Coronavirus (COVID-19)

Health Insurance Information

What if I think I have coronavirus (COVID-19)?
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What will my health insurance cover for coronavirus (COVID-19)?
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  • NY Coverage.  If you have individual or group health insurance coverage that you or your employer bought in New York, including through the NY State of Health Marketplace or the New York State Health Insurance Program (NYSHIP) for public employees, you are covered for the testing and treatment for novel coronavirus (COVID-19) as described below.
  • Out-of-State Coverage.  If your employer bought your policy in another state, contact your employer because the protections described below might not apply.
  • Self-Funded Coverage.  If your employer self-funds the coverage, contact your employer because the protections described below might not apply.
  • Medicare.  If you have Medicare, check with the Centers for Medicare & Medicaid Services (CMS) at (800) MEDICARE, the Medicare Rights Center at (800) 333-4114, www.medicare.gov, or the CMS fact sheet because different protections will apply.
  • Medicaid, Essential Plan, or Child Health Plus coverage.  If you have Medicaid, Essential Plan, or Child Health Plus, check the Governor’s website https://www.governor.ny.gov/news/governor-cuomo-announces-new-directive-requiring-new-york-insurers-waive-cost-sharing or the Department of Health’s website www.health.ny.gov.
 
What benefits will my NY health insurance policy cover?
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You should check your health insurance policy, or contact your insurer or employer, to understand the benefits covered under your policy.  Health insurance policies typically cover the following services that you may need:      

  • Lab Tests
  • Radiology Services
  • Doctor’s Office Visits
  • Telehealth Services (if offered by your provider)
  • Immunizations  
  • Urgent Care 
  • Emergency Room Care
  • Ambulance Services
  • Inpatient Hospital Care
  • Home Health Care (if hospitalization would otherwise be needed)
  • Prescription Drugs
Will I have to pay my deductible, copayment, or coinsurance for diagnosis or treatment of COVID-19 under my NY insurance policy?
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  • Lab Tests - Public Lab.  The COVID-19 oral/nasal swab test is now done through public health laboratories, including New York State’s Wadsworth Center and the federal Centers for Disease Control and Prevention (CDC), and there is no charge to you.
  • Lab Tests - Other Labs.  The Department of Financial Services issued a regulation so you will not have to pay your copayment, coinsurance, or deductible when you go to an in-network laboratory for a test to diagnose COVID-19.
  • Diagnosis.  The Department of Financial Services issued a regulation so you will not have to pay your copayment, coinsurance, or deductible when you go to your in-network doctor, an in-network provider at another outpatient setting, an in-network urgent care center, or an emergency room to diagnose COVID-19, including when the services are provided through telehealth.
  • Treatment. You will have to pay your copayment, coinsurance, or deductible for any follow-up care or treatment.
 
Do I have to pay my deductible, copayment, or coinsurance for diagnosis or treatment of COVID-19 if I have a high deductible health plan (HDHP) with a health savings account (HSA)?
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  • Diagnosis.  The Department of Financial Services issued a regulation so you will not have to pay your copayment, coinsurance, or deductible when you go to your in-network doctor, an in-network provider at another outpatient setting, an in-network urgent care center, or an emergency room to diagnose COVID-19, including when the services are provided through telehealth.   The Internal Revenue Service (IRS) recently released guidance about high deductible health plans.
  • Treatment.  You will have to pay your copayment, coinsurance, or deductible for any follow-up care or treatment.
 
What if I get charged a deductible, copayment, or coinsurance?
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  • Contact your insurer.  Let your insurer know if you were charged a deductible, copayment, or coinsurance and request a refund or credit for that payment.
  • Contact the Department of Financial Services.  If you are unable to resolve the issue after contacting your insurer, file a complaint with DFS at www.dfs.ny.gov/complaint
 
