I’m covered under my employer’s health plan and I’m feeling unwell. If I go to get tested for COVID-19, will it be covered?
In response to COVID-19, New York Governor Andrew Cuomo issued a directive on March 3 requiring commercial fully insured health plans in the state to waive any cost-sharing related to laboratory testing for COVID-19. Self-funded plans are federally regulated and do not have to follow New York State mandates. Some are choosing to opt into this coverage, but are not yet required to do so. Following a meeting with President Trump and Vice President Pence, many leading insurance companies announced that they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost sharing that would otherwise apply to the test. It is important to understand that there are specific criteria that must be met in order for physicians to request the testing be completed. If you present with similar symptoms, but are not tested for COVID-19, the claims may be processed under the applicable medical benefit.
If you suspect that you may need testing, please call your primary care doctor before going there. The same applies to emergency rooms and urgent care centers. Special protocols will need to be followed upon your arrival.
What if I test positive for COVID-19? Will the treatments be covered under my health insurance?
Right now the majority of the legislation has been surrounding the testing for COVID-19. Treatment may be subject to your regular cost sharing arrangement dependent on your plan. Check with your carrier for specifics on how these claims would pay.
I have an HSA and am enrolled in a High Deductible Health Plan (HDHP). Doesn’t that mean that all of my testing and treatment have to apply to my deductible?
The IRS announced that HSA-qualified health plans may cover testing for and treatment of COVID-19, even if participants haven’t reached their deductible. This is still dependent on your specific plan, so please check with your carrier for more information. Previously, the IRS required that these types of services must be applied to the deductible. They are now allowing for this requirement to be waived in light of the COVID-19 pandemic.
I’m on Medicare. Will testing and treatment for COVID-19 be covered?
The President directed CMS to provide more flexibility to Medicare Advantage and Part D Plans to ensure that they have the tools they need to provide seniors with the best coverage. As a result, CMS published a memorandum to Medicare Advantage and Part D health and prescription drug plans informing them of the flexibilities they have to provide healthcare coverage to Medicare beneficiaries for COVID-19 testing, treatments and prevention. The memorandum outlines that Medicare Advantage and Part D plans have to adhere to the following flexibilities:
- waiving cost-sharing for COVID-19 tests
- waiving cost-sharing for COVID-19 treatments in doctor's offices or emergency rooms and services delivered via telehealth
- removing prior authorizations requirements
- waiving prescription refill limits
- relaxing restrictions on home or mail delivery of prescription drugs
- expanding access to certain telehealth services
These waivers break down barriers to beneficiaries accessing care and allow plans to work with pharmacies and providers to treat patients without burdensome requirements limiting their options during this outbreak.
This action is part of the broader effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high risk of complications from the COVID-19 virus – have access to the benefits that can help keep them healthy while helping to contain the spread of this disease. To keep up to date with the important work CMS is doing in response to COVID-19, visit the Current Emergencies Website. To view CMS's memorandum for MA and Part D plans, click here.
NYS DBL, Short Term Disability (STD), Long Term Disability (LTD) and Paid Family Leave (PFL) Coverage
If I contract the coronavirus, will I be covered under NYS DBL or voluntary short/long term disability?
At this time, this is being treated as any other illness or virus. If you are no longer able to perform the major duties of your job due to the sickness, you may be eligible for benefits. Your physician will need to complete their portion of the claim form and attest to the disability. Eligibility will be determined based on medical documentation received by the carrier. Elimination periods and benefit duration limits would still apply as with any other disability claims.
What if I don’t have the coronavirus, but am told that I need to stay quarantined?
At this time, individuals who are quarantined, but are not sick are not eligible for coverage, unless your coverage has a Quarantine Rider on it. Policies written in NYS do not have Quarantine Riders as they are not available in NYS.
What if I don’t have coronavirus, but a member of my family does and I need to care for them? Can I use PFL?
In order to be eligible for Paid Family Leave (PFL), an eligible family member for whom the employee is caring would need to have medical documentation that certifies the individual’s condition as meeting the definition of a serious health condition. Therefore, at this time, a diagnosis without certification by a doctor of a serious health condition, a quarantine order, a need to self-quarantine due to lowered immunity, or the need to care for a child due to school closures would not qualify.
The coronavirus situation continues to evolve and change daily, and the government is proposing changes that may impact the handling of these claims. Because this is a fast-changing event, the U.S. Centers for Disease Control and Prevention (CDC) website continues to be the best resource for up-do-date information. Information about COVID-19 can also be found at the New York State Department of Health’s website. If you live outside of New York state, please check with your state’s health department. We will follow the changes in legislation very closely and make sure to keep you updated so that you can continue to Be Bold, Be Strong, Be Protected, but above all, Be Safe.