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Insurance and Coronavirus COVID-19

Insurance and Coronavirus COVID-19

For the most up-to-date information visit coronavirus.ohio.gov.  Additionally, a call center to answer questions regarding COVID-19 is now open. The call center will be open 7 days a week from 9 a.m.-8 p.m. and can be reached at 1-833-4-ASK-ODH (1-833-427-5634). 

Health insurance coverage plays a critical role in the public's ability to access health care services. The Ohio Department of Insurance wants to ensure that consumers and insurers have the information needed about insurance coverage during the ongoing coronavirus (COVID-19) outbreak.

Consumers

1. Will my insurance cover treatment for COVID-19?

In general, comprehensive health insurance plans will cover medically necessary treatment for COVID-19 just like any other illness. 

2. Can my insurance carrier cancel or refuse to renew my insurance policy if I am diagnosed with COVID-19 or a preexisting respiratory illness?  

No.  Both Ohio insurance law and federal law prohibit individual and group accident and sickness insurance carriers from canceling coverage or refusing to renew coverage based on a health condition, including in connection with COVID-19. However, these consumer protections do not apply to short-term, limited-duration health insurance coverage or excepted benefit policies.

3. Who pays for COVID-19 diagnostic testing if needed?  

The Federal Centers for Disease Control and Prevention (CDC) and the Ohio Department of Health (ODH) are currently covering the cost of the lab test for the presence of COVID-19.  Yet, provider offices, labs, urgent care facilities, and hospitals, might still charge their own fees for collecting the specimens, which then could be billed to the patient or to the patient’s health insurance issuer. Call your insurance provider to discuss available coverage.  

4. Who is paying for the COVID-19 vaccine?

If you choose to get a COVID-19 vaccine, you will not have to pay. Vaccine doses purchased with taxpayer dollars will be given to Ohioans who choose to receive them at no out-of-pocket cost. Vaccine providers will be able to charge an administration fee for giving the shot to someone. Providers can get this fee reimbursed by the patient’s public or private insurance company or, for uninsured patients, by the federal Health Resources & Services Administration’s Provider Relief Fund.

For more information about the COVID-19 vaccine please visit coronavirus.ohio.gov

5. What if I have health concerns that require emergency medical services?  

Insurance carriers must cover emergency services for an emergency medical condition at in-network cost-sharing levels regardless of which provider performs the services. Emergency services include transportation services, such as ambulance services, as well as inpatient and outpatient hospital services that are needed to evaluate or stabilize the patient. It is a good idea to determine in advance of an emergency situation arising, which hospitals and other emergency service providers are in-network, although in some instances balance billing may still occur. Many individuals who have contracted COVID-19 have not required emergency services. Still, exceptional circumstances may arise.

6. Is there a number to call for Medicare Beneficiaries and Caregiver Inquiries?  

Yes. If you are a Medicare patient or caregiver, please contact The Ohio Senior Health Insurance Information Program (OSHIIP) at 800-686-1578, Monday-Friday 7:30 am to 5 pm. You may also visit medicare.gov or call 800-Medicare (800-633-4227) 24 hours each day.

Insurers

1. What should I be doing as an insurer to prepare for COVID-19 inquiries and claims?

Review claims handling and utilization review procedures:

  • Closely monitor guidance from the Centers for Disease Control and Prevention (CDC) and the Ohio Department of Health (ODH). Adjust your procedures as needed to ensure consistency with their guidance. For example:
    • Proactively implement a claim review process that takes into account the prudent layperson standard for emergency care related to COVID-19 and flu-like symptoms.
    • Ensure consistency with CDC guidelines that require four negative tests before discontinuing transmission-based precautions for a patient hospitalized with COVID-19.

Review and update contingency plans:

  • Make sure your contingency and preparedness plans are up-to-date in case you need to add resources to answer calls, staff nurse lines, or member chat services, or provide similar customer assistance.