Will my health insurance cover telehealth services?
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  • If Covered at Your Provider’s Office.  Your insurer must cover your telehealth service if the service would have been covered if you went to your provider’s office or facility.  However, your insurer may require telehealth services to be provided by an in-network provider.
  • No Cost-Sharing for COVID-19 Diagnosis.  The Department of Financial Services issued a regulation so you will not have to pay your copayment, coinsurance, or deductible when you receive in-network telehealth services to diagnose COVID-19.
  • No Cost-Sharing for Other Treatment.  The Department of Financial Services issued a regulation so that during the State of Emergency declared by Governor Cuomo for COVID-19, you will not have to pay your copayment, coinsurance, or deductible when you receive in-network telehealth services.  This includes treatment of COVID-19 and any other health care services that are unrelated to COVID-19 if the services would have been covered if you went to your provider’s office or facility.  If you have a high deductible health plan with a HSA, you may still need to meet your deductible.  Contact your insurer for more information about your high deductible plan.
  • Telephone Calls and Videos Included in Telehealth.  The Department of Financial Services issued guidance on the ways you may receive telehealth services.  During the State of Emergency declared by Governor Cuomo for COVID-19, telehealth includes telephone calls or video visits with your in-network provider (including when you use your smart phone or other device) when medically appropriate if all other requirements for a covered health care service are met under your policy.
  • Contact Your Provider.  You should check with your provider to see if your provider offers telehealth services.
 
Can I receive mental health and substance use disorder treatment through telehealth?
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  • If Covered at Your Provider’s Office.  Your insurer must cover your telehealth service for mental health or substance use disorder treatment if the service would have been covered if you went to your provider’s office or facility.  However, your insurer may require telehealth services to be provided by an in-network provider.
  • No Cost-Sharing for Other Treatment.  The Department of Financial Services issued a regulation so that during the State of Emergency declared by Governor Cuomo you will not have to pay your copayment, coinsurance, or deductible when you receive in-network telehealth services.  This includes mental health and substance use disorder treatment services if the services would have been covered if you went to your provider’s office or facility.  If you have a high deductible health plan with a HSA, you may still need to meet your deductible.  Contact your insurer for more information about your high deductible plan.
 
What if there isn’t an in-network provider who can treat me?
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  • Access to Out-of-Network Provider.  If there isn’t an in-network provider with the training and experience to meet your health care needs, you can go to an out-of-network provider at your in-network cost-sharing.
  • Ask for Approval.  You must ask your insurer for approval before you see the out-of-network provider. Your insurer must make a decision within the time required by law.
  • Appeal.  If your insurer denies your request, you have a right to appeal that denial with your insurer and then to request an independent external appeal.  Learn how to file an External Appeal.
 
What if there isn’t a prescription drug on my insurer’s formulary?
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  • Formulary Appeal.  If you have coverage for prescription drugs, and your insurer’s formulary does not include a prescription drug that your doctor thinks you need, you can use your insurer’s formulary exception process to request coverage of an off-formulary prescription drug.
 
What if I want more than a 30-day supply of my prescription?
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  • Check your Insurance Policy.  Many insurance policies cover a 90-day supply of prescription drugs if you use their mail order pharmacy.
  • Contact Your Doctor.  Your doctor or health care provider may need to write your prescription a certain way so that the pharmacy can fill a 90-day supply.
 
What happens if I need emergency care?
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  • Hospital ER.  You are covered for medically necessary emergency services in hospitals.  You are only responsible for your in-network deductible, copayment, or coinsurance.
  • Large Group Coverage.  If you have large group coverage that was purchased in NY (usually through your employer), you are covered for medically necessary emergency services in hospitals located in the U.S. and its territories, Canada, and Mexico.
  • Individual and Small Group Coverage.  If you have individual coverage (including under a qualified health plan) or small group coverage that was purchased in NY, you are covered for medically necessary emergency services in hospitals worldwide.No Preauthorization.  Your insurer cannot require you to get preauthorization before you receive emergency care.
  • Out-of-Network Hospitals.  If you go to an emergency room at an out-of-network hospital, your insurer is required to cover your care until you are stabilized, and after that, you may need to transfer to an in-network hospital for the rest of your care.
 
What if I receive a surprise bill?
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  • In-Network Cost-Sharing.  Your insurer must protect you from surprise bills, including those for testing and treatment of COVID-19.  You are only responsible for your in-network, copayment, coinsurance, or deductible if you sign an assignment of benefits form.
  • Surprise Bill For Services At In-Network Hospital or Ambulatory Surgical Center.  It’s a surprise bill if an out-of-network doctor treats you and an in-network doctor was not available, or you had unforeseen services, or you didn’t know the doctor was out-of-network.  It is not a surprise bill if you chose to receive services from an out-of-network doctor instead of from an available in-network doctor.
  • Surprise Bill If You Are Referred By Your Doctor.  It’s a surprise bill if, during your in-network doctor’s office visit, an out-of-network provider treats you, or your doctor takes a specimen from you (for example, blood) and sends it to an out-of-network laboratory, or when referrals are required under your plan and your doctor refers you to an out-of-network provider.  It is not a surprise bill if you signed a written consent that you knew the services were out-of-network and would not be covered by your health plan.

