OHIC Guidance 2020-05-07.
• Network Adequacy: RI Bulletin 2020-01 with supporting documents. Health carriers shall continually assess their provider networks to ensure adequacy to handle the expected increase in the need for services due to COVID-19.
• Utilization Review and Preauthorization: RI OHIC Bulletin Health carriers shall not use preauthorization requirements as a barrier to access testing or treatment for COVID-19.
• Access to Prescription Drugs: RI OHIC Bulletin. Health insurers shall ensure coverage for advance prescription refills and medical supplies to enable enrollees to maintain at least a 30-day supply (or 90-day supply for maintenance medications) during this outbreak.
• Regulatory Filings and Deadline Extensions: RI OHIC Bulletin. Health insurers shall provide timely information to OHIC and Rhode Island Medicaid (where applicable) on the steps being taken in response to the COVID-19.
• Other – Administrative Processes: RI Bulletin 2020-4. Insurers are encouraged to explore ways to streamline or delay the submission of administrative paperwork and should explore ways to make claims processes easier and more responsive, such as electronic delivery of claims payments. 
• Other – Preventive Visits: OHIC Guidance 2020-05-26. In order to return to a more timely and balanced schedule of wellness visits as COVID-19 restrictions are lifted, EOHHS and OHIC are directing all MCOs and all Carriers to amend any existing wellness visit limitations from “one preventive visit every 365 days” to “one preventive visit in a calendar year/plan year” for the years 2020-2022. (05/29/2020)
• Other – Affordability Standards Regulatory Flexibilities to Address Provider Financial and Operational Stability During the COVID-19 State of Emergency: Bulletin 2020-02. Health insurers are expected to take temporary measures in various contractual situations with providers, such as hospital contracts and population-based contracts, in order to address provider financial and operational challenges resulting from reduced utilization of services and increased resource demands. (05/29/2020)

South Carolina

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: At this time, all in-person visits to the offices of the SCDOI are suspended until further notice. DOI staff can still be reached through phone or email.
• Policy Cancellations, Non-renewals, and Grace Periods: SC DOI Bulletin 2020-02. Insurers are urged to extend premium payment deadlines, provide additional time before non-renewals or cancellations become effective, and waive fees, penalties or other charges relating to an insured’s temporary inability to submit premium payments as a result of this pandemic.
• Cost Sharing Waivers for COVID-19 Coverage: SC COVID-19 Information Page. Health insurance issuers are required to waive cost-sharing for COVID-19 testing.
• Telehealth: SC DOI Bulletin 2020-02. Insurers are urged to increase access to medical care via telehealth.
• Utilization Review and Preauthorization: SC COVID-19 Information Page. Health insurance issuers are required to waive preauthorization requirements for COVID-19 testing.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-05. The Department is allowing insurers an additional 30-60 days to complete certain financial filings. To receive the additional time, insurers must submit a notification for late filing. All extension requests are subject to approval. Insurers should submit an electronic copy of their notification of intent to file specific filings by the deadlines listed in the bulletin, or send an extension request to [email protected] or [email protected], as applicable. Additionally, hard copy and notarization filing requirements are currently waived, with electronic submissions serving as an acceptable substitute. However, companies will be expected to submit all temporarily waived hard copy and notarized filings within 60 days once the state of emergency has been lifted. (5/01/2020)
• Access to Prescription Drugs: SC DOI Bulletin 2020-02. Insurers are urged to relax time limitations to allow for early prescription refills and relax prescription drug formulary limitations.

