Coronavirus Health Insurance Benefits

Leaders of the major health insurance companies in the U.S. agreed to expand insurance benefits related to Coronavirus/COVID-19, in a historical meeting held at the White House yesterday (March 10, 2020).  Present at the meeting were executives from:

• Aetna
• Blue Cross Blue Shield (BCBS) Association (representing the 36 BCBS plans throughout the nation, including Anthem)
• Cigna
• Humana
• UnitedHealth Group (aka United Healthcare)

Collectively, the insurers/administrators in attendance provide coverage/services to over 240 million Americans.  As an insurance broker/consultant, we’re beginning to see details trickle in from all of our carrier partners, relative to this announcement.  It’s important to note that each insurer and plan may have a different nuance to how they’re addressing the agreed upon expansion of benefits.  Accordingly, readers are encouraged to check with the appropriate contact for guidelines particular to affected plans.

Here’s what we know so far, but we’ll certainly be monitoring the situation closely, and providing additional information as it becomes available.

1. The agreement addressed the waiver of so called plan related “cost sharing”.  Health insurance cost sharing comes in many forms including copays, deductibles, and coinsurance.  Not all plans look or function the same, so this benefit relaxation will apply differently, depending on the type/style of plan one has (e.g., HMO, PPO/Traditional Copay, PPO/HDHP, PPO/HSA/HDHP etc.).
2. Related to the aforementioned “waiver of plan related cost sharing”…the IRS released guidance today (March 11, 2020) allowing otherwise ineligible HSA qualified High Deductible Plans (HDHP) to waive the deductible for testing and treatment of coronavirus.  Here’s the actual text within the guidance – “The IRS guidance states that high deductible health plans with health saving accounts will not lose their plan status if they provide medical care services and items related to the testing or treatment of the coronavirus prior to a plan member meeting the deductible. It provides employers and insurers with flexibility to cover those services without cost-sharing”.
3. Insurers and employers may allow early refills of necessary prescription drugs, and encourage the use of 90-day retail and mail order fills.
4. Insurers and employers may waive plan related cost sharing and/or fees associated with tele-health (aka virtual healthcare, tele-doc, tele-medicine), allowing for remote care.  Some insurers/plans that have not previously offered tele-health may begin doing so immediately to expand access to care/treatment.
5. Insurers/Administrators may waive prior authorization requirements that might otherwise apply to treatment options for coronavirus/COVID-19.
6. There was a reference to “no surprise billing” for services related to coronavirus/COVID-19. This term has different meanings, depending on the plan and situation.  Suffice to say, we believe for purposes of testing/treatment of coronavirus/COVID-19 it means that the cost of services provided by non-contracted/Non-PPO providers will not be exorbitant, or appreciably higher than the fees billed by contracted/PPO providers.

Importantly, there was no announcement or agreement relative to costs associated with quarantining patients.  As a general rule, most health insurance plans would exclude coverage/benefits for quarantining.  In this instance, the announcement would give insurers/employers the option of providing coverage and waivers of cost sharing for medically related treatment received while quarantined.

The announcement clearly extends these benefit expansions to private/fully-insured plans (e.g., individual, small group, large group, etc.), Medicare, Medicare Advantage, and Medicaid.  However, self-insured employer plans have decision making authority over these coverage expansions; so again, we encourage affected individuals to check with their health insurance benefit representatives for clarity and guidance.

Finally, the Centers for Disease Control and Prevention (CDC) has released detailed guidance to assist employers with planning/preparing/responding to coronavirus/COVID-19.  Here is a link to this valuable guidance – https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fspecific-groups%2Fguidance-business-response.html

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