CurrentNorth Dakota Insurance DepartmentPolicy 2020-12

COVID-19 Vaccination Administration Costs

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This bulletin governs coverage and reimbursement for COVID-19 vaccination administration by fully insured and self-funded group health plans, individual health plans, and short-term limited-duration plans. It requires vaccination administration to be covered without consumer cost-sharing and requires reasonable reimbursement for both in-network and out-of-network providers, including specified public and tribal health facilities.

Policy Summary

PayerNorth Dakota Insurance Department

PolicyCOVID-19 Vaccination Administration Costs

Policy CodePolicy 2020-12

Change TypeCoverage and reimbursement requirement

Effective DateNovember 30, 2020

Next Review DateUpon rescission of Executive Order 2020-03, unless renewed

Key ActionHealth plans must cover COVID-19 vaccination administration without consumer cost-sharing and must not deny reasonable reimbursement solely because the provider is out of network.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$0Consumer cost-sharing

All dosesVaccine dose coverage

In/out-of-networkNetwork reimbursement

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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.

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Policy Summary

PayerNorth Dakota Insurance Department

PolicyCOVID-19 Vaccination Administration Costs

Policy CodePolicy 2020-12

Change TypeCoverage and reimbursement requirement

Effective DateNovember 30, 2020

Next Review DateUpon rescission of Executive Order 2020-03, unless renewed

Key ActionHealth plans must cover COVID-19 vaccination administration without consumer cost-sharing and must not deny reasonable reimbursement solely because the provider is out of network.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$0Consumer cost-sharing

All dosesVaccine dose coverage

In/out-of-networkNetwork reimbursement

COVID-19 Vaccination Administration Coverage

COVID-19 vaccination administration costs must be covered without cost-sharing for the specified health plans and vaccination settings below.

ALL of the following

Plan type
- Self-funded group health plans
- Fully insured group health plans, including small-group and large-group plans
- Individual health plans
- Short-term limited-duration plans
The service is administration of a COVID-19 vaccination, whether the vaccination is a single-dose vaccine or requires a series of two or more doses.
The consumer is not charged a copayment, coinsurance, or deductible for receiving the vaccination.
The administering provider is eligible for reasonable reimbursement of the vaccination administration fee, regardless of whether the provider is in-network or out-of-network.
Out-of-network provider setting includes
- Private health care facilities
- North Dakota's 28 local public health units
- Tribal health facilities for the Mandan, Hidatsa, & Arikara Nation (Three Affiliated Tribes), the Spirit Lake Nation, the Standing Rock Sioux Tribe, the Turtle Mountain Band of Chippewa Indians, the Sisseton-Wahpeton Oyate Nation, and the Trenton Indian Service Area.
Coverage without cost-sharing is required under section 3203 of the CARES Act, the Public Health Service Act, and the Interim Final Rule issued October 28, 2020.
Bulletin 2020-12 expires and is rescinded upon rescission of Governor Burgum's Executive Order 2020-03, unless otherwise renewed by the North Dakota Insurance Department.

Reimbursement and Facility Requirements

Billing Rule

Reimburse vaccination administration without cost-sharing

Cover COVID-19 vaccination administration without consumer cost-sharing. Do not deny reasonable reimbursement for administration fees solely because the administering provider is out of network.

No consumer copay, coinsurance, or deductible may be charged for receiving the vaccination.
Apply this requirement to single-dose vaccinations and vaccination series requiring two or more doses.

Billing Rule

Include public and tribal health facilities

Treat public facilities as out-of-network providers whose reasonable vaccination administration fees may not be denied, including North Dakota’s twenty-eight local public health units and the identified tribal health facilities.

Include facilities serving the Mandan, Hidatsa, & Arikara Nation (Three Affiliated Tribes), Spirit Lake Nation, Standing Rock Sioux Tribe, Turtle Mountain Band of Chippewa Indians, Sisseton-Wahpeton Oyate Nation, and Trenton Indian Service Area.

Provider Network Status

Out-of-network provider

DefinitionA provider outside the health plan's network.

Private facilitiesIncludes private health care facilities.

Public facilitiesIncludes public facilities, including North Dakota's twenty-eight local public health units.

Tribal health facilitiesIncludes tribal health facilities for the Mandan, Hidatsa, & Arikara Nation (Three Affiliated Tribes), the Spirit Lake Nation, the Standing Rock Sioux Tribe, the Turtle Mountain Band of Chippewa Indians, the Sisseton-Wahpeton Oyate Nation, and the Trenton Indian Service Area.