On the heels of Governor Murphy declaring New Jersey a state of emergency with regard to the COVID-19 (coronavirus), this morning the Commissioner of the New Jersey Department of Banking & Insurance, Marlene Caride, issued Bulletin No. 20-03 to provide guidance to health insurance companies, health maintenance organizations, health service corporations, and other entities issuing health benefit plans in New Jersey on how best to respond to the global coronavirus outbreak. Significantly, in order to assure that cost-sharing does not present a barrier to consumers receiving medically necessary screening and testing for the coronavirus, the Department is advising carriers to refrain from imposing cost-sharing for any emergency room visit at an in-network or out-of-network hospital, any in-network office visit, or any in-network urgent care visit center when the purpose of the visit is to be tested for the coronavirus. Carriers are also instructed to waive any cost-sharing for medically necessary coronavirus laboratory tests provided by in-network or out-of-network laboratories and are further advised to notify as quickly as possible, the carrier’s contracted providers that the carrier is waiving these cost-sharing obligations.
The Bulletin further advises carriers to take certain action to:
- notify their insureds of precautions to be taken in the event of suspected exposure to the coronavirus;
- devote resources to inform consumers of available benefits;
- address network adequacy and access to out-of-network services;
- expedite timely determinations with respect to utilization management;
- provide telehealth medical advice and treatment with regard to individuals who may have difficulty making an office visit where the medical professional believes that a phone call would alleviate the need for a hospital visit;
- cover costs if immunization for the coronavirus becomes available;
- expand access to prescription drugs;
- ensure emergency care; and
- quickly process medical bills for inadvertent out-of-network services in connection with the virus.
Questions regarding the Bulletin should be directed to the Department’s Life Health Bureau at email@example.com.