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New Jersey Department of Banking & Insurance Issues Bulletin on Implementation of State Over-the-Counter Covid-19 Testing Mandate | Bressler, Amery & Ross, PC

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The January 10, 2022 federal guidance implementing the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act (the “Federal Guidance”) requires coverage of the FDA-approved over-the-counter (“OTC”) COVID-19 test , with or without mandate or individual clinical assessment by a treating healthcare provider. In accordance with federal guidance, this expanded coverage requirement became effective on January 15, 2022 and is in effect during the federal public health emergency.

The New Jersey Department of Banking & Insurance issued a bulletin on January 20 advising all health insurers, HMOs, health care providers (Horizon) and any other entity issuing health insurance plans in New Jersey of their obligation to provide insured individuals to provide what is required prominently displayed on the carrier’s website. The bulletin is linked here.

The information displayed must comply with federal guidelines and include an “FAQS ABOUT AFFORDABLE CARE ACT IMPLEMENTATION PART 51, FAMILIES FIRST CORONAVIRUS RESPONSE ACT AND CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT IMPLEMENTATION.”

The information displayed must also be sufficient for insured persons to understand where tests are available without paying any costs. Carriers must also warn insured persons of circumstances where OTC COVID-19 testing costs may apply, even if the testing is not conducted through an applicable direct insurance option. Any safe harbor approach adopted by an airline must comply with federal guidelines and be clearly explained to the individuals concerned.

In addition, the Department has also recently been organized pursuant to Executive Order 281 and this PL 2021, c. 310 repealed PL 2020, c. 3 and PL 2020, c. 7 and re-codified the obligation to provide insurance coverage without imposing co-payment, prior authorization requirements or other medical treatment for testing for COVID-19, provided a physician has issued a medical order for the testing. Finally, the law requires coverage for items and services provided or provided to an individual during a healthcare provider’s office visits, including in-person visits and telemedicine and telemedicine encounters, urgent care center visits, and emergency room visits that result in an order for a test to be performed on COVID-19. The coverage requirement applies in every part of the federal emergency declared in response to COVID-19.

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