Coronavirus testing at the Vermont State Laboratory
Under a new rule announced Wednesday, commercial insurance companies cannot charge Vermonters out-of-pocket costs for testing and treating COVID-19 during the state of emergency.
The new regulations require most insurance plans to waive all fees, copays, coinsurance and deductibles for those seeking diagnosis and treatment of the disease caused by the coronavirus.
"During this unprecedented emergency, Vermonters deserve access to the care they need to stay safe and healthy,” Gov. Phil Scott said in a press release. “As we work to expand testing to more Vermonters with symptoms of COVID-19, it is critical that our efforts to help control the spread of the virus are not affected by insurance costs.”
The emergency regulation covers the most common type of health care insurance in Vermont, where an employer pays an insurance company — such as Blue Cross Blue Shield — to assume the risk of paying medical bills for members. It does not cover self-funded plans, where employers assume the risk and pay a third-party administrator to manage the payments. The state does not regulate what are known as self-insurance plans.
The emergency regulation is retroactive to March 13, the date Scott declared a state of emergency to help combat the pandemic sweeping the state. That means carriers are required to reimburse members who have already paid such out-of-pocket expenses.
“The COVID-19 pandemic has evolved quickly and is impacting the economic lives of so many Vermonters,” Michael Pieciak, commissioner of the Department of Financial Regulation, said in the press release. “Accordingly, we have been working closely with our health insurers to eliminate financial barriers to testing and treatment of the disease.”
The rule requires insurers to cover the costs of testing done by the federal Centers for Disease Control and Prevention, Vermont Department of Health or approved private labs. It applies to member visits to doctor’s offices, urgent care centers or emergency rooms for diagnosis. Insurers are already required to cover out-of-network services, if necessary.
It also requires insurers to cover all “medically necessary” treatment, whether in a hospital or at home, including medications, with no payment required of members.
The move is the latest in a series of efforts to ensure those who need treatment can get it in Vermont. These include requiring insurers to cover the cost of COVID-19 testing, provide grace periods for people struggling to pay premiums, and expanding coverage of remote medical consultations.
Anyone with questions about insurance coverage of COVID-19 in the state can call 800-964-1784 or email [email protected].
Correction, April 16, 2020: A previous version of this story incorrectly identified Blue Cross Blue Shield as a for-profit insurance company. It is a nonprofit.