South Dakota

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: The DOI continues to perform all primary functions remotely. There may be a short delay in typical response times.
• Policy Cancellations, Non-renewals, and Grace Periods: SD DIR Bulletin 20-02. The Division urges health carriers to make reasonable accommodation for premium payments prior to cancellation and refrain from cancelling coverage for individuals that have been diagnosed with COVID-19. Carriers may elect to extend premium grace periods.
• Cost Sharing Waivers for COVID-19 Coverage: SD DIR Bulletin 20-02. All health carriers must waive cost sharing for COVID-19 testing. Carriers are encouraged to waive cost sharing (copayment, coinsurance, deductibles) for telehealth services.
• Telehealth: SD DIR Bulletin 20-02. Health carriers are strongly encouraged to expand the availability of telemedicine services for all care by eliminating barriers to its use.
• Network Adequacy: SD DIR Bulletin 20-02. The Division urges health care providers to expand acceptance of insurance coverage by joining additional networks and allow access to out-of-network providers at in-network cost sharing if there is not an adequate number of in-network providers.
• Utilization Review and Preauthorization: SD DIR Bulletin 20-02. Preauthorization requirement for COVID-19 testing or treatment should be waived or expedited. Further, health carriers should be prepared to expedite utilization review and appeal processes for services related to COVID-19.
• Access to Prescription Drugs: SD DIR Bulletin 20-02. Health carriers are urged to allow early refills on maintenance prescription medication, without additional authorization requirements. 

Tennessee

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: The Department is working remotely and remains fully operational. The Department encourages all communication by email.
• Policy Cancellations, Non-renewals, and Grace Periods: TDCI Bulletin 20-03. The Department requests that carriers explain existing grace periods and eliminate late fees, non-sufficient funds fees, and installment fees to delay cancellation of coverage.
• Cost Sharing Waivers for COVID-19 Coverage: TDCI Bulletin 20-02. The Department requests that health carriers waive cost-sharing for COVID-19 testing.
• Telehealth: TDCI Bulletin 20-02. Health carriers are reminded to review state law regarding the delivery of health care services via telehealth.

  Executive Order 36. Health insurance carriers are urged to provide coverage for the delivery of clinically appropriate, medically necessary covered services via telemedicine to all providers, irrespective of network status or originating site. (5/22/2020)

  Executive Order 63 extends various provisions of Executive Order 36 through October 30, 2020 including the Governor’s recommendation for insurers to provide access to telemedicine services. (10/16/2020)

• Network Adequacy: TDCI Bulletin 20-02. Health carriers are requested to verify their provider networks are adequate to handle a potential increase in the need for healthcare services in the event more COVID-19 cases are diagnosed.
• Utilization Review and Preauthorization: TDCI Bulletin 20-02. Health carriers are reminded that they must comply with the timeframes for utilization review decisions under state law and be prepared to expedite the process for COVID-19 treatment. In addition, the Department instructs carriers to not use preauthorization requirements as a barrier to access treatment for COVID-19.
• Access to Prescription Drugs: TDCI Bulletin 20-02. Health carriers are requested to make expedited formulary exceptions for insureds suffering from health conditions that may seriously jeopardize the insured’s health or life.
• Regulatory Filings and Deadline Extensions: . The Department requests that health carriers provide information on the steps they are taking in response to TDCI Bulletin 20-02. Additionally, the Department requests that health carriers report to the Department whenever they receive a claim for COVID-19 testing in Tennessee. All entities are strongly encouraged to make filings electronically. TN COVID Guidance. 
• Other – Access to Out of Network Services: Bulletin 20-08. In the event emergency services or COVID testing and treatment services are rendered to an insured by an out-of-network health care provider, such provider may bill the health carrier directly and the health carrier may reimburse such provider the amount the insured's health care plan would pay for such services if rendered by an in-network provider as payment in full. Providers are urged not to additionally bill the insured. (5/01/2020)

Texas

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees are working remotely. Business continues but may be delayed as department resources are stretched thin.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin B-0007-20. The department encourages insurers to consider implementing or extending premium payment grace periods, suspending premium payments temporarily, and allowing payment plans.
• Cost Sharing Waivers for COVID-19 Coverage: TDI Bulletin B-0005-20 and TDI Bulletin B-0017-20. Insurers are reminded that they must comply with the Family First Coronavirus Response Act by covering COVID-19 testing and related visits without cost sharing.
• Telehealth: TDI Bulletin B-0005-20. Insurers are encouraged to expanded use of telemedicine.

