March 6, 2020, the OCI issued a bulletin to assist individuals and regulated entities regarding the provision of insurance-related services during the COVID-19 public health challenge.
Both insurance and health services providers are requested to remove any barriers to testing and treatment for COVID-19. Insurancers, healthcare providers and individuals to take the following measures immediately:
- Preparedness – Health Plan Issuers should review processes and procedures to address any COVID-19 cases in WI. They should continually assess their readiness and make necessary adjustments.
- Information Access – Health Plan Issuers should make all necessary and useful information available on their websites and train their nurse-help lines staff accordingly. Useful links may include a link to the Wisconsin Department of Health Services information regarding COVID-19 at https://www.dhs.wisconsin.gov/disease/covid-19.htm or to the Centers for Medicare and Medicaid at https://www.cms.gov/newsroom/press-releases/cms-prepares-nations-healthcarefacilities-coronavirus-threat.
- Testing for COVID-19 – WAIVING Cost Share for necessary testing and treatment for COVID-19.
- Telehealth Delivery of Services – Encourage the use of telehealth services to eliminate exposure to COVID-19.
- Network Adequacy & Access to Out-of-Network Services – ensure all their providers are prepared to handle any COVID-19 cases.
- Prior Authorization Requests – Health Plan issuers should be prepared to waive the prior authorization requests that may inhibit the timely reaction to any COVID related cases.
- Immunization – Once the vaccine is available, insurers are encouraged to cover that with no cost-share for individuals.
- Access to Prescription Drugs – Health plan issuers should be prepared to expedite formulary exceptions in the event of shortages or need for non-formulary drugs for the treatment of COVID-19.
“Because of the possibility of self-quarantine for infected, exposed, or at-risk individuals, OCI is requesting that Health Plan Issuers be flexible on prescription drug supply limitations and early refill limitations. Health Plan Issuers are requested to allow insureds to fill and refill prescription medications for up to a 90 day supply or until the prescription expires, if shorter. In addition, Health Plan Issuers are asked to allow for early refills without additional authorization requirements.”State of Wisconsin Office of the Commissioner of Insurance – Bulletin – March 6, 2020