HARRISBURG – Gov. Tom Wolf announced today that the Pennsylvania Insurance Department, in collaboration with the Department of Health, is submitting for publication a notice to the Pennsylvania Bulletin outlining proactive steps and recommendations for consumers and major health insurers to help mitigate the potential impact of COVID-19 in Pennsylvania.
“The commonwealth remains laser-focused on mitigation of COVID-19,” Wolf said. “Posting these recommendations for health insurers further reinforces our commitment to making sure all Pennsylvanians have the health care they need during this uncertain time.”
“Health insurance coverage plays a critical role in the affordability and access to health care services,” said Insurance Department Commissioner Jessica Altman. “We must all be prepared to address this public health crisis, and that includes continually assessing and making adjustments to increase access to necessary care for Pennsylvanians.”
The Pennsylvania Bulletin is akin to a guidebook for proposed rules and regulations for state agencies and is regarded as the prime source for timely information.
Notice Regarding Coronavirus (COVID-19) Insurance Coverage, provides several recommendations for health insurers, including:
- Providing access to accurate information, informing insureds of available benefits and quickly responding to inquiries about coverage.
- Providing telehealth delivery of services instead of in-person health care services and being prepared to meet any increased demand for that means of delivery.
- Verifying provider networks are adequate to handle a potential increase in the need for health care services related to COVID-19.
- Easing preauthorization requirements, so that they are not a barrier to access necessary treatment for COVID-19, and being prepared to expedite utilization review and appeal processes for services related to COVID-19.
- Easing access to prescription drugs, making expedited formulary exceptions, and permitting the temporary use of out-of-network pharmacies (at in-network cost-sharing) in the event of medication shortages at in-network pharmacies.
Major health insurers in Pennsylvania have announced they are taking the necessary steps to cover medically appropriate COVID-19 diagnostic testing and associated treatment for consumers, and have committed to waive any cost-sharing for the testing.
This increased access to testing is especially critical as multiple commercial medical labs are in the process of implementing testing capabilities and some have begun to perform tests.
“All of the major insurers in Pennsylvania’s market have already stepped up and made proactive announcements to ensure access to medically recommended health care services and testing related to COVID-19,” added Altman.
“This bulletin further outlines areas where I am asking insurers to be vigilant and take additional steps as needed in their responses to COVID-19.”
The department encourages patients to be aware of steps their insurance company is taking to increase access to necessary care related to COVID-19.
Consumers with excepted benefit policies, short-term, limited duration health insurance coverage, and or health care sharing ministries, need to understand these plans can have significant limitations on coverage and may not provide the same level of access.
Self-funded coverage, which is not within the department’s regulatory jurisdiction, may also have different limitations. However, the department is encouraging health insurers to coordinate closely with the business they administer on behalf of employers who self-fund their health benefits to ensure consistency in access across all forms of coverage.
“The opportunity to conduct in-state testing without putting the financial burden on consumers allows us to better identify those at risk,” said Secretary of Health Dr. Rachel Levine.
“Removing the financial consumer obligations associated with tests and care will allow more individuals with symptoms to come forward and be tested.”
The Insurance Department, in partnership with the Departments of Health and Human Services, developed an FAQ that provides information and answers to common questions related to insurance coverage and COVID-19.
For up-to-date information on COVID-19 in Pennsylvania, visit the PA Department of Health’s dedicated Coronavirus webpage that is updated daily.
The Pennsylvania Insurance Department has a consumer services team available to answer questions about insurance coverage and benefits at 877-881-6388. PID may also provide assistance if a consumer receives an unexpected bill related to COVID-19, or other health care services.