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COVID-19 State Regulatory Reaction

Many states have been issuing emergency alerts, orders, and bulletins requiring insurers to comply with new emergency regulations regarding COVID-19 (coronavirus outbreak). The situation is changing daily.

At least 49 jurisdictions have published advisory notices/regulations and or declared a public health emergency or a national disaster emergency. They are : AL, AK, AZ, CA,CO, CT, DE, DC, FL, GA, HI, IL,IN. KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM , NY, NC, ND, OH, OK, OR , PA, PR, RI, SC, SD, TN, TX, UT, VT, WA, WV, WY.

Some of the recent requirements are summarized below:

  • Notification: Requirements to send notices out to the insureds keeping them informed; and/or requirements to send notice to the DOI on the actions the carrier is taking to ensure health needs are met
  • Grace Period: extending the grace period from 30 days to 90 days
  • Waiver of Deductibles for testing
  • Site of Testing: Coverage for testing services regardless of any site of service or network participation requirements
  • Telemedicine: insurers cannot deny coverage simply because it was provided via telemedicine
  • Network Adequacy and Access to out of Network Services: Health carriers must provide access to an out of network provider in the event the in-network providers are not adequate to handle the increase need for health care.
  • Utilization Review: Carriers must not let pre-authorization requirements be a barrier to access to necessary testing. take steps to minimize the extent of a require pre-authorization
  • Prescription Refills: Carriers must ensure members have continuous access to prescription medication

Multiple message have been posted in SERFF:

  • Kansas stated that the deemer clause has been suspended.
  • Michigan advised that they are committed to continued review of SERFF filings even as staff are working remotely.
  • Pennsylvania is requesting that insurers { voluntarily) withdraw any filing that is not necessary and essential to an insurers operation.
  • New Mexico is requiring any insurer who has underwritten an excepted benefit plan on a group or individual basis must send a notice out to their insureds advising them that the plan is limited in nature and may not provide sufficient protection. Information must be given on how to obtain major medical coverage.

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