BIDEN-HARRIS ADMINISTRATION MANDATE FOR COVERAGE OF COVID-19 HOME TESTS

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE Russell Toal DEPUTY SUPERINTENDENT Jennifer A. Catechis Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2022-002 January 24, 2022 TO: ALL INSURERS LICENSED TO SELL HEALTH INSURANCE IN NEW MEXICO RE: BIDEN-HARRIS ADMINISTRATION MANDATE FOR COVERAGE OF COVID-19 HOME TESTS On January 10, 2022, the Biden-Harris Administration announced that all private health insurance companies and group health plans must cover the cost of over-the-counter (OTC), FDA- approved COVID-19 tests for all covered members beginning on January 15. The New Mexico Superintendent of Insurance, Russell Toal, is requesting that all major medical health insurers abide by the Administration’s mandate. Insurers must cover as many as 8 home COVID tests per month for every covered person, including covered dependents. For example, a family of four, all covered by the same plan, is entitled to have up to 32 tests paid for per month. A health care provider’s order is not required for this coverage. Additionally, insurers are reminded that there is no limit on the number of covered tests, including at-home tests, “…when ordered or administered by a health care provider after a clinical assessment, including for those who may need them due to underlying medical conditions.”1 1 Please see: https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurancecompanies-group-health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html and https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free B U L L E T I N 2 0 2 2 - 0 0 2 P a g e | 2 Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us The Administration’s mandate requires insurers to cover the entire cost of home tests when purchased from the insurer’s preferred pharmacies, stores or on-line suppliers. Insurers should encourage members to purchase their tests at these preferred outlets, and to buy them at that pharmacy counter, so the member does not have to pay out-of-pocket, file a claim, and then wait to be reimbursed. If a covered person purchases a test out-of-network, the insurer is required to reimburse the member up to $12 per test, or the total cost of the test, whichever is less. If the insurer has not arranged for a preferred outlet(s) for the purchase of home COVID tests, or if preferred sources are not available to a member, the insurer must cover the full cost for each test. In all cases, cost-sharing cannot be applied to the purchase of home tests. Superintendent Toal urges insurers to issue clear information to their members on how to purchase home COVID tests including a list, or a link to a list, of preferred pharmacies, stores and other suppliers and a description of the reimbursement that members will receive depending on where they purchase tests. In addition, insures should include an explanation that members are not responsible for cost-sharing, and directions on how to file a claim. Finally, the Superintendent strongly encourages insurers to develop user-friendly methods for members to submit claims online. Access to home COVID tests is essential for schoolchildren and their families, teachers, preschoolers and childcare workers, and many working people. Home tests help to reduce the spread of COVID, and they help individuals protect their loved ones and co-workers from COVID. Thank you for your cooperation in supporting your members in New Mexico. ISSUED this 24th day of January, 2022. SUPERINTENDENT OF INSURANCE _________________________________ RUSSELL TOAL