New York – Waiver of Copayments, Coinsurance, and Annual Deductibles for Mental Health Services Rendered by In-Network Providers on an Outpatient Basis for Essential Workers

Published: 05.04.2020

When: Effective immediately; expires July 31, 2020.

Why: To ensure that essential workers have access to mental health services this amendment is promulgated on an emergency basis for the preservation of public health and general welfare.

What: The amendment provides that no essential worker shall be required to pay, copayments, coinsurance, or annual deductibles (unless required by federal law for a high deductible health plan) for mental health services rendered by in-network providers on an outpatient basis for essential workers.

Also, the amendment requires every health care plan to provide written notification of the requirements of the amendment to its in-network mental health providers to ensure that the providers do not require an insured to pay a copayment, coinsurance, or annual deductible that is prohibited from being imposed pursuant to the amendment.

Furthermore, every health care plan is expected to reimburse a provider, including reimbursement for the insured’s waived copayment, coinsurance, or annual deductible, with respect to any affected claims.

Who: Health care plans: Insurers and health maintenance organizations who issue a policy or contract delivered or issued in New York that provides comprehensive coverage for hospital, surgical, or medical care must comply with the temporary directive.

Essential workers: The rule applies to essential workers defined as individuals who are, or were, during the current state of emergency declared by Governor Andrew M. Cuomo on March 7, 2020, employed as:

  • Health care workers, first responders, or in any position within a nursing home, long-term care facility, or other congregate care setting.
    • The list of essential workers includes additional occupations such as correction/parole/probation officers; direct care providers; and firefighters. Please see the link below for the complete list.
  • Essential employees who directly interact or interacted with the public while working, including: animal care workers (e.g., veterinarians); automotive service and repair workers; retail workers at essential businesses (e.g., grocery stores, pharmacies, convenience stores, gas stations, and hardware stores); teachers, professors, educators. (Please see the link below for the complete list.)

New York Executive Order Number 202.25:

The complete list of essential workers may be found using the below link. Please see the Emergency Adoption – NYS Department of Financial Services, Sixteenth Amendment to 11 NYCRR 52 (Insurance Regulation 62): dfs.ny.gov/system/files/documents/2020/05/reg62_amend60_txt.pdf