   

  Emergency Rule 28 TAC section 35.1. A health benefit plan must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service to the same extent that the plan provides coverage for the service in an in-person setting. TDI Extension of Emergency Rule 28 TAC section 35.1 extends the rule through September 12, 2020. (06/26/2020)

   

• Utilization Review and Preauthorization: TDI Bulletin B-0005-20. Insurers are encouraged to waive requirements for preauthorization, referrals, notification of hospital admission, or medical necessity reviews for care consistent with CDC guidance.

  TDI Bulletin B-0025-20. The Department encourages health insurers, health maintenance organizations (HMOs), and utilization review agents to extend prior authorizations for elective procedures authorized before the Governor’s executive order on March 22, 2020, directing a postponement of those procedures. (5/15/2020)

   

• Access to Prescription Drugs: TDI Emergency Rule 2020-6305 (codified as 28 TAC section 35.2). Health benefit plans must extend established prior authorization approvals for 90 days, must authorize payment for a one-time 90-day refill of any covered prescribed drug regardless of last fill date, and must make alternative drugs available on-formulary or in the same tier without requiring prior authorization.

  TDI website statement 2020-07-16. The Department has extended TDI Emergency Rule 2020-6305 through September 27, 2020. (07/17/2020)

• Regulatory Filings and Deadline Extensions: TDI Bulletin B-0009-20 and modified financial filing deadlines chart. The TDI has posted a modified filings chart with some reporting deadlines extended. The TDI is also accepting electronic submissions, electronic signatures, and is suspending payment for financial filings requiring payment by check.

  TDI Bulletin B-0024-20. The TDI will delay collection of 2019 mandated health benefits cost and utilization data from health benefit plan issuers to 2021. At that time, health benefit plan issuers will report data from 2019 and 2020. (5/08/2020)

   

• Other – Prompt Claims Payment Extension: Bulletin B-0007-20. Insurers are granted a 15-day extension for claims payments under the Texas prompt payment laws.

  TDI Bulletin B-0005-20. Insurers are encouraged to waive penalties, restrictions, and claims denials for necessary out-of-network services. 

Utah

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 2020-3 and Bulletin 2020-4. The Department reminds insurers that they may elect to not receive premium during the time that an employer is closed but continuing to pay employees. Insurers are also encouraged to adjust premiums where possible, especially where premium is based on payroll, sales, or other projections that don’t reflect actual performance.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 2020-01. Insurers are encouraged to waive cost sharing for COVD-19 testing.

  Bulletin 2020-13. The Department interprets the federal FFCRA and CARES Act (both of which require coverage for COVID-19 testing without cost sharing, in various settings and circumstances) as applying to all insurers that offer group or individual health benefit plans in Utah. (5/15/2020). Bulletin 2020-16 provides additional guidance concerning federal requirements for coverage of COVID-19 testing. (09/04/2020)

   

• Telehealth: Bulletin 2020-01. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.
• Network Adequacy: Bulletin 2020-01. The DOI is asking that health carriers verify their provider networks are adequate to handle a potential increase in the need for health services due to COVID-19.
• Utilization Review and Preauthorization: Bulletin 2020-01. Health insurers are asked to waive any prior authorization or precertification requirements associated with COVID-19 testing or treatment.
• Access to Prescription Drugs: Bulletin 2020-01. Health insurers are encouraged to allow insureds to obtain one-time refills before a scheduled refill date.
• Regulatory Filings and Deadline Extensions: Bulletin 2020-06. The DOI is allowing 30 and 60 day extensions for regulatory filings as set forth in the Bulletin. The insurer must first request the extension.

