The preliminary reported impact of COVID-19 on ACA premiums
This paper examines the reported impact of COVID-19 on preliminary rate filings among six states and D.C. that have been publicly released as of June 15, 2020.
In the interest of public safety and the protection of residents, State Departments of Insurance (“Department” or “DOI”) have issued special rules, regulations, and guidance for insurers related to the COVID-19 pandemic. The scope of this report is limited to such information applicable to life, accident and health insurance only and focuses the impact that COVID-19 regulatory actions have on product administration, including the following primary topics:
Additional information is provided where state guidance expands beyond these eight categories. The chart below is organized by state and the relevant topics for each state are identified by the bolded, underlined text. Where possible, we have provided links to the relevant sources. The Interstate Insurance Product Regulation Commission (Insurance Compact) also has a COVID-19 resource page with significant information related to resources and filings. For a full PDF version of all jurisdictions with embedded links, please contact email@example.com.
IMPORTANT: The information provided herein is not intended to be a comprehensive compilation of all state rules, regulations, and guidance related to COVID-19. Readers should review the linked sources for complete information on the categories covered and refer to the Department website links provided for guidance on other topics. Additionally, state regulatory responses to the COVID-19 pandemic are constantly evolving. As such, this document may need revision to account for changes in Department positions. We intend to provide updates as they become available; please refer to the date above, which represents the most recent revisions. This document is prepared and maintained by Stacy Koron, Taylor McKinnon, and Stephen Tabachnick in Milliman’s Tampa office. You may reach Stacy at firstname.lastname@example.org.
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
DOI website (no dedicated COVID-19 page)
Order R20-04. Insurers may request filings originally submitted as File and Use be treated as Prior Approval if their company experiences operational challenges due to COVID-19. The division reserves the right to treat File and Use filings as Prior Approval if deemed necessary by the director.
Bulletin 21-2020 establishes a 45-day moratorium on cancellation or nonrenewal for premium nonpayment for policyholders who have been diagnosed with COVID-19 or who have been laid off or lost business as a result of the pandemic. (5/15/2020)
Bulletin 23-2020. The Department reminds all health insurance carriers offering health insurance plans, including short-term limited-duration insurance plans that they must comply with the reimbursement requirements for healthcare services provided through telemedicine found in Ark. Code Ann. § 23-79-1602(c) and (d). (5/15/2020)
Bulletin No. 24-2020. The Department directs all health insurance carriers offering health insurance plans, including short-term limited-duration insurance plans to suspend random audits of pharmacies and to suspend the requirement that pharmacy plan beneficiaries sign for the rendering of pharmacy services. (05/15/2020)
Bulletin 23-2020. The Department directs all health insurance carriers offering health insurance plans, including short term limited-duration insurance plans, to suspend payment audits of hospitals and healthcare providers for 45 days effective May 05, 2020. (05/15/2020)
Bulletin B-4.107. Carriers are directed to defer the triggering of a grace period for policyholder nonpayment of premium, and are urged to extend premium deferrals and premium due dates, accept partial payments, establish payment plans, and waive late fees or other penalties in order to ease consumer hardship. (4/24/2020)
Emergency Regulation 20-E-07. Treatment of COVID-19 is subject to the provider reimbursement requirements, in-network benefits, direct payment rules and consumer protections against balance billing under Colorado law. (4/24/2020)
Bulletin No. B-4.108. Health insurance companies must utilize both in-network and in-state out of network laboratories to process COVID-19 tests with no cost share by the covered person. Additonally, the carrier must reimburse any in-state out of network laboratory used to process COVID-19 tests in accordance with Colorado laws relating to emergency medical services. Carriers shall also cover cost sharing where licensed health care providers are administering testing for COVID-19, including in-network urgent care center settings, emergency room settings, and nontraditional care settings. (5/08/2020)
Bulletin No. FS-36. First quarter financial report deadline has been extended to June 15, 2020 (previously May 15). The due date for annual statement supplements has also been extended to June 15, 2020.
Bulletin No. HC-90-20A. State extended ACA filings; the due date for such filings until July 6, 2020 for forms and July 20, 2020 for rates.
Bulletin No. FS-38. For Domestic companies, the Department is willing to extend financial reporting deadlines for certain required hard copy filings by up to 90 days by request and subject to Department approval. If your domestic company believes that it will not be able to meet any of the filing deadlines listed in this bulletin, please contact the Department at email@example.com to submit a request for waiver of the filing deadline. (5/08/2020)
Bulletin No. FS-39. For Foreign companies, the Department is willing to extend financial reporting deadlines for certain required hard copy filings by up to 90 days by request and subject to Department approval. If your foreign company believes that it will not be able to meet any of the filing deadlines listed in this bulletin, please contact the Department at cid.foreignFinRegFilings@ct.gov to submit a request for waiver of the filing deadline. (5/08/2020)
Bulletin No. HC-81-20A. The Department is removing a recently established requirement for rate filing submissions which obligated health insurers to include a demonstration of compliance with non-quantitative treatment limitations (NQTLs). This demonstration of compliance requirement has been removed due to the pandemic. (05/15/2020)
According to the Department's COVID-19 Website, the Quarterly Comprehensive Health Reporting (QCH) filing deadline for the first quarter of 2020 has been extended from May 15 to June 15, 2020. (5/15/2020)
Directive 20-EX-4. Insurers are also requested to reimburse labs which are testing for COVID-19 at an in-network rate.