Increase member communications as needed:

  • Topics to consider include when to seek medical care and the availability of options such as telemedicine and nurse lines that can provide quick access to care and limit exposure to new infections in waiting rooms.

Ohio Businesses

Business Interruption Insurance Overview

The Ohio Department of Insurance is receiving inquiries about business interruption insurance. Business interruption coverage is typically triggered under a commercial insurance policy when a covered risk/peril causes physical damage to the insured premises resulting in the need to shut down business operations. For example, if a fire damages a business and the business cannot operate during repairs, business interruption coverage could be available subject to the terms and limits in the policy.

Most policies require a waiting period of 24 to 72 hours before coverage begins and coverage continues for a reasonable period of time to restore the property and reopen, subject to the coverage limit of liability. Some commercial policies provide Business Interruption coverage when a business is shut down due to an Order by a civil authority. However, in most cases, the policy will require a physical loss from a covered peril as the underlying cause of the business shut down to apply.

Insurance policies typically have exclusions of coverage for risks that are too great to be underwritten at an affordable price. For example, commercial and personal property insurance policies typically contain specific exclusions for loss or damage caused by war, nuclear action, and radiation. The potential loss from such perils is so extreme that providing coverage would jeopardize the financial solvency of property insurers. Global pandemics like COVID-19 usually fall into this category. In fact, in the wake of previous pandemic threats, including SARS, insurance companies developed standardized language to exclude coverage for losses from viral and bacterial infections” However, policies can be different.

The Ohio Department of Insurance is a great resource for employers and consumers who have questions about insurance. We recommend that businesses review their policies and reach out to their insurance agent or the department with any questions. Businesses can reach out to our Consumer Services Division at Consumer.Complaint@insurance.ohio.gov or by calling 800-686-1526.

Travel

1. Does travel insurance cover risks related to COVID-19 if I get sick while traveling?  

It depends.  Unless a travel insurance policy contains an exception applicable to COVID-19, a policy of travel insurance that covers the risks of sickness, accident, or death incident to travel presumptively would cover such risks relating to COVID-19 if experienced while traveling. The extent of coverage for health care services, including emergency transportation within a foreign country, as well as the costs of returning to the United States for further treatment, may depend on the terms of the policy so be sure to check with your insurance carrier.  

2. Does travel insurance cover cancellation or interruption risks related to COVID-19?  

Trip cancellations and trip interruptions due to known, foreseeable, or expected events, epidemics, or fear of travel are generally not covered.  This may vary by state, and other coverage and exclusions may apply.  On January 21, CDC activated its Emergency Operations Center to better provide ongoing support to the COVID-19 response and therefore became a known event.  If you purchased a trip cancellation or trip interruption policy after January 21, 2020, it is possible that you may not be covered if your trip is canceled due to a COVID-19 event—such as a coronavirus outbreak at your destination, or a quarantine that prevents you from traveling.  Please check with your insurance carrier for coverage and policy details.

Bulletins

2020-02: Access to Coverage for Ohioans Impacted by the COVID-19 Virus

2020-03: RESCINDED Health Insurance Coverage Flexibility for Ohio Employees

2020-04: RESCINDED Temporary Suspension of Pharmacy Audits During Declared State of Emergency

2020-05: COVID-19 Testing and Treatment: Out-of-Network Coverage

2020-06: Coverage for Individuals With Expired Driver Licenses

2020-07: RESCINDED Property and Casualty, Life, and Long Term Care Insurance Premium Payments During State of Emergency

2020-08: Temporary Licenses During State of Emergency

2020-09: Extension of Financial Filing Deadlines and Procedural Requirements as a Result of COVID-19 Recommendations and Orders

2020-12: RESCINDED Property and Casualty, Life, and Long Term Care Insurance Premium Payments During State of Emergency

2021-03: Premium Payment Flexibility

Questions

If you have additional insurance-related questions...

...the Ohio Department of Insurance’s consumer services representatives can help. Contact the department at 800-686-1526.

For the most up-to-date coronavirus, COVID-19 information, visit coronavirus.ohio.gov.