CurrentNorth Dakota Insurance DepartmentPolicy 2020-12

COVID-19 Vaccination Administration Costs

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Coverage and reimbursement for COVID-19 vaccination administration under self-funded and fully insured group health plans, individual health plans, and short-term limited-duration plans in North Dakota, without consumer cost sharing and regardless of provider network status.

Policy Summary

PayerNorth Dakota Insurance Department

PolicyCOVID-19 Vaccination Administration Costs

Policy CodePolicy 2020-12

Change TypeNo material change

Effective DateNovember 30, 2020

Next Review DateN/A

Key ActionDo not charge consumers a copayment, coinsurance, or deductible for receiving a COVID-19 vaccination.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$0Consumer cost sharing

All dosesVaccination dosing

28Eligible ND local public health units

5Eligible tribal facilities or service areas

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CurrentNorth Dakota Insurance DepartmentPolicy 2020-12

COVID-19 Vaccination Administration Costs

Customize your policy alerts

Sign up for North Dakota Insurance Department Policy 2020-12 alerts

Get alerted when Policy 2020-12 changes without checking for updates manually.

Monitor payer policy activity

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Policy Summary

PayerNorth Dakota Insurance Department

PolicyCOVID-19 Vaccination Administration Costs

Policy CodePolicy 2020-12

Change TypeNo material change

Effective DateNovember 30, 2020

Next Review DateN/A

Key ActionDo not charge consumers a copayment, coinsurance, or deductible for receiving a COVID-19 vaccination.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$0Consumer cost sharing

All dosesVaccination dosing

28Eligible ND local public health units

5Eligible tribal facilities or service areas

COVID-19 Vaccination Administration Coverage

The Commissioner expects the following plans to cover COVID-19 vaccinations without cost sharing:

ALL of the following

ALL of the following
- Plan is a self-funded or fully insured group health plan, individual health plan, or short-term limited-duration plan.
- Service is administration of a COVID-19 vaccination, whether provided as a single dose or as a series requiring two or more doses.
- No copayment, coinsurance, or deductible is charged to the consumer.
- Administering provider receives reasonable reimbursement for administration fees regardless of whether the provider is in-network or out-of-network.

Reimbursement and Consumer Cost Sharing

Billing Rule

Reimburse administration fees regardless of network status

Do not deny reasonable reimbursement for COVID-19 vaccination administration fees based solely on provider network status. Reimburse administration fees for covered vaccinations provided by both in-network and out-of-network providers.

This applies to providers administering either a single-dose vaccination or a vaccination series requiring two or more doses.

Billing Rule

Waive consumer cost sharing

Do not charge the consumer a copayment, coinsurance, or deductible for receiving a COVID-19 vaccination. This applies whether the vaccination is administered as a single dose or as a series of two or more doses.

Consumer cost sharing for COVID-19 vaccination administration: $0.

Key Terms

Out-of-network provider

DefinitionA provider outside the plan network, including private health care facilities, public facilities, North Dakota's twenty-eight local public health units, and specified tribal health facilities or service areas.

COVID-19 vaccination

DefinitionA COVID-19 vaccination delivered as a single dose or as a vaccination series requiring two or more doses.