Bulletin 2020-11. New Department rules establish a 30-60 day premium payment deadline extension in certain circumstances during COVID-19. (4/24/2020)
Bulletin 2020-11. New Department rules require coverage of off-formulary prescriptions if there is a shortage of a covered formulary drug, and require coverage of a 90-day supply of covered maintenance medications. (4/24/2020)
Department Guidance 04-30-2020. In order to assist hospitals and healthcare facilities with focusing resources on the pandemic, insurers are required to waive preauthorization for various inpatient services and patient facility transfers. (5/15/2020)
Emergency Rule 37. All health insurance issuers shall evaluate differences in cost-sharing responsibilities for their insureds seeking in-network and non-network care and ensure that patients in areas in which in-network surge capacity is exceeded are not subject to unreasonable cost sharing requirements due to access limitations.
ME BOI Emergency Response Order 03-27-2020. Carriers are required, when requested by an employer, to suspend the application of any group health plan contract provision that terminates coverage when an eligible employee is no longer actively employed by the group policyholder, provided that the employer’s offer of continued coverage is made to all affected employees on a nondiscriminatory basis.
Emergency Response Order 03-20-2020. Coverage of telehealth is expanded to include “audio-only telephone,” which had previously been excluded in Maine statutory definition of telehealth.
For all other individual and group policyholders - Until at least June 1, 2020, carriers must provide relief from premium cancellation to any individual policyholder not receiving APTC and to any small or large group policyholder, if the policyholder applies to the carrier for such relief and certifies that the policyholder’s inability to make timely premium payment was the result of hardship arising out of the COVID-19 pandemic.
Bulletin 2020-13. The Division expects carriers will provide coverage for medically necessary emergency department and inpatient services rendered by out-of-network acute care hospitals without prior authorization requirements. (5/08/2020)
Bulletin 2020-15. The Division expects carriers to forego prior authorization for any scheduled surgeries and behavioral health or non-behavioral health admissions at acute care and mental health hospitals for a period of 60 days. This bulletin applies to all inpatient treatment, both COVID-19 and non-COVID-19. (5/08/2020)
Bulletin 2020-16. Carriers may develop utilization review systems that apply to COVID-19 tests, provided that they are consistent with the provisions of MGL c. 176O. (5/22/2020)
Bulletin 20-07. The DOI waives telehealth provider licensing requirements and encourages carriers to expand coverage for telehealth services. Bulletin 20-15 extends the provisions of Bulletin 20-07 through June 15, 2020. (5/15/2020)
Bulletin No. 20-07. Network providers should be encouraged to utilize telehealth services. Carriers are required to update telehealth policies to include telephone-only services.
Insurance Circular Letter No. 7 (2020). All insurance entities are urged to allow consumers to defer payments at no cost, extend payment due dates, or waive late or reinstatement fees which will avoid a lapse in coverage.The NY DFS also issued a model notice for life insurers and fraternal benefit societies regarding extended grace periods. Guidance regarding this notice can be found here and here.
Regulation 216. The Department has issued emergency rules relating to grace periods and premium repayments, which are extended by 30 days by Executive Order 202.28. (5/15/2020)
Insurance Circular Letter No. 10 (2020). The NY DFS has adopted the 60th Amendment to Regulation 62 which prohibits health insurers from imposing cost-sharing for mental health services rendered by in-network providers on an outpatient basis for essential workers, regardless of whether the services are provided by telehealth. (5/08/2020)
Insurance Circular Letter No. 11 (2020). Issuers are directed to comply with the requirements of the 57th Amendment of Insurance Regulation 62 for COVID-19 testing covered under comprehensive health insurance policies and contracts and provided to nursing home and adult care facility personnel covered under the policy or contract consistent with EO 202.30, including the prohibition on cost sharing for such testing. 05/22/2020)
Issuers are directed to ensure that, as applicable, their telehealth programs with participating providers are robust and will be able to meet any increased demand. NY DFS Insurance Circular Letter No. 3 (2020) (issued 03-02-2020).
58th Amendment to Insurance Regulation 62. During the state of emergency related to COVID-19, no policy or contract delivered or issued for delivery in this State that provides comprehensive coverage for hospital, surgical, or medical care shall impose, and no insured shall be required to pay, copayments, coinsurance, or annual deductibles for an in-network service delivered via telehealth when such service would have been covered under the policy if it had been delivered in person. (05/22/2020)
Deferral Order. Insurers are ordered to provide a 30-day deferral of premiums due if requested by an insured. Extended Order 04-21-2020 extends the deferral order to 05/27/2020. See also Bulletin 20-B-07. (4/24/2020)
NC statutes section 58-3-228 requires health benefit plans to cover one early refill of a prescription drug, or to fill one replacement prescription of a drug that was recently filled, during disasters in the state (see Bulletin Number 20-B-04).
