BISMARCK, N.D. – Insurance Commissioner Jon Godfread today issued a Bulletin to all North Dakota health and travel insurance companies regarding coverage and access to testing for Coronavirus Disease 2019 (COVID-19). The bulletin urges companies to waive cost sharing requirements for the testing of COVID-19 and encourages health insurance companies to review other operations in preparation for COVID-19 potentially coming to North Dakota.
“Today, we asked our health insurers to waive any cost-sharing, including co-pays, deductibles and co-insurance for COVID-19 laboratory testing so that cost sharing does not serve as a barrier to accessing this important health testing,” Godfread said. “As the situation continues to evolve, North Dakotans should be assured that their health insurers are ready and able to handle this public health challenge. The most important thing we can all do is be prepared. Good hand washing, staying home if you are sick, and contacting your medical providers in the event you do have symptoms will go a long way toward preventing a public health crisis in North Dakota.”
Commissioner Godfread and the Insurance Department have been in contact with North Dakota health insurance carriers and other state and federal partners to discuss potential solutions to address the spread of the COVID-19.
“Our health insurers have assured me that they are prepared and will continue to monitor the developments here in North Dakota and across the country,” Godfread said. “This bulletin is a collaborative effort with our industry and to their credit they have been great partners in making sure North Dakota consumers have access to the testing they need. This has truly been an all hands-on deck scenario, which is to the benefit of North Dakota consumers.”
The bulletin outlines ten measures that the industry will be taking or plans to take as COVID-19 continues to progress. Those points include:
- Preparedness. Health carriers should review their internal processes and operations to ensure that they are prepared to address COVID-19 cases in North Dakota, including providing insureds with information and timely access to all medically necessary covered health care services. As the COVID-19 situation continues to evolve, health carriers should continually assess their readiness and make any necessary adjustments
- Information Access. Access to accurate information and avoiding misinformation are critical. Therefore, health carriers are asked to inform insureds of available benefits, quickly respond to insured inquiries, and consider revisions needed to streamline responses and benefits for insureds. Health carriers should make all necessary and useful information available on their websites and staff their nurse-help lines accordingly.
- Testing for COVID-19. The Department asks health carriers to waive any cost-sharing, including co-pays, deductibles and coinsurance for CDC-recommended laboratory testing of COVID-19 so that the cost sharing does not serve as a barrier to access to these important tests. In addition, health carriers are also asked to waive the cost-sharing for an in-network provider office visit, urgent care center visit and an emergency room visit when testing for COVID-19. Waiving cost-shares may be done on a retrospective case-by-case basis upon a confirmed COVID-19 diagnosis.
- Telehealth Delivery of Services. Given that COVID-19 is a communicable disease, some insureds may be using telehealth services instead of in-person health care services. Health carriers are reminded to review N.D.C.C. § 26.1-36-09.15 regarding the delivery of health care services via telehealth. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.
- Network Adequacy and Access to Out-of-Network Services. Health carriers are asked to verify their provider networks are adequate to handle a potential increase in the need for health care services in the event COVID-19 cases are diagnosed in North Dakota. If a health carrier does not have a health care provider in its network with the appropriate training and experience to meet the particular health care needs of an insured, health carriers are asked to make exceptions to provide access to an out-of-network provider at the in-network cost-sharing.
- Prior Authorization. Health carriers are asked to waive any prior authorization requirements associated with COVID-19 testing or treatment.
- Immunizations. Although a vaccine is not currently available for COVID-19, it has been reported to be in development. In the event an immunization becomes available for COVID19, the Department requests that health carriers immediately cover the immunization at no cost sharing for all covered members.
- Access to Prescription Drugs. Health carriers are asked, where appropriate, to make expedited formulary exceptions if the insured is suffering from a health condition that may seriously jeopardize the insured’s health, life, or ability to regain maximum function or if the insured is undergoing a current course of treatment using a non-formulary prescription drug.
- Surprise Medical Bills. The Department is requesting out-of-network providers and facilities to accept the highest of the health carrier’s in-network reimbursement as full and final payment and to hold harmless insureds who receive surprise medical bills for health care services as it relates to testing and treatment of COVID-19. In order to protect consumers from unexpected out of pocket costs, the North Dakota Insurance Department encourages providers to use the insured’s in-network laboratory facilities.
- Travel Insurance. Unless a travel insurance policy contains an exception applicable to COVID-19, a policy of travel insurance that covers the risks sickness, accident, or death incident to travel presumptively must cover such risks relating to COVID-19. The extent of coverage for health care services, emergency transportation within a foreign country, as well as the costs of returning to the United States for further treatment.
“Our goal right now is to be as prepared as we can possibly be for any potential COVID-19 cases. Preventing and delaying the spread of this virus is a top priority of all levels of government. By working with the health insurance carriers in our state, we can take the necessary steps to ensure people seek treatment when its required and have that access to the coverage they need,” Godfread said.
North Dakotans are encouraged to take the necessary steps to reduce any potential spread of COVID-19. Those steps include:
- Washing hands often with soap and water.
- Covering coughs and sneezes with a tissue.
- Cleaning frequently touched surfaces and objects.Getting plenty of rest, drinking fluids, eating healthy foods, and managing stress can help prevent getting COVID-19 and help recovery from it.
Symptoms of COVID-19 include fever, cough and shortness of breath. The symptoms may appear in as few as two days or as long as 14 days after exposure.
If you develop symptoms:
- Contact your health care provider before going to the hospital, clinic, or emergency room.
- Avoid contact with other people.
- Follow the directions of your provider and public health officials.
For more information please visit www.nd.gov/ndins/bulletins.