Originally issued March 11 and most recently extended Nov. 18, an emergency regulation issued by Gov. Jared Polis and enforced by the Division of Insurance ensures the following coverage and cost-sharing requirements for COVID-19 claims:
- In-network telehealth services for COVID-19-related testing and treatment with no cost share for the covered person.
- COVID-19 diagnostic testing, including in-home tests, with no cost share for the covered person and no collection of cost share by providers.
- Any test for detecting or diagnosis for COVID-19, including serological testing, and any non-COVID tests a provider determines medically appropriate to determine the need for COVID-19 diagnostic testing of the covered, even if the visit does not result in an order for or administration of a COVID-19 test.
- Cost sharing for an in-network provider office visit, in-network urgent care center visit, emergency room visit, and non-traditional care settings where licensed health care provider are administering the testing.
Carriers must ensure timely testing, diagnosis and screening for COVID-19, covering testing if performed by an out-of-network provider if an in-network provider is unable to conduct the testing, and utilize both in-network and in-state out-of-network laboratories to process COVID-19 tests with no cost share to the covered person.
This applies to all carriers offering individual, small group and large group health benefit plans, student health plans, and managed care plans, including health-savings-account-qualified health benefit plans, and grandfathered health benefit plans that are subject to the insurance laws of Colorado. Carriers who are third-part administrators for self-funded plans are strongly encouraged -- but not required -- to follow these requirements. Read the full regulation here.