LH BULLETIN NO. 2020-02 (AMENDED)
To: All Life & Health Insurers and Health Maintenance Organizations Licensed in Oklahoma
From: Glen Mulready, Insurance Commissioner
Date: March 17, 2020 (Updated April 29, 2020)
Re: CORONAVIRUS (COVID-19)
The Governor of the State of Oklahoma has issued a Declaration of Emergency. That Executive Order 2020-07 was issued March 15, 2020.
All health carriers, other insurance industry representatives and other interested parties are encouraged to review the latest Oklahoma information about COVID-19 released by the Oklahoma Department of Health. (https://coronavirus.health.ok.gov/).
The Department is issuing this bulletin to assist individuals and entities regulated by the Department in effectuating the provisions of insurance related services during this urgent public health challenge.
The Oklahoma Department of Insurance is directing health carriers providing coverage through health benefit plans to Oklahoma residents to take the following immediate measures related to the potential impact of COVID-19.
- Health carriers shall review their internal processes and continuity of operations, including ability to telecommute, to ensure that they are prepared to address COVID-19 cases in Oklahoma and serve their members, including by 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 shall continually assess their readiness and make any necessary adjustments. This includes notifications to producers and brokers to keep consumers up to date.
- Access to accurate information and avoiding misinformation are critical. Therefore, health carriers shall inform insureds of available benefits specifically related to telemedicine, quickly respond to insured inquiries, and consider revisions needed to streamline responses and benefits for insureds. Health carriers shall make all necessary and useful information available on their websites and staff their nurse-help lines accordingly.
- All health carriers shall not require specific platforms for providers and facilities to perform telemedicine services for the insureds.
- Health carriers shall waive any cost-sharing for COVID-19 laboratory tests so that cost-sharing does not serve as a barrier to access to this important testing. In addition, health carriers shall also waive the cost-sharing for an in-network provider office visit and an in-network urgent care center visit when testing for COVID-19. Health carriers shall follow federal guidelines with respect to payment of anti-body tests related to COVID-19.
- Given that COVID-19 is a communicable disease, some insureds may be using telehealth services instead of in-person health care services. Health carriers shall review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand. Additionally, health carriers shall waive telehealth copayments for insureds and reimburse the provider for the copayment.
- Health carriers shall 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 Oklahoma. 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 shall make exceptions to provide access to an out-of-network provider at the in-network cost-sharing.
- Timely decision making is critically important to responding appropriately to COVID-19, and it is particularly important with respect to utilization review. Health carriers are reminded that utilization review decisions must be made in the timeframes required. Health carriers shall not use preauthorization requirements as a barrier to access necessary treatment for COVID-19, and health carriers shall be prepared to expedite utilization review and appeal processes for services related to COVID-19, when medically appropriate.
- Health carriers shall, where appropriate, 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.
- Health carriers and other entities regulated by my office, shall accept as valid and binding, any claim or claim related document bearing an e-signature or an e-notary as otherwise authorized pursuant to Oklahoma law.
- Health carriers shall identify and remove barriers to testing and treatment of COVID-19 and be prepared to address COVID-19 cases in Oklahoma. The Department extends its appreciation to health carriers in working with the State to address this public health challenge.
- Health carriers shall not cancel the coverage of any person who has been diagnosed with COVID-19 and is unable to return to work or maintain coverage under their current health carrier because of COVID -19 for the next ninety (90) days. Health carriers shall extend the traditional thirty (30) day grace period to a sixty (60) day grace period for nonpayment of premiums. All health carriers shall continue to pay claims without regard to premium payment status during the (60) day period. Claims may not be pended for payment during the (60) day period nor shall carriers recoup claims payment amounts from future provider reimbursements. Carriers shall follow all state, federal and administrative guidance related to cancellations. Federal rules governing marketplace policies (ACA) will remain in effect with respect to grace periods.
- Carriers shall suspend underwriting rules related to group participation minimum requirements that would normally cause a group policy to be canceled.
Pharmacy Benefit Manager
- The term “administrator” as used herein shall mean a pharmacy benefit manager or other provider of administrative services in connection with the prescription component of health insurance or health benefit plans.
- Pharmacists writing “COVID-19” or substantially similar language on a prescription shall be equivalent to receiving a signature. No signature will be required at the time of delivery of a prescription by any person or entity providing delivery services related to the prescription. Pharmacy benefit managers shall immediately cease all audits while the Declaration of Emergency is in place. Additionally, a sixty (60) day supply may be provided for a thirty (30) day prescription for maintenance drugs with appropriate copays, and Administrators shall suspend refill-too-soon edits. This does not apply to controlled substances. Further, all restrictions on pharmacies doing mail order shall be waived.
- Pharmacy benefit managers and allied health providers are subject to price gouging laws. The Department will continue to work with the Attorney General to enforce them.
- Administrators are reminded that current law requires them to update their maximum allowable cost lists and any other pricing benchmarks used to determine pharmacy reimbursement rates at least once every seven (7) days.
- Administrators shall not restrict a covered person’s ability to select any pharmacy that is in the Administrator’s pharmacy provider network, regardless of whether the network is a preferred provider network.
Medical Professional Liability Insurance
- In discussing medical professional liability coverage (“MPL”) with various insurers, we are pleased to report that companies are taking the lead to ensure that physicians’ coverage is being expanded in a number of ways designed to facilitate delivery of health care in connection with COVID-19. Coverage limitations regarding state licenses have been generally relaxed to provide coverage in states other than the doctor’s principal licensor state, subject to state or federal waivers. We ask that all MPL insurers are following this initiative.
- For answers to additional questions about MPL coverage for COVID-19 claims, providers please check your carrier’s website for FAQs. For information involving coverage for transmission of the virus to employees, review your workers compensation policy for potential coverage. For claims involving transmission of the virus to members of the general public, please review your general liability policy for potential coverage.
This Bulletin is intended to apply to all insured plans that are regulated by the Oklahoma Insurance Department, but it is strongly recommended that Oklahoma self-funded plans follow the same directives.
The provisions of this bulletin are in effect until the emergency is no longer in effect.
Questions or comments applicable to this bulletin should be directed to Mike Rhoads (firstname.lastname@example.org) or Ron Kreiter (email@example.com), Oklahoma Insurance Department, 400 NE 50th Street, Oklahoma City, OK 73105-1816.