Additional Guidance Relating to COVID-19 (Domestic and Foreign Insurers Bulletin No. 116)
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State-level bulletin issuing mandatory and advisory guidance to insurance carriers, producers, and adjusters doing business in Delaware regarding cancellations/nonrenewals, telemedicine reimbursement, waiver of prior authorization and cost-sharing for COVID-19 testing and treatment, and communications during the COVID-19 State of Emergency.
The Sixth Modification prohibits, without a court order, suspension, cancellations, and nonrenewals due to nonpayment of premium during the State of Emergency for covered policies and covered policyholders.
Carriers must reimburse telemedicine services provided through telehealth in accordance with law and are encouraged to authorize reimbursement for services provided by any provider authorized by law to provide those services.
The Fifth Modification and the Declaration make mandatory the waiver of prior authorization requirements for lab testing and treatment of confirmed or suspected COVID-19 patients.
The Department will not enforce against issuers who amend catastrophic plans to provide pre-deductible coverage for COVID-19 services.
If carriers/producers/adjusters cannot provide hard-copy communications due to work-from-home, electronic or telephonic communications are acceptable if a communication log is maintained.
Carrier Coverage & Operational Rules During State of Emergency
COVID-19 Carrier Coverage and Operational Criteria
Carrier obligations and permissible practices during the State of Emergency:
ALL of the following
- Policyholders are encouraged to contact their carriers to discuss options if suffering hardship due to COVID-19 related restrictions.
- Producer licensees must take all necessary actions to ensure ability to promptly service claims and provide essential services to insureds affected by COVID-19.
ALL of the following
- Carriers must reimburse providers for telemedicine services provided through telehealth in accordance with law.
- Patients need not present in person and need not be physically located in Delaware when services are provided.
- Out-of-state providers who would be permitted under Title 24 may provide telemedicine to Delaware residents; carriers are encouraged, notwithstanding network rules, to authorize reimbursement for services provided by any provider authorized by law to provide those services to help prevent community spread.
ALL of the following
- All prior authorization requirements for lab testing and treatment of confirmed or suspected COVID-19 patients shall be waived for insurers subject to state regulation under Title 18.
- All COVID-19 testing shall be made available to persons who meet CDC criteria as established and modified from time to time; testing must be provided without regard to ability to pay, type of insurance, or network participation.
- Testing sites, providers and entities offering testing shall make testing available to any person presenting who meets CDC criteria; costs not covered by individuals or insurers will be covered by Delaware's Health Care Connection Program as applicable.
ALL of the following
- Per the Federal Families First Coronavirus Response Act, private insurers must waive cost sharing for FDA EUA diagnostics for SARS-CoV-2 and the associated visit during the emergency period, without requiring deductible, prior authorization, or other utilization management.
Department guidance and operational accommodations
- The Department will exercise enforcement discretion and will not enforce against issuers that amend catastrophic plans to provide pre-deductible coverage for COVID-19 related services to remove financial barriers.
- If hard-copy communications cannot be mailed due to work-from-home, electronic or telephonic communications are acceptable provided a log or record is maintained; hard-copy must be provided upon request.
ALL of the following
- "Covered insurance policy" includes health, life, disability, property, motor vehicle, and commercial/business insurance; "covered policyholder" means an individual or business entity laid off, fired, or required to close or significantly reduce business due to the State of Emergency.
ALL of the following
- The Department expects carriers to abide by the Governor's Fifth and Sixth Modifications and related Declaration regarding waivers of prior authorization, availability of testing, and the prohibition on cancellations/nonrenewals without a court order.
Testing Codes and Testing Eligibility
| References federal requirement to cover FDA EUA diagnostics for SARS-CoV-2 and associated visit without cost-sharing; no specific CPT/ICD codes provided. |
Provider & Carrier Operational Actions (Prior Auth, Cancellations, Producer Duties)
Waive prior authorization and cost‑sharing for COVID‑19 testing and related visits
Carriers must waive all prior authorization requirements for laboratory testing and for treatment of confirmed or suspected COVID-19 patients, and federal law requires waiving cost‑sharing (including deductible and other utilization management) for FDA EUA SARS‑CoV‑2 diagnostic tests and the associated visit during the emergency period.
- All COVID-19 testing shall be made available to persons who meet CDC criteria as established and modified from time to time; testing must be provided regardless of ability to pay, insurance type, or network participation. [[DO NOT INCLUDE IN USER-FACING TEXT]]
- Federal Families First Coronavirus Response Act requires private insurers to waive cost sharing for FDA EUA diagnostics and associated visits during the emergency period.
Suspension of cancellations/nonrenewals and producer responsibilities
Without a court order, insurers may not lapse, terminate, or forfeit a covered insurance policy for nonpayment of premium during the State of Emergency; producers must take necessary actions to promptly service claims and provide essential services to insureds experiencing COVID‑19‑related hardship.
- Covered insurance policy includes health, life, disability, property, motor vehicle, and commercial/business policies.
- Covered policyholder means an individual or business laid off, fired, or required to close or significantly reduce operations due to the COVID‑19 State of Emergency.
- Policyholders are encouraged to contact carriers to discuss options if suffering hardship; producer licensees must ensure ability to service claims and provide essential services.
Key Definitions
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