On August 31, 2021, Commissioner Anderson issued Bulletin 2021-08. The bulletin provides guidance to insurers on COVID-19 testing, treatment and vaccines. The state of emergency issued by Gov. Baker on March 10, 2020, ended as of June 15, 2021. However, on May 28, 2021 the state issued a declaration of a public health emergency due to the continuing threat of COVID-19. This bulletin clarifies the Division of Insurance’s expectations of insurance carriers since the risk of COVID-19 has not been eliminated.
The bulletin indicates that carriers must continue to cover COVID-19 testing without cost-sharing or utilization management for symptomatic individuals, people identified as close contacts of someone with COVID-19, and asymptomatic individuals as long as the individual qualifies under criteria established by the state’s Secretary of Health and Human Services, the Department of Public Health or the federal government. Specifically, polymerase chain reaction (PCR) tests and antigen tests must be covered.
The bulletin also reminds carriers that they are expected to provide coverage for all emergency, inpatient services, outpatient services and cognitive rehabilitation services related to COVID-19 without the use of a prior authorization process. Additionally, carriers should cover all claims where COVID-19 is listed as a diagnosis without cost-sharing.
Carriers are also expected to provide coverage for all COVID-19 vaccines without cost-sharing or utilization management. While carriers are expected to cover services that may be related to reactions to the COVID-19 vaccine, they can apply cost-sharing since those services are not considered related to the treatment of COVID-19.
The division also expects carriers that are acting as administrators for employer-sponsored self-insured plans to take steps that are consistent with the bulletin’s provisions. Both employers of fully insured and self-insured health plans should be aware of this guidance.
Bulletin 2021-08 »
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