|FOR IMMEDIATE RELEASE
August 20, 2021
CONTACT: Jim Carson, Communications Director
CONNECTICUT INSURANCE COMMISSIONER: ALL INSURED
ARE ELIGIBLE FOR ‘NO-COST’ COVID-19
CORONAVIRUS VACCINE BOOSTER SHOT
Connecticut Insurance Department Commissioner Andrew N. Mais is reminding consumers that there should be no out-of-pocket cost for the COVID-19 vaccine booster shot for those covered by fully insured and self-funded plans.* The booster shot is pending authorization from the Federal Drug Administration and is still awaiting a recommendation from the Centers For Disease Control’s (CDC) Advisory Committee on Immunization Practices (ACIP). The CDC has announced that fully vaccinated individuals with the Pfizer and Moderna vaccine will need a booster shot to keep up their immunity against COVID-19.
Treatment for COVID-19 is covered under all fully insured plans, including high deductible plans, and also covered under most self-funded employer sponsored plans. Members in an employer sponsored plan should verify with their carrier or employer specifics of their coverage for COVID-19 treatment.
“Insurers in Connecticut have answered the call and protected those most affected by our current crisis by waiving out-of-pocket expenses for appropriate COVID-19 testing and treatment for all fully insured plans,” said Commissioner Mais. “Thanks to recent changes in federal law, employer-based plan sponsors are required to follow suit and remove all cost sharing for appropriate testing and vaccines and will cover recommended booster shots for their workers and their families.”
The Connecticut Insurance Department regulates fully insured health insurance plans, including those with high-deductible health plans, issued in the State of Connecticut only.
Consumers should take note that there are some differences among plans and policyholders should contact their insurer or employer to provide additional information on important details.
Some employers, especially large ones, sponsor self-funded health plans that are regulated by the U.S. Department of Labor under ERISA. Those plans are required to cover COVID-19 testing with no out-of-pocket costs due to recent changes in federal law.
The FFCRA was enacted on March 18, 2020
Group health plans and health insurance issuers offering group or individual health insurance coverage to provide benefits for certain items and services related to diagnostic testing for the detection of SARS-CoV-2 or the diagnosis of COVID-19 when those items or services are furnished on or after March 18, 2020, and during the applicable emergency period. Under the FFCRA, plans and issuers must provide this coverage without imposing any cost-sharing requirements (including deductibles, copayments, and coinsurance) or prior authorization or other medical management requirements. Plans and issuers must cover items and services furnished to an individual during visits that result in an order of, or administration of, a COVID-19 diagnostic test, but only to the extent that the items or services relate to the furnishing or administration of the test or to the evaluation of such individual for purposes of determining the need of the individual for the product, as determined by the individual’s attending healthcare provider.
The CARES Act was enacted on March 27, 2020
Section 6001 of the FFCRA includes a broader range of diagnostic items and services that plans, and issuers must cover without any cost-sharing requirements or prior authorization or other medical management requirements.
*COVID-19 vaccines, including COVID-19 booster shots, with a recommendation in effect from the CDC’s Advisory Committee on Immunization Practices must be covered without cost sharing in accordance with section 3203 of the CARES Act and the implementing regulations. Coverage is for all health plans, including fully insured, and self-funded, individual and group health plan under these Acts. It also includes private employment-based group health plans (ERISA plans), non-federal governmental plans (such as plans sponsored by states and local governments), and church plans. Consumers and policyholders should contact their insurer or employer for information on the out-of-pocket costs for COVID-19 treatment, if any. The American Rescue Plan Act changed the way Access Health CT calculates financial help for their customers for this year and for 2022 and may significantly lower the cost of health insurance for many. More information is available here.
For the most up-to-date information from the State of Connecticut on COVID-19, including guidance and other resources, visit ct.gov/coronavirus. Regular email news updates are available from the Governor’s Office by subscribing online here.
About the Connecticut Insurance Department: The mission of the Connecticut Insurance Department is to protect consumers through regulation of the industry, outreach, education and advocacy.
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