Neil V. Birkhoff

Neil V. Birkhoff
Principal

Deductible Requirements May Be Waived for COVID-19 Related Services

The Centers for Medicare and Medicaid Services (CMS) yesterday issued two FAQs to clarify coverage for the diagnosis and treatment of COVID-19 by catastrophic health plans. Generally, a catastrophic health plan may not provide coverage of an essential health benefit (EHB) before a participant meets the plan’s deductible. CMS, by these FAQs, is announcing that it will not take action against any health issuer that amends its plan to provide coverage without cost-sharing requirements (deductibles) for COVID-19 related services. CMS further announced it is encouraging state insurance agencies to take a similar approach.

FAQ1 explains catastrophic health plans must cover EHBs, which includes coverage for the diagnosis and treatment of COVID-19. The FAQ1 notes, however, that diagnostic and treatment services generally are subject to cost-sharing requirements (deductibles) under current laws.

FAQ2 then declares that “[i]n light of the public health emergency posed by COVID-19, … HHS [will] allow issuers of catastrophic health plans to provide coverage for the diagnosis and treatment of COVID-19 even before enrollees (participants) meet plan deductibles.

While this policy announcement from CMS allows issuers of catastrophic health plans to waive deductibles, individuals with coverage under a catastrophic health plan must check with the issuer of their plan to determine if deductibles are being waived.


Read more legal updates on COVID-19 from Woods Rogers attorneys.

If you have questions about catastrophic plan coverage and COVID-19,
contact Neil Birkhoff at birkhoff@woodsrogers.com.