posted by AHIP
on March 9, 2020
The health and well-being of people comes first, as our country prepares for the possibility of widespread infection from COVID-19 and takes action to mitigate the impact. Health insurance providers are taking decisive action to help prevent the spread of COVID-19, to ensure that people have coverage for and access to needed testing, and to help patients who are infected receive the care and treatment they need. The AHIP Board of Directors has committed to helping America’s powerful health care system meet the challenges posed by COVID-19.
Below are frequently asked questions of health insurance providers on COVID-19. Visit this site for announcements from individual health insurance providers.
Health insurance providers routinely cover diagnostic lab tests consistent with an individual’s health insurance coverage. Initially, COVID-19 testing was available only from CDC and public health departments, with the government covering the cost.
As testing becomes available from CLIA-certified labs and commercial labs, health insurance providers will cover the tests for their enrollees consistent with the terms of their plans and any emergency plans they have in place.
Several labs are gearing up to make diagnostic testing much more widely available in the coming days and weeks including, for example, LabCorp, Quest Diagnostics, and Co-Diagnostics. Health insurance providers are working with their state and local health departments to learn what facilities have been approved for testing.
Health insurance providers may choose to waive cost sharing associated with commercial lab tests, and some states have required state-regulated health insurance plans to waive certain costs. People with questions about their coverage should contact their health insurance provider.
CDC supports testing a wide group of symptomatic and asymptomatic patients, when referred to testing by a doctor. Clinicians are advised to use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested, based on the local impact of and exposure to COVID-19, as well as the clinical course of illness.
Health insurance providers continue to cover medically necessary health care costs to treat infectious diseases, including COVID-19, based on the terms of an individual’s insurance plan. At this time, there is no specific antiviral treatment or vaccine for COVID-19. People should receive care from their doctor to help relieve symptoms as they would other viral respiratory infections.
Vaccines are an essential and highly effective way to prevent infectious disease in large populations. Unfortunately, a vaccine for COVID-19 is not yet available.
Health insurance providers cover vaccines recommended by CDC’s Advisory Committee on Immunization Practices (ACIP). At this time, ACIP has not provided guidance on a future vaccine for COVID-19. If and when ACIP recommends a vaccine, it will be covered similar to other vaccines.
Most of these supplies are not currently covered by insurance plans or reimbursed by insurance providers. Some of these supplies may be included in the services provided by home care providers under an individual’s insurance coverage for certain medical conditions currently under treatment, such as wound care.
In general, health insurance providers cover emergency transport as medically necessary within the terms of the health plan contract.
Health insurance providers will likely incur these costs, but based on experiences with past epidemics, they may not be able to negotiate payment based on in-network rates.
Yes. Hospital quarantine stays for enrollees diagnosed with COVID-19 will be covered in accordance with the terms of the individual’s health insurance coverage.
This will depend on each individual’s coverage and if telemedicine is part of their benefits. Health insurance providers are proactively communicating with the people they serve about the telehealth services available to them.
At this time, health insurance providers have not seen an increase in such requests. However, insurance providers have emergency plans for global pandemics that allow for changes in their practices. Any modifications are carefully implemented to consider the risks of medications being misused, misplaced, or expiring. Health insurance providers are carefully monitoring COVID-19 developments and may make adjustments to policies as appropriate.
At this time, treatment of COVID-19 is being addressed in the same manner as other viral respiratory infections, in accordance with the terms of an individual’s insurance plan. However, health insurance providers have emergency plans for global pandemics that allow for the modification of their practices. Any modifications are carefully implemented to balance access to care with ensuring patient safety and evidence-based medicine. Health insurance providers are carefully monitoring COVID-19 developments and will make necessary modifications accordingly.
At this time, COVID-19 is being treated like other viral respiratory infections and any cost-sharing and/or deductible obligations would be in accordance with the terms of an individual’s insurance plan. Health insurance providers have emergency plans in place for global pandemics that allow for the modification of their practices. Health insurance providers are carefully monitoring COVID-19 developments, and may modify their coverage determinations accordingly. Insurance providers will also apply deductible and/or cost-sharing requirements in accordance with federal and state guidance.
Referrals should not be required for patients seeking treatment for COVID-19. Typically, referral requirements depend on which labs are designated to do diagnostic testing and if the insurance provider has a contract with that lab. As diagnostic tests for COVID-19 become more widely available, patients should have access to tests when ordered by their doctor.
If a person has short-term disability coverage and is unable to work because of a confirmed COVID-19 infection or another illness while quarantined, disability income protection insurance providers will consider a claim and the claimant may qualify for benefits.
An individual under quarantine who is not disabled by COVID-19 symptoms or symptoms of another illness will not meet the definition of “disabled” under disability income protection policies. In such cases, insurance providers may be able to work with employers and employees to support working remotely.
Private disability income protection policies are designed to be integrated with the sick leave and paid time off benefits that employers provide to employees. In many cases, employees would continue to receive salary during a two-week quarantine period.
In the event of a serious pandemic during which employers are compelled to close workplaces, many employers may choose to continue to pay salaries during the closure.
Health insurance providers are working directly with the CDC and health experts across the nation to share information, mitigate health risks to Americans, and keep Americans informed. For example, insurance providers are: