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Does my plan include COVID-19 testing and treatment?

Does my plan include COVID-19 testing and treatment?

我的計劃是否涵蓋 COVID-19 測試和治療?

Some carriers are now considering COVID-19 treatment to be an “Essential Health Benefit” (EHB) of their plans, and are adding extra language to their plans to ensure coverage for COVID-19 testing and treatment. The Centers for Medicare and Medicaid Services (CMS) issued an FAQ on COVID-19, which states that COVID-19 testing and treatment must be covered as an EHB of most plans. However, cost-sharing and plan benefits vary and are specific to each separate plan. 一些保險公司現在正在考慮將COVID-19治療作為其計劃的"基本健康福利"(EHB),並在他們的計畫中增加額外的語言,以確保COVID-19測試和治療的覆蓋面足夠廣。醫療保險和醫療補助服務中心 (CMS) 發佈了 COVID-19 的常見問題解答,其中規定 COVID-19 測試和治療必須作為大多數計劃的 EHB 項目。但是,費用分攤和計劃收益各不相同,並且特定於每個單獨的計劃。

The CMS FAQ states that medically necessary isolation or quarantine, required by a physician during hospital treatment, is generally considered an EHB and must be included in plans. However, quarantine outside a medical facility without the oversight of a doctor is not a medical treatment and therefore not an EHB. CMS 常見問題解答指出,在醫院治療期間醫生要求進行必要的醫療隔離通常被視為 EHB,而且必須包含在計劃中。然而,在沒有醫生監督的醫療設施外隔離不是醫學治療,因此不是EHB。

Most fully insured health plans in California and Nevada consider COVID-19 testing to be a preventive benefit, with no cost-sharing to policyholders. Any treatment needed as a result of such testing, however, will likely be run through the policyholder’s plan as normal, with standard cost-sharing. 加州和內華達州大多數完全投保的健康計劃認為COVID-19測試是一種預防性福利,投保人無需分擔費用。然而,這種測試所需的任何治療都可能正常通過投保人的計劃,並配以標準費用分攤。


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