The Texas Department of Insurance (TDI) encourages issuers of alternative health plans to consider taking the following actions, as applicable, related to prevention, testing, and treatment of COVID-19:
- Waive copayments, co-insurance, and deductibles for COVID-19 testing that is consistent with guidance issued by the Centers for Disease Control and Prevention (CDC), and cover the full cost to get the test and related testing services.
Note that the federal Families First Coronavirus Response Act (H.R. 6201) and the more recent Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (H.R. 748) require covered plans to provide COVID-19 testing at no cost to the consumer.
- Waive consumer cost-sharing and facilitate expanded use of telemedicine.
- Cover necessary medical equipment, supplies, and services.
- Waive penalties, restrictions, and claims denials for necessary out-of-network services.
- Waive requirements for preauthorization, referrals, notification of hospital admission, or medical necessity reviews for care consistent with CDC guidance.
- Allow extra time for health providers and facilities to file claims.
- Authorize payment to pharmacies for up to a 90-day supply of any prescription medication for individuals, regardless of when the prescription was filled.
- Waive copayments, co-insurance, and deductibles for qualifying coronavirus preventive services as defined under the CARES Act.
Provide information to consumers
Issuers of alternative health plans should develop consumer materials, such as a resource page on a plan’s website, to explain coverage for COVID-19 testing and treatment under the plan and related information.
Report your actions
TDI asks that issuers of alternative health plans, other than self-funded employer plans, report their actions related to COVID-19 to COVID19Response@tdi.texas.gov. Send updates as they become available. We will make this information available to health-care providers and consumers on the coronavirus resource page on the TDI website.