Further to our previously issued insurance Legal Alerts concerning potential coverage for coronavirus-related claims, we now focus on recent action by insurance regulators—in particular, Maryland.
We previously reported that New York and New Jersey have taken extraordinary measures. The New York Department of Financial Services recently mandated insurers to provide a COVID-19 “Explanation of Benefits” for all business interruption coverage. The New Jersey insurance regulators now require business interruption insurers under its control to provide coverage for COVID-19, regardless of regulator-approved “virus” exclusions in the policies.
As New York and California regulators, among others, have done in mandating full coverage for the cost of coronavirus consultation, testing, and treatment, including remote telehealth services, Maryland has now become active by enacting legislation with respect to health insurance carriers as a result of COVID-19. The following new regulations, issued by Governor Larry Hogan to control the spread of the COVID-19 virus, are now in effect:
- Health carriers must waive any cost-sharing, including co-payments, coinsurance, and deductibles, for any visit to diagnose or test for COVID-19, regardless of the setting of the testing. For example, the test could be given in an emergency room, a physician’s office, or an urgent care center.
- Health carriers must waive any cost-sharing for laboratory fees related to COVID-19.
- Health carriers must waive any cost-sharing for COVID-19 vaccinations.
- The Maryland Insurance Commissioner may require a health carrier to pay claims related to COVID-19 that the carrier has denied as experimental.
- A health carrier shall evaluate a request to use an out-of-network provider to test for COVID-19 solely on the basis of whether the test is medically necessary or appropriate.
- Health carriers may only require prior authorization for COVID-19 testing based on medical necessity.
- The Maryland Insurance Administration is instituting an expedited grievance procedure to review adverse decisions on requests for coverage for COVID-19 testing.
Recognizing that the spread of COVID-19 has disrupted supply chains and led to quarantines in areas where it has spread and that individuals who require prescription medications may find that their access to the medications and to health care, in general, is disrupted, Maryland’s Insurance Commissioner, invoking his emergency powers, issued Bulletin 20-05 (March 6, 2020), requiring carriers to waive any time restrictions on prescription medication refills, and to authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date upon which the prescription medication had most recently been filled by a pharmacist. This will allow individuals to obtain medications in advance of any quarantine. In addition, the Commissioner will promulgate emergency regulations to implement the above requirements. Numerous state insurance departments have taken similar action.