Vermont

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy renewals, Cancellations, and Grace periods: DOI website statement 03-23-2020. Insurers are requested to provide their policyholders with a reasonable grace period to pay insurance premiums to avoid policies being cancelled for nonpayment of premium due to the COVID-19 public health emergency.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin #209, Emergency Rule H-2020-03-E and Bulletin #214 (09/04/2020). Insurers are directed to waive cost-sharing for medically necessary COVID-19 testing performed by the CDC, Vermont DOI and any CDC or Vermont DOI approved laboratory, including in-network office visits, urgent care visits and emergency visits. Emergency Rule H-2020-03-E. Health insurers shall cover medically necessary COVID-19 treatment and preventive services, whether delivered in an inpatient or outpatient setting with no cost sharing. Additionally, insurers shall cover ambulance transport of insureds with diagnosed or suspected Covid-19 with no cost sharing. (4/24/2020)
• Telehealth: Memo March 3, 2020 and Emergency Rule H-2020-02-E. Insurers are urged to expand coverage and reimbursement of telemedicine services. The Emergency Rule requires telemedicine coverage to be offered by health insurance plans and workers’ compensation carriers. There are specific requirements in the rule regarding scope of coverage, cost sharing, and reimbursement, among others.
• Access to Prescription Drugs: Bulletin #210. Insurers are directed to make at least a 30-day supply of medication available for refills.

  Emergency Rule H-2020-03-E. Health insurers shall cover medically necessary prescription drugs in connection with services for COVID-19 with no cost sharing.

   

  Emergency Rule H-2020-04-E. The Department has issued a new Emergency Rule effective July 01, 2020 in response to the pandemic which requires health insurers to suspend prescription drug deductibles for all generic drugs classified as preventive care for purposes of 26 U.S.C. § 223(c)(2)(C) and to suspend prescription drug deductibles for brand and biological drugs classified as preventive care for purposes of 26 U.S.C. § 223(c)(2)(C) when no generic drug alternative is available in that drug class. The purpose of this emergency rule is to suspend health insurance plan deductible requirements for certain prescription drugs while ensuring that high-deductible health plans maintain eligibility for a health savings account under 26 U.S.C. § 223. (06/05/2020)
• Other – Routine audits suspension: Bulletin #211. Insurers are required to suspend all routine audits of health providers, although insurers remain authorized to conduct audits in the case of suspected fraud or other violations.

  Bulletin #215 rescinds Bulletin #211 effective August 03, 2020. (09/04/2020)

• Other – Access to Out of Network Services: Emergency Rule H-2020-03-E. Health insurers shall cover out-of-network services for the diagnosis and treatment of COVID-19 with no co-payment, coinsurance, or deductible requirements for members if in-network providers are unavailable. (4/24/2020)
• Other – Relaxation of Credentialing Verification Practices: Emergency Rule H-2020-05-E. A health insurer shall allow for individual health care providers to deliver and be reimbursed for services provided across health care settings as needed to respond to Vermonters’ evolving health care needs, including relaxing provider credentialing requirements for physicians or other health care professionals who hold a license in another State and provide health care services to patients in Vermont, either in person or remotely, by means of telemedicine or otherwise, and with respect to other health care professionals who have been issued temporary Vermont licensure during the COVID-19 State of Emergency. (10/16/2020)

Virginia

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: VBI Notice 03-27-20rev. Insurers are encouraged to relax due dates for premium payments, extend grace periods, waive late fees and penalties, allow payment plans for premium payments to otherwise avoid a lapse, and to only cancel or non-renew policies after exhausting all reasonable efforts to work with policyholders to continue coverage in coverage.
• Regulatory Filings and Deadline Extensions: VBI Administrative Letter 2020-02. The VBI will extend certain annual and quarterly filing deadlines by 30-60 days upon request to the Department and subject to Department approval. Insurers should submit filing extension requests to [email protected]. Additionally, hard copy and notarized filing requirements are temporarily waived, with electronic submissions being accepted as a substitute. However, insurers are still expected to submit all temporarily waived hard copy and notarized filings within 60 days after the state has allowed a return to work. (4/24/2020)
• Other – Claims processing: VBI Notice 03-25-20. The VBI encourages insurers to continue to process and adjust claims quickly and by all available means. 

Washington

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Emergency Order 20-02. Regulated Entities must allow a grace period for payment of premiums no less than 60 days. If a longer period is offered, it must be applied uniformly. Partial Extension of Emergency Order 20-02 clarifies that the Emergency Order 20-02 premium grace period requirement is not extended and will expire effective May 23, 2020. (05/29/2020)

   

  Emergency Order No. 20-04. All Regulated Entities offering standalone dental plans certified by the Health Benefit Exchange must offer at least a 60-day grace period. If a longer period is offered, it must be applied uniformly.