Bulletin 2020-10. Regarding the three types of available COVID-19 tests (PCR tests, antigen tests, and antibody tests), the Department expects carriers offering health benefit plans to cover PCR tests and antigen tests designed to detect the presence of COVID-19 when a patient’s symptoms indicate the medical need to conduct a test. The Department expects carriers to cover antibody tests only when they are FDA-authorized and are deemed medically necessary by a health professional. (5/22/2020)
ODI Bulletin 2020-05. Testing and treatment for COVID-19 shall not be subject to preauthorization requirements.
Emergency Order 2020-05-05. For health insurers offering coverage other than accidental death and dismemberment, disability, and long term care policies, Emergency Order 2020-03-25 is terminated and replaced with this order. This order requires health insurers offering coverage other than accidental death and dismemberment, disability, and long term care policies to provide a minimum 60-day grace period for premium payments, suspend all involuntary cancellations and nonrenewals, and pay claims incurred during the first month of the grace period. (5/08/2020)
Executive Order 36. Health insurance carriers are urged to provide coverage for the delivery of clinically appropriate, medically necessary covered services via telemedicine to all providers, irrespective of network status or originating site. (5/22/2020)
TDI Bulletin B-0025-20. The Department encourages health insurers, health maintenance organizations (HMOs), and utilization review agents to extend prior authorizations for elective procedures authorized before the Governor’s executive order on March 22, 2020, directing a postponement of those procedures. (5/15/2020)
TDI Bulletin B-0024-20. The TDI will delay collection of 2019 mandated health benefits cost and utilization data from health benefit plan issuers to 2021. At that time, health benefit plan issuers will report data from 2019 and 2020. (5/08/2020)
TDI Bulletin B-0005-20. Insurers are encouraged to waive penalties, restrictions, and claims denials for necessary out-of-network services.
Bulletin 2020-13. The Department interprets the federal FFCRA and CARES Act (both of which require coverage for COVID-19 testing without cost sharing, in various settings and circumstances) as applying to all insurers that offer group or individual health benefit plans in Utah. (5/15/2020)
Emergency Rule H-2020-03-E. Health insurers shall cover medically necessary prescription drugs in connection with services for COVID-19 with no cost sharing.
Emergency Order No. 20-04. Regulated Entities must pay all claims for services that are rendered to enrollees during the first thirty days of the grace period, that are covered under the terms of the health plan and current law then in effect. (5/01/2020)
Emergency Proceeding 20-EO-07. Health insurers must provide benefits for diagnostic testing of COVID-19 without cost sharing for all individuals who reside or work in nursing homes in the state of West Virginia, and for all individuals who reside or work in assisted living residences and residential care communities licensed by the DHHR Office of Health Facility Licensure and Certification (OHFLC). The Insurance Commissioner will take a non-enforcement position regarding midyear plan changes, so long as those changes are made to provide increased coverage for services related to the diagnosis and treatment of COVID-19. (5/15/2020)
Emergency Proceeding 20-EO-08. Health insurers must provide benefits for diagnostic testing of COVID-19 without cost sharing for all individuals who work in child care centers licensed by the DHHR’s Bureau for Children and Families. The Insurance Commissioner will take a non-enforcement position regarding midyear plan changes, so long as those changes are made to provide increased coverage for services related to the diagnosis and treatment of COVID-19. (5/15/2020)
Bulletin No. 20-07. The Department does not intend to extend the deadline for insurance premium tax payments (due April 15, 2020), the deadline for health insurers to file their Annual Grievance Reports (March 31, 2020) or the deadline for supplemental filings to Annual Statements (April 1, 2020). Companies should contact the DOI if extensions are needed.
Bulletin 2020 04 21. Newly enacted law requires insurers offering disability insurance, defined network plans, and preferred provider plans to cover testing for COVID-19 without copayment or coinsurance if the plan or policy includes coverage for testing of infectious diseases.
Bulletin 2020 04 21. Newly enacted law, s. 609.205, WI Stats, prohibits Insurers offering disability insurance, defined network plans, and preferred provider plans from requiring prior authorization for early refills of a prescription drug or imposing a limit quantity of prescription drugs that may be obtained if the quantity is no more than a 90-day supply. (4/24/2020)
Bulletin 2020 03 19. Insurers that will not be able meet a filing deadline required by law or the DOI should contact the DOI to discuss alternative arrangements.
Bulletin 2020 04 02. The DOI is currently NOT granting any extensions for the filing deadline (June 1, 2020) for the Corporate Governance Annual Disclosures.
COVID-19 life and health insurance regulation update
State Departments of Insurance have issued special rules, regulations, and guidance for insurers related to the COVID-19 pandemic. The scope of this report is limited to such information applicable to accident and health insurance only and focuses the impact that COVID-19 regulatory actions have on product administration.