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Polis orders state-regulated insurance to waive COVID-19 test fees

Gov. Jared Polis said the state's Division of Insurance is directing carriers to drop any upfront cost to patients insured through the individual market.

DENVER — Colorado Gov. Jared Polis (D) on Monday ordered health insurers regulated by the state to waive fees associated with COVID-19 testing.

Under this policy, Polis said there are to be no co-pay, deductible or co-insurance costs to patients related to the novel coronavirus.

“We are all in this together, and we must continue working together to protect our health and safety," Polis said in the bulletin from his office. "This important step will help ensure cost barriers do not stand in the way of people getting tested. The earlier that we can diagnose and isolate those testing positive for COVID-19, the better we can prevent it from spreading.” 

This applies only to plans controlled by the Colorado Division of Insurance. People will know if their plan falls into this category if their insurance card says “CO-DOI” in the bottom corner. People with insurance through an employer are not covered by the directive.

For a COVID-19 test, a patient must meet requirements including:

  • They have been in contact with someone else who tested positive and show symptoms of fever or lower respiratory illness.
  • They have symptoms and have traveled to areas where infection rates are high.
  • They have a severe respiratory illness that doesn't test positive for something else, like the flu.

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These are the rules outlined in the state bulletin about the new mandate:

Telehealth

The Division is directing carriers to conduct an outreach and education campaign to remind individuals of their telehealth coverage options. In addition, the Division is directing carriers to provide telehealth services to cover COVID-19-related in-network telehealth services at no cost share, including co-pays, deductibles, and coinsurance that would normally apply to the telehealth visit. The Division will be issuing an emergency regulation formalizing this directive.

Information on how to contact the telehealth providers of specific carriers is listed here.

Prescription refill

To the extent consistent with clinical guidelines, the Division is directing carriers to cover an additional one-time early refill of any necessary prescriptions to ensure individuals have access to their necessary medications should they need to limit close contact with others. Carriers shall not apply a different cost-sharing amount to an early fill of a prescription due to concerns about COVID-19. This recommendation does not apply to prescription drugs with a high likelihood of abuse, such as opioids. The Division will be issuing an emergency regulation formalizing this directive.

Co-pays, deductibles, and co-insurance (“cost-shares”)

In accordance with the recent announcement by the federal government that testing for COVID-19 is an Essential Health Benefit and Colorado State law, the Division is directing carriers to ensure that coverage is provided for COVID-19 testing without the requirement that consumers pay co-pays, deductibles or co-insurance. Carriers are directed to waive cost-sharing for an in-network provider office visit, an in-network urgent care center visit, and an emergency room visit when a covered person is seeking testing for COVID-19. Carriers are reminded that if an in-network provider is unable to conduct testing for COVID-19, carriers must cover such testing if performed by an out-of-network provider pursuant to § 10-16-704(2)(a), C.R.S. The Division will be issuing an emergency regulation formalizing these directives.

In-network coverage

In addition, the insurance companies will be directed to waive any cost-sharing for an in-network health care provider office visit, an in-network urgent care center visit or an emergency room visit when a covered person is seeking testing for COVID-19. If an in-network health care provider cannot do such testing, the insurance company must cover an out-of-network provider for the testing. As with the telehealth directives, the DOI will be issuing an emergency regulation to formalize this specific directive.

If you have questions about coverage, contact the Division of Insurance at 303-894-7490 or 800 930-3745, or email DORA_Insurance@state.co.us

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