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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. 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 o fan emergency situation arising in which hospitals and other emergency service providers are in-network, however, because, 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.

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

Yes.  If you have questions regarding Medicare beneficiaries please visit Medicare.gov or call 800-Medicare (800-633-4227). For Medicare caregiver questions or concerns,  please visit the Ohio Department of Aging website or call 866-243-5678 to find the Area Agency on Aging serving your community. 

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.

Agents

1. How do I contact the License Division during the COVID-19 emergency?

License Division can be reached by email at licensing@insurance.ohio.gov or by phone at 614-644-2665.

2. Is the department issuing temporary licenses?

Yes, the department is currently issuing temporary licenses for resident major line agents. Click here: Temporary Licenses During the COVID-19 Emergency to learn more.

3.  Is the department offering insurance licensing examinations during the COVID-19 emergency?

Yes, Ohio’s test centers are open and continue to offer insurance licensing examinations while following the CDC’s recommendations on social distancing To schedule an exam, contact PSI at www.psiexams.com or 800-733-9267.

4. What happens if my pre-licensing education course completion certificate expires, can I still use it to test? 

Due to COVID-19, any person who completed their pre-license education course from September 17, 2019 to present date may use their course completion certificate(s) (expired or not) to take the appropriate Ohio insurance examination(s).  Normally, the pre-license education course completion certificates expire 180-calendar days from the date of course completion.  Waiver of the 180-calendar day expiration of the certificates is a temporary measure, therefore, the department encourages candidates with qualifying expired certificates to schedule and sit for their exam as soon as possible.

5. Can I complete my fingerprint requirements during the COVID-19 emergency?

Yes, the Ohio Attorney General’s office continues to process criminal background checks. Check the list of National WebCheck vendors to find a location. Please note that the PSI test centers are NOT currently processing fingerprint for the criminal background checks.  

6. Have there been any legislative actions for license renewal and continuing education relief as a result of COVID-19?

Yes, House Bill (HB) 197 was signed by Governor DeWine on Friday, March 27, 2020 and House Bill (HB) 404 was signed by Governor DeWine on Monday, November 23, 2020.  HB 197 extended license expiration dates due to the COVID-19 pandemic thru 12/1/2020 to provide relief to insurance license-holders whose license expires during the state of emergency declared by the Governor through Executive Order 2020-01D, issued March 9, 2020.  HB 404 provides a temporary extension of license expiration dates until July 1, 2021 for any license-holder who has a license expiration date that falls between March 9, 2020 thru April 1, 2021. 

In order to implement the provisions of both bills, the following applies to any individual or business entity that holds an active license with the Ohio Department of Insurance. This includes major lines agents; limited line agents; title agents; title insurance marketing representatives; managing general agents; public insurance adjusters and agents; reinsurance intermediary brokers and managers; surety bail bond agents; surplus lines brokers; third party administrators; and viatical settlement brokers.

  • License Expiration Date: If a license expires between March 9, 2020 thru April 1, 2021, it will remain active beyond its assigned expiration date, but must be renewed no later than July 1, 2021. All late fees will be waived and license-holders do not need to take any actions to receive the temporary extension afforded by HB 404.  In order to ensure that license-holders are able to submit a renewal application at any time between 90-days prior to the expiration date and July 1, 2021, the department will periodically adjust expiration dates within the department’s computer system and the National Insurance Producer Registry (NIPR). While the adjusted expiration dates may appear different from the dates allowed through HB 404, the temporary revised expiration date has been selected to ensure access to NIPR remains assessable to submit a renewal application. The department will continuously adjust the license expiration dates of affected licenses until the extension granted through HB 404 ends on July 1, 2021.  
  • Continuing Education Requirements: Due to the extension of expiration dates, the deadline for completing continuing education requirements is also extended to match the temporary license expiration date. Continuing education requirements must be completed prior to submission of a renewal application.  

Only current license-holders whose license expires between March 9, 2020 thru April 1, 2021 are affected by this recent legislation; unless specifically ordered otherwise, there is no change to the legal requirement to obtain a license or to comply with all other applicable laws and regulations during the state of emergency.

While license-holders have extra time to renew their licenses, the department encourages renewals to be completed as soon as possible to ensure timely processing. 

7. Why did my license expiration date change?

License expiration dates have changed in order to accommodate the temporary extension requirement according to HB 404.   The Department’s computer system and NIPR’s business rules limit how early a renewal application can be submitted prior to the license expiration date.  The window to submit a license renewal application is 90 days prior to the license expiration date. Therefore, the department will continue to adjust your license expiration date in phases in order to stay within the 90-day window needed to submit a renewal application at your convenience.   

Ultimately, you will have until July 1, 2021 to complete any required continuing education credits and to submit your license renewal application.   However, the department recommends not waiting until the last opportunity to complete the requirements to renew your license due to the volume of license applications that will be due at the same time.

8. What happens if I do not submit a renewal application on or before July 1, 2021?

Licenses will be become inactive on July 2, 2021 for all licenses with a July 1, 2021 temporary expiration date, if required renewal application(s) are not submitted to the department on or before July 1, 2021. 

9. Do I have to submit 2 applications before July 1, 2021?

If you are licensed for Surety Bail Bond, Third Party Administrator or a Viatical Settlement Broker and you did not renew your license in 2020 you will need to submit one renewal application for 2020 and a second renewal application for 2021 in order to prevent the license from inactivating in July 2021.  Both applications will need to be accompanied by all of the required renewal attachments and fees.  It is recommended to submit the applications via paper (mail) if you need or want to submit the applications at the same time.  If you want to submit the renewal applications electronically, you will need to submit the applications at least 30 days apart.    

10. Do I need to complete my continuing education credits prior to submitting a license renewal application?

Yes, if continuing education credits are required to renew a license.  However, renewal applications should not be submitted until after the continuing education credits have been satisfied.

Use the following link to find Ohio approved CE courses: https://gateway.insurance.ohio.gov/UI/ODI.Licensing.CourseFinder.Public.UI/Course.mvc/DisplaySearch

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

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.