   

• Cost Sharing Waivers for COVID-19 Coverage: Emergency Order 20-02. Insurers are required to cover health care provider visits in connection with COVID-19 and FDA-authorized COVID-19 testing without cost sharing including test panels for influenza A & B, norovirus and other coronaviruses, and respiratory syncytial virus (RSV). Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 COVID-19 and respiratory panel testing cost sharing waiver provisions to June 21, 2020. (05/29/2020). Further Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 COVID-19 and respiratory panel testing cost sharing waiver provisions to July 19, 2020. (06/26/2020)

  Third Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 COVID-19 and respiratory panel testing cost sharing waiver provisions to August 16, 2020. (07/17/2020)

  Further Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 COVID-19 and respiratory panel testing cost sharing waiver provisions to September 15, 2020. (09/04/2020)

  Further Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 COVID-19 and respiratory panel testing cost sharing waiver provisions to October 14, 2020. (10/16/2020)

  Further Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 COVID-19 and respiratory panel testing cost sharing waiver provisions to November 13, 2020. (10/16/2020)

• Telehealth: Emergency Order 20-02. Carriers are permitted to use non-HIPAA compliant platforms to provide telehealth to the extent that 1) the provider and their patient are not already using a HIPAA compliant platform, or 2) the regulated entity is not making HIPAA compliant platforms available to all in-network providers, or 3) the use of a HIPAA compliant platform offered by the regulated entity is not readily and easily available to the provider or enrollee. Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 telehealth provisions to June 21, 2020. (05/29/2020). Further Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 telehealth provisions to July 19, 2020. (06/26/2020)

  Third Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 telehealth provision to August 16, 2020. (07/17/2020)

  Further Partial Extension of Emergency Order 20-02 updates the expiration date of the Emergency Order 20-02 telehealth provision to September 15, 2020. (09/04/2020)

  Proclamation 20-29. Insurers are prohibited from reimbursing in-network providers for telemedicine services at a lower rate than would be paid for in-person services.

   

• Network Adequacy: Emergency Order 20-01. If a carrier has an insufficient number or type of providers in their network to provide testing and treatment of COVID-19, the carrier must ensure that the enrollee obtains the covered service from another provider or facility at no greater cost than if the provider were in-network. Extension of Emergency Order 20-01 extends the expiration date of Emergency Order 20-01 by 30 days to June 03, 2020. (5/08/2020). Further Extension of Emergency Order 20-01 extends the expiration date of Emergency Order 20-01 by an additional 30 days to July 03, 2020. (06/05/2020)

  Third Extension of Emergency Order 20-01 updates the expiration date of Emergency Order 20-01 to August 02, 2020. (07/17/2020)

  Fourth Extension of Emergency Order 20-01 updates the expiration date of the order to September 27, 2020. (09/04/2020)

  Fifth Extension of Emergency Order 20-01 updates the expiration date of the order to October 25, 2020. (10/16/2020)

• Utilization Review and Preauthorization: Emergency Order 20-01. Insurers are ordered to suspend any prior authorization requirements that apply to covered diagnostic testing and treatment of coronavirus. Extension of Emergency Order 20-01 extends the expiration date of Emergency Order 20-01 by 30 days to June 03, 2020. (5/08/2020). Further Extension of Emergency Order 20-01 extends the expiration date of Emergency Order 20-01 by an additional 30 days to July 03, 2020. (06/05/2020)

  Third Extension of Emergency Order 20-01 updates the expiration date of Emergency Order 20-01 to August 02, 2020. (07/17/2020)

  Fourth Extension of Emergency Order 20-01 updates the expiration date of the order to September 27, 2020. (09/04/2020)

  Fifth Extension of Emergency Order 20-01 updates the expiration date of the order to October 25, 2020. (10/16/2020)

