On January 15, 2021, Director Wing-Heier issued orders R21-01, R21-02, R21-03 and R21-04. These emergency measures were issued following the governor’s extension of his public health disaster emergency order regarding COVID-19.
R21-01 requires insurers to waive any cost sharing for laboratory diagnostic testing for respiratory syncytial virus, influenza and COVID-19. It also requires insurers to cover telehealth service categories no less generously than required by Medicare under the national public health emergency as long the public health emergency is in effect. It requires insurers to allow early refills or replacements of lost or damaged medications and expects this flexibility to continue for the duration of the public health disaster emergency. Insurers are required to allow affected consumers to obtain emergency supplies or refills without applying additional authorization requirements. In addition, consumers must be able to access their necessary prescriptions from a local retail pharmacy even if their prescription supply is normally provided by mail order without concern of a penalty. These requirements do not apply to prescriptions containing opioids. Finally, insurers are required to suspend any contract prohibition of family members providing covered home healthcare services during the public health emergency disaster.
R21-02 requires insurers to allow 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. Insurers shall allow employers to continue providing coverage to employees under group policies regardless of any “actively at work” or similar eligibility requirement in the policy. Additionally, insurers are not allowed to increase premium rates or terminate a group policy based on a group’s decreased enrollment or participation due to COVID-19 during a plan year.
R21-03 requires insurers to cover infusion therapies intended to treat COVID-19, cover the vaccine administration at zero cost sharing, and recognize any provider offering the vaccine consistent with a state vaccination program.
R21-04 requires insurers to waive any requirements for location-based credentialing and pay claims for covered services when consumers are billed for services located at, sponsored by or facilitated by the local, state or federal government during this pandemic until such alternate sites are closed.
The orders are effective on January 15, 2021, and expire on February 14, 2021, or until the governor declares that the public health emergency is over.
Employers with plans regulated by the state should be aware of these orders.
R21-01 » R21-02 » R21-03 » R21-04 »
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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