03/19/2020

ODI bulletin: Access to Coverage for Ohioans Impacted by the COVID-19 Virus

Telemedicine coverage by health insurers

The Ohio Department of Insurance (ODI) issued Bulletin 2020-02 (Access to Coverage for Ohioans Impacted by the COVID-19 Virus) on March 11, 2020, notifying companies of their obligations to ensure access to the health care services to test and treat COVID-19.

For health insurance, ODI reminded health insurers of certain coverage obligations, such as the following:

• To apply a prudent layperson standard to emergency services related to COVID-19 and related symptoms
• To evaluate the appropriateness of utilization management techniques as applied to the testing or treatment of COVID-19
• To encourage health insurers to cover telemedicine, and where telemedicine is covered, to cover telemedicine services related to COVID-19 testing and treatment

  • Telemedicine - Issuers that provide coverage for services delivered via telemedicine are expected to provide such coverage for COVID-19 testing and treatment. Issuers that do not currently provide this coverage are encouraged to implement early adoption of the Ohio law requirements effective January 1, 2021. Under those requirements, issuers are prohibited from excluding coverage for a service that is otherwise covered under the health plan solely because it is delivered as a telemedicine service. Issuers are also required to cover telemedicine services on the same basis and to the same extent that the plan provides coverage for in-person services.

• To afford insureds the opportunity to appeal claims denials and to request external review
• To ensure that provider networks are adequate to handle testing and care for COVID-19
• To provide both standard and expedited formulary exceptions for non-formulary drugs; and to authorize extended supplies as medically appropriate
• To keep consumers informed about available benefits, to ensure that nurse helplines are appropriately staffed, to respond timely to inquiries, and to make necessary and useful information available on their website

As to travel insurance, ODI Bulletin 2020-02 states that unless a specific exclusion encapsulating COVID-19 applies, a travel insurance policy that covers sickness, accident, disability or death must cover all risks related to COVID-19 according to the terms of the policy.

Importantly, ODI instructed insurers that any insurer unable or unwilling to comply with the recommendations made in the bulletin above must inform the ODI of the reasons for its inability or unwillingness to comply within five working days from the effective date of this Bulletin, so by March 18, 2020.