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COVID-19 vaccine must be covered by health insurance providers in New York

During a press conference on Wednesday, Governor Andrew Cuomo said that insurance providers would have to pick up any costs associated with the COVID-19 vaccine.

Later in the day, Superintendent of Financial Services Linda Lacewell said the DFS had issued an emergency regulation to ensure immediate coverage of the COVID-19 vaccine by health insurers licensed in New York State.

“As part of New York’s ongoing strategy to contain the pandemic, DFS has taken this action to ensure that cost-sharing is not an obstacle to New Yorkers receiving the vaccine,” said Superintendent Linda A. Lacewell. “This regulation cements New York health insurers’ obligation to provide immediate coverage of the vaccine at no cost, consistent with federal rules.”  

DiSanto Propane (Billboard)

The emergency regulation  announced today shortens the time frame for insurers to begin covering the COVID-19 vaccine. Specifically, authorized insurers and health maintenance organizations that issue a policy or contract providing hospital, surgical, or medical care coverage are required by the regulation to provide coverage of COVID-19 immunizations and their administration immediately upon the earlier of the following events: 

(1) The issuance by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices of a recommendation for the COVID-19 immunization;  

(2)  The issuance by the U.S. Preventive Services Task Force of a recommendation with an “A” or “B” rating for the COVID-19 immunization; or  

(3) The determination by the Superintendent of Financial Services, in consultation with the Commissioner of Health, that a policy or contract must cover the COVID-19 immunization.  

Consistent with Governor Cuomo’s recent Executive Order, the regulation also requires COVID-19 immunizations to be covered under grandfathered (pre-Affordable Care Act) health plans. In addition, the regulation requires coverage for COVID-19 immunizations administered by out-of-network providers until the expiration of the federally declared public health emergency and the disaster emergency declared by Governor Cuomo under Executive Order 202, as extended.