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COVID-19 Coverage for Self-Insured and Fully-Insured Plans in Specific States

The federal emergency legislation, if passed by the Senate and signed by President Trump, would require COVID-19 testing benefits to be covered by self-insured employer health plans and by fully-insured group health plans at 100% with no employee cost-sharing. Several states, including California, New York, Maryland, and Washington state (as of 3/16) are now requiring that fully-insured health plans sitused (located in that jurisdiction for legal purposes) in that state waive any cost-sharing for all screenings and testing related to coronavirus. In other words, if a medical professional recommends someone be screened or tested for COVID-19, fully-insured medical plans in those states cannot charge a deductible, coinsurance or copay for services related to COVID-19 testing, including ER visits, urgent care clinic visits, office visits, etc.  However,  the mandates do not require fully-insured plans to cover hospital stays for more severe COVID-19 cases. Instead, the no cost-sharing requirements imposed by these states focuses on testing and diagnosis, and not full treatment of coronavirus.

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