    Learn more about the protections for surprise bills.
 
What if my insurer denies treatment as not medically necessary?
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Can my insurer cancel or refuse to renew my insurance policy if I get COVID-19?
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  • Cancellation Not Permitted.  Your insurer can’t cancel or non-renew your policy because you get sick, including if you are diagnosed with COVID-19.
 
What happens if I lose my health insurance when I am sick?
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If you lose your insurance coverage and you are totally disabled (including as a result of COVID-19), you have the following protections if you meet the requirements below.

  • Individual Coverage.  If you are totally disabled on the date your individual health insurance policy terminates, your insurer will continue to pay for covered services for up to 12 months, or until you are no longer disabled, if sooner.  You must have received treatment for your disability before your policy ends.  The extended benefits are only available to treat the condition causing your disability.
  • Group Coverage Terminated for Non-Payment of Premiums or You Are No Longer Eligible for Coverage.  If you are totally disabled on the date your coverage terminates, your insurer will provide benefits for a hospital stay beginning, or surgery performed, within 31 days from the date your coverage ends, or until you are no longer disabled, if sooner.  The hospital stay or surgery must be to treat the condition causing your disability.
  • Group Coverage Terminated for Loss of Employment.  If you are totally disabled on the date your coverage terminates, your insurer will provide benefits for covered services during a period of total disability for up to 12 months from the date your coverage ends, or until you are no longer disabled, if sooner.  The extended benefits are only available to treat the condition causing your disability.  Also, your insurer is not required to extend benefits if you have coverage for the services under another group health plan.
  • No Premium Payments.  You are not responsible for paying premiums during an extension of benefits.
  • Need More Information?  Contact your insurer for more information about your rights if you are disabled and lose your coverage.
 
I have health insurance through my employer. What happens if I lose my job?
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  • COBRA and Continuation of Coverage.  Employers that provide group health insurance coverage must offer employees (and their dependents) who lose coverage because of a loss of employment, loss of eligibility for coverage, or reduction in hours the right to continue the coverage under the employer’s health plan.  Please visit the Department of Financial Services’ resource page for information on continuing your health insurance.  COBRA or continuation coverage is only available if your employer keeps the group policy after you lose your job.  If your employer goes out of business or no longer provides group health insurance to employees, you cannot get COBRA or continuation benefits.  However, you can get coverage through the NY State of Health:  The Official Health Plan Marketplace.
 
Who pays the premium if I continue my health insurance through my former employer if I lose my job?
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  • Employee Pays the Premium.  You or your covered dependent pay the cost of your continued health insurance.  This premium may not be more than 102% of the group premium.
 
Will I be notified by my employer about continuing my health insurance if I lose my job?
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  • Employer Provides Notification.  Your employer or its benefit administrator must tell you about your right to continue health insurance coverage.  You have at least 60 days to elect to continue your coverage from the later of (1) the date your coverage terminates or (2) the date you are sent notice of your right to continue your coverage.
 
My job was terminated because my employer went out of business.  Can I still continue my group health insurance?
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  • Group Contract Terminates.  If your employer went out of business, you will not be able to get COBRA or continuation coverage.  You will need individual coverage. The NY State of Health:  The Official Health Plan Marketplace has several options for coverage, which could provide you with lower-cost or no-cost coverage depending on your income.  You also have the right to buy individual coverage through the insurer that provided your group coverage, known as a “conversion” policy. Your insurer will notify you of the right to buy a conversion policy.  You have 60 days to apply for this coverage.
 
If I am uninsured, what options do I have for health insurance for myself and my family?
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  • Individual Coverage and Tax Credits.  You and your family have many health insurance options available through NY State of Health:  The Official Health Plan Marketplace.  You can quickly compare health plan options and apply for assistance that could lower the cost of health coverage.
  • Medicaid, Essential Plan, and Child Health Plus.  You and your family may also qualify for free or low-cost coverage from Medicaid, the Essential Plan, or Child Health Plus through the Marketplace.
  • Special Enrollment Period.  If you don’t have health insurance, you can buy individual coverage through the Marketplace until April 15 during a special enrollment period.  If you lost your employer coverage, you have a separate special enrollment period to buy health insurance coverage though the Marketplace for 60 days after your loss.