December 08, 2020

NOTICE TO HEALTH CARRIERS CONCERNING

COVID-19 IMMUNIZATION AT “NO COST” AND OUT-OF-

NETWORK REIMBURSEMENT

The Connecticut Insurance Department (CID), in accordance with Section 3203 of the CARES Act and the Fourth COVID-19 Interim Final Rule (IFC-4) issued by CMS¹, is providing this Notice as guidance to confirm that all fully insured ACA compliant health plans and self-funded health plans shall not apply any cost sharing, including but not limited to copays, coinsurance and deductibles to members who receive approved COVID-19 immunizations from in-network and/or out-of-network health care providers.

In accordance with Governor Lamont’s Executive Order (EO) No. 9Q, dated December 7, 2020², reimbursement to an out-of-network health care provider for the administration of an approved COVID-19 immunization shall be the amount that would be paid under Medicare for the administration of said immunization. As is customary, in-network providers will be reimbursed for such services at in-network negotiated rates.

Paul Lombardo, Director
Life and Health Division