• Access to Prescription Drugs: Emergency Order 20-01. Insurers are ordered to allow enrollees to obtain a one-time refill of their covered prescription medications prior to the expiration of the waiting period between refills so that enrollees can maintain an adequate supply of necessary medication. Extension of Emergency Order 20-01 extends the expiration date of Emergency Order 20-01 by 30 days to June 03, 2020. (5/08/2020). Further Extension of Emergency Order 20-01 extends the expiration date of Emergency Order 20-01 by an additional 30 days to July 03, 2020. (06/05/2020)

  Third Extension of Emergency Order 20-01 updates the expiration date of Emergency Order 20-01 to August 02, 2020. (07/17/2020)

  Fourth Extension of Emergency Order 20-01 updates the expiration date of the order to September 27, 2020. (09/04/2020)

  Fifth Extension of Emergency Order 20-01 updates the expiration date of the order to October 25, 2020. (10/16/2020)

• Other – Employer-Sponsored Health Insurance: Department Website Guidance. Health insurers have flexibility to define who is eligible for coverage under employer-sponsored health plans and employers are encouraged to be flexible with coverage.
• Other – Surprise Medical Billing: Emergency Order No. 20-06. All health carriers authorized or admitted to offer health plans or short term limited duration medical plans must hold harmless Washington-resident enrollees from balance billing for COVID-19 diagnostic testing processed by in-state, out-of-network laboratories and out-of-state, out-of-network laboratories, when COVID-19 diagnostic testing is determined to be medically necessary by the enrollee’s health care provider. (06/05/2020)

  Extension of Emergency Order 20-06 extends the expiration date of the order to September 27, 2020. (09/04/2020)

  Further Extension of Emergency Order 20-06 extends the expiration date of the order to October 25, 2020. (10/16/2020)

West Virginia

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Employees working remotely. Business continues.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 20-07. Insurers must not issue a cancellation notice or nonrenewal notice pertaining to any insurance policy, plan or contract if the reason for cancellation or nonrenewal is a result of adverse circumstances resulting from the COVID-19. Insurers are encouraged to voluntarily institute moratoriums on cancellations or premium collections and allow for alternative payment arrangements, deferred premium payments, premium holidays and acceleration or waiver of underwriting requirements so that policyholders do not become delinquent during and as a result of the crisis. Bulletin 20-11. If a company implements premium refunds to policyholders, it is the Department’s general position that any premium tax or surcharge assessed against the portion of an insurance premium that is refunded should also be refunded to policyholders. (5/08/2020)
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 2020-01 and Bulletin 20-15 (09/04/2020. Insurers asked health carriers to waive cost-sharing for COVID-19 testing, including in-network office visits, urgent care visits and emergency visits. 

  Emergency Proceeding 20-EO-07. Health insurers must provide benefits for diagnostic testing of COVID-19 without cost sharing for all individuals who reside or work in nursing homes in the state of West Virginia, and for all individuals who reside or work in assisted living residences and residential care communities licensed by the DHHR Office of Health Facility Licensure and Certification (OHFLC). The Insurance Commissioner will take a non-enforcement position regarding midyear plan changes, so long as those changes are made to provide increased coverage for services related to the diagnosis and treatment of COVID-19. (5/15/2020)

  Emergency Proceeding 20-EO-08. Health insurers must provide benefits for diagnostic testing of COVID-19 without cost sharing for all individuals who work in child care centers licensed by the DHHR’s Bureau for Children and Families. The Insurance Commissioner will take a non-enforcement position regarding midyear plan changes, so long as those changes are made to provide increased coverage for services related to the diagnosis and treatment of COVID-19. (5/15/2020)

  Bulletin 20-14. An at-home COVID-19 testing kit must be covered by an insurer without imposing any cost-sharing requirements, prior authorization, or other medical management requirements on the individual covered under the plan or policy when (1) the individual requesting the test undergoes a valid screening or eligibility assessment; (2) the screening or eligibility assessment is reviewed and evaluated by a licensed healthcare provider; (3) the licensed healthcare provider is acting within the scope of his or her license; and, (4) the licensed healthcare provider authorizes or orders the at-home COVID-19 test for the individual. (09/04/2020)

