Insurance Law Alert

In order to continue to ensure that cost-sharing is not a barrier to consumers receiving screening and testing for COVID-19 as testing procedures expand and develop throughout New Jersey, and consistent with federal guidance implementing the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act2, the Department of Banking and Insurance (“Department”) is expanding the requirements in Bulletin 20-03 to require carriers and other issuers of health benefit plans  to cover, without cost-sharing, without prior authorization or other medical management requirements, any SARS-COV-2 molecular test authorized pursuant to the DOH standing order. This requirement includes such testing, regardless of site as authorized by the DOH Standing Order, including tests administered at any in or out-of-network community-based, county testing, or private testing site, (including, but not limited to, in and out-of-network hospitals, provider offices, urgent care centers, and pharmacies), and includes items and services furnished to an individual during such visits that result in an order for or administration of a SARS-COV-2 molecular test.  Carriers must treat any such test authorized pursuant to the DOH standing order as medically appropriate for the individual.  Carriers must not impose cost-sharing for SARSCOV-2 molecular tests provided by in-network or out-of-network laboratories.  Carriers are also advised to notify, as expeditiously as possible, the carrier’s contracted providers that the carrier is waiving cost-sharing as described above.  Please see the linked bulletin for greater detail.  

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