Insurance Circular Letter No. 10 (2020)

May 2, 2020

STATUTORY REFERENCES: N.Y. Ins. Law §§ 301, 3216, 3217, 3217-h, 3221, 4303, and 4306-g; N.Y. Pub. Health Law §§ 2999-cc and 4406

I. Purpose

The Governor of New York has declared a state of emergency to help New York more quickly and effectively contain the spread of the novel coronavirus (“COVID-19”). While the COVID-19 crisis has had an immeasurable impact on all New Yorkers, the impact on essential workers, including health care workers, first responders and other frontline essential employees, has been especially difficult as they have had to interact directly with the public while working during this public health emergency to ensure that essential services continue to be available for all New Yorkers. For health care workers and first responders, in particular, witnessing the devastating effects of COVID-19 firsthand can take an emotional and psychological toll.

The following persons are “essential workers” for purposes of this circular letter:

1. individuals who are, or were, during the current state of emergency, employed as health care workers, first responders, or in any position within a nursing home, long-term care facility, or other congregate care setting, including:
   • correction/parole/probation officers;
   • direct care providers;
   • firefighters;
   • health care practitioners, professionals, aides, and support staff (e.g., physicians, nurses, and public health personnel);
   • medical specialists;
   • nutritionists and dietitians;
   • occupational/physical/recreational/speech therapists;
   • paramedics/emergency medical technicians;
   • police officers;
   • psychologists/psychiatrists; and
   • residential care program managers; and
2. individuals who are, or were, during the current state of emergency, employed as essential employees who directly interact with the public while working, including:
   • animal care workers (e.g., veterinarians);
   • automotive service and repair workers;
   • bank tellers and other bank workers;
   • building code enforcement officers;
   • childcare workers;
   • client-facing case managers and coordinators;
   • counselors (e.g., mental health, addiction, youth, vocational, crisis, etc.);
   • delivery workers;
   • dentists and dental hygienists;
   • essential construction workers at occupied residences or buildings;
   • faith-based leaders (e.g., chaplains and clergy members);
   • field investigators/regulators for health and safety;
   • food service workers;
   • funeral home workers;
   • hotel/motel workers;
   • human services providers;
   • laundry and dry-cleaning workers;
   • mail and shipping workers;
   • maintenance and janitorial/cleaning workers;
   • optometrists, opticians, and supporting staff;
   • retail workers at essential businesses (e.g., grocery stores, pharmacies, convenience stores, gas stations, hardware stores);
   • security guards and personnel;
   • shelter workers and homeless support staff;
   • social workers;
   • teachers/professors/educators;
   • transit workers (e.g., airports, railways, buses, and for-hire vehicles);
   • trash and recycling workers; and
   • utility workers.

The purpose of this circular letter is to advise insurers authorized to write accident and health insurance in this state, Article 43 corporations, health maintenance organizations, municipal cooperative health benefit plans, and prepaid health services plans (collectively “issuers”) of additional actions the Department of Financial Services (the “Department”) is taking to ensure access to critical mental health support services for essential workers.

II. Discussion

In an effort to ensure that individuals have access to health care services during the COVID-19 pandemic, including mental health services, the Department issued Insurance Circular Letter No. 6 on March 15, 2020, which provides guidance to issuers as to requirements for coverage of telehealth services. On March 16, 2020, the Department promulgated an emergency regulation prohibiting issuers from imposing copayments, coinsurance, and annual deductibles (“cost-sharing”) on in-network telehealth services, including mental health services when provided via telehealth, during the state of emergency declared by Governor Cuomo.

In an effort to provide additional support for essential workers, the Department is promulgating an emergency regulation to prohibit issuers from imposing cost-sharing for mental health services rendered by in-network providers on an outpatient basis for essential workers, regardless of whether the services are provided by telehealth. The emergency regulation is effective for 90 days, at which point the Department may issue a further emergency regulation.

III. Applicability to Third-Party Administrators of Self-Funded Plans

Adherence to the emergency regulation is critical to ensure that essential workers are able to access mental health services they need. Third-party administrators that are licensed by the Department as independent adjusters are strongly encouraged to seek to apply the provisions of this circular letter and the emergency regulation to their administrative services arrangements with self-funded plans.

IV. Conclusion

The emotional and psychological well-being of essential workers is critically important in the continuing fight against COVID-19. It is in the public interest that these workers receive the mental health services they need, regardless of whether those services are provided through telehealth or an in-person visit. Therefore, the Department’s emergency regulation requires issuers immediately to waive cost-sharing for these critical services.

Please submit any questions regarding this circular letter by email to [email protected].

Very truly yours,

Lisette Johnson
Chief, Health Bureau