• Telehealth: Bulletin 2020-01. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand. 
• Network Adequacy:  Bulletin 2020-01. The DOI is asking that health carriers verify their provider networks are adequate to handle a potential increase in the need for health services due to COVID-19.
• Utilization Review and Preauthorization: Bulletin 2020-01. The DOI reminds health carriers that they must comply with the timeframes for utilization review decisions under state law and be prepared to expedite the process for COVID-19 treatment. In addition, the DOI instructs carriers to not use preauthorization requirements as a barrier to access treatment for COVID-19. 
• Access to Prescription Drugs: Bulletin 20-05. Health insurers are required to cover an additional one-time early refill of any necessary prescriptions, shall permit insureds to obtain a 90-day supply of maintenance drugs, and shall make expedited formulary exceptions for insureds suffering from health conditions that may seriously jeopardize the insured’s health or life.
• Regulatory Filings and Deadline Extensions: Insurers are instructed to provide the DOI with information related to their response to COVID-19 and the specific steps they are taking in response to Bulletin 2020-01.
  

  Bulletin No. 20-07. The Department does not intend to extend the deadline for insurance premium tax payments (due April 15, 2020), the deadline for health insurers to file their Annual Grievance Reports (March 31, 2020) or the deadline for supplemental filings to Annual Statements (April 1, 2020). Companies should contact the DOI if extensions are needed.

• Other– Claims Processing: Emergency Proceeding 20-EO-01. The DOI has declared an insurance emergency in West Virginia due to COVID-19 and has ordered insurers to continue to process claims quickly and by all available means.
• Other – Prescription Drug Delivery Methods: Emergency Proceeding 20-EO-05. Pharmacies are permitted to deliver prescription medications to insureds and customers via common carrier, mail delivery, or other home delivery methods and insurance companies are not permitted to deny coverage on the basis of such delivery methods.

Wisconsin

DOI COVID-19 webpage

Department Guidance

• Department Resources and Functions: Bulletin 2020-03-20. All filings that are deemed approved if DOI does not disapprove the filing within a certain period of time are hereby disapproved. This disapproval is preliminary and DOI will continue to review the filing to determine if a final disapproval or approval is warranted.
• Policy Cancellations, Non-renewals, and Grace Periods: Bulletin 2020-03-20. Insurers are encouraged to offer flexibility such as offering non-cancellation periods, deferred premium payments, premium holidays and acceleration or waiver of underwriting requirements. Accommodations should not be applied in an unfairly discriminatory manner.
• Cost Sharing Waivers for COVID-19 Coverage: Bulletin 2020-03-06. The DOI requests health carriers to waive cost-sharing for COVID-19 testing.

  Bulletin 2020 04 21. Newly enacted law requires insurers offering disability insurance, defined network plans, and preferred provider plans to cover testing for COVID-19 without copayment or coinsurance if the plan or policy includes coverage for testing of infectious diseases. 

  Notice 04-19-2020 and Press Release 04-19-2020. Wisconsin health insurers must cover cost sharing for COVID-19 testing based on the federal FFCRA and CARES Act. (5/22/2020)

   

• Telehealth:  Bulletin 2020-03-06 and Bulletin 2020-10-13. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.
• Network Adequacy:  Bulletin 2020-03-06. The DOI is requesting that health carriers verify their provider networks are adequate to handle a potential increase in the need for health services due to COVID-19.
• Utilization Review and Preauthorization:  Bulletin 2020-03-06. Health Plan Issuers are requested to expedite prior authorization requests to the extent possible. Health Plan Issuers should not use prior authorization requirements as a barrier to access necessary treatment for COVID-19 and should be prepared to expedite grievances and appeal processes for services related to COVID-19, when medically appropriate.
• Access to Prescription Drugs: Bulletin 2020-03-06. Health Plan Issuers are requested to make expedited formulary exceptions if the insured is suffering from a health condition that may seriously jeopardize the insured's health or life or if there is a shortage of a formulary drug. Health Plan Issuers are requested to allow insureds to refill prescription medications for up to a 90-day supply or until the prescription expires, if shorter. In addition, Health Plan Issuers are asked to allow for early refills without additional authorization requirements.

  Bulletin 2020 04 21. Newly enacted law, s. 609.205, WI Stats, prohibits Insurers offering disability insurance, defined network plans, and preferred provider plans from requiring prior authorization for early refills of a prescription drug or imposing a limit quantity of prescription drugs that may be obtained if the quantity is no more than a 90-day supply. (4/24/2020)

• Regulatory Filings and Deadline Extensions:  Bulletin 2020 03 19. Department is waiving continuing education requirements for resident licensees that expire on March 31, 2020, for licensees that are unable to complete courses online.

  Bulletin 2020 03 19. Insurers that will not be able meet a filing deadline required by law or the DOI should contact the DOI to discuss alternative arrangements.

  Bulletin 2020 04 02. The DOI is currently NOT granting any extensions for the filing deadline (June 1, 2020) for the Corporate Governance Annual Disclosures.

• Other – Minimum Hours Flexibility and Continuation: Bulletin 2020 03 26. The DOI reminds insurers that they are allowed to work with employers to allow coverage to employees working less than 30 hours per week or placed on furlough and encourages insurers to make this option available to employers. Insurers are also encouraged to work with employers to provide options to continue dental, vision, and prescription drug benefits when offered under separate policies. (4/24/2020)
• Other – Access to Out of Network Services: Bulletin 2020 04 21. Newly enacted law, s. 609.205, WI Stats, requires insurers offering a defined network plan or a preferred provider plan to provide coverage for services, treatment, or supplies for COVID-19 from non-participating providers when there are access limitations to participating providers due to the public health emergency. During a public health emergency when an insured receives services, treatments or supplies from a non-participating provider the plan may not require the insured to pay, including cost-sharing, an amount greater than the insured would have paid if the services, treatment or supplies were provided by a participating provider.
• Other – Prohibition of Discrimination Based on COVID-19: Bulletin 2020 04 21. Newly enacted law, s. 609.205, WI Stats, prohibits insurers offering health benefit plans, defined network plans, or preferred provider plans from establishing rules for eligibility that are based upon a suspected, current, or past diagnosis of COVID-19. Coverage may not be canceled, a rate filing may not be modified, nor may a grace period be refused on the basis that an insured is suspected of, or has a current or past diagnosis of, COVID-19. (4/24/2020)

Wyoming

DOI website (no dedicated COVID-19 page)

Department Guidance

• Department Resources and Functions: The majority of the Wyoming Insurance Department (Department) will be teleworking from home by order of the Governor. The office will remain open to the public until the Department of Health decides otherwise. 
• Cost Sharing Waivers for COVID-19 Coverage:Bulletin 20-01. Health insurers should waive any cost-sharing for laboratory diagnostic testing for respiratory, syncytial virus (RSV), influenza, respiratory panel test, and COVID-19. In addition, health insurers are also asked to waive the cost-sharing for an office visit and urgent care center associated with the above testing as well as for an emergency room visit with testing for the above. This waiver is applicable to in-network and out-of-network providers, facilities, and laboratories. 

   

  Informational Bulletin 06-10-2020. Regarding the three types of available COVID-19 tests (PCR tests, antigen tests, and antibody tests), the Department expects carriers to cover PCR tests and antibody tests when a patient’s symptoms indicate the medical need to conduct a test. The Department anticipates that insurers will cover antibody tests only when such tests are medically necessary in order to support diagnosis or treatment for COVID-19 or for treatment of another disease when information about COVID-19 antibodies may impact the future outcome of that treatment for an individual. These tests must be prescribed by a physician and cannot be merely requested by a consumer. (06/26/2020)

   

• Telehealth:Bulletin 20-01. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand and to liberalize telehealth benefits.
• Regulatory Filings and Deadline Extensions: Health Insurers were required to send COVID-19 coverage plans to the DOI by